Last Modified: 2011-07-14
(2) Decrease in plasma oncotic pressure.
(3) Elevation of interstitial oncotic pressure.
(2) Decreased ADH and ANP.
(3) Loss of subcutaneous tissue and moisture.
(4) Reduced thirst mechanisms.
(2) peripheral edema, JVD, bounding pulse, inc BP
(3) dyspnea, crackles, pulmonary edema
(5) seizures, coma
(2) fluid restriction
(3) sodium restriction
(4) paracentisis (extreme)
(2) inadequate fluid intake
(3) plasma-to-interstitial fluid shift ("3rd spacing")
(2) thirst, dry mouth
(3) decreased skin turgor
(4) decreased capillary refill
(5) postural hypotension, inc pulse, dec CVP
(6) dec UOP, inc urine concentration
(7) inc respiratory rate
(8) weight loss
(9) seizure, coma
(2) inc sodium intake
(3) dec sodium excretion (aldosterone mechanism)
(2) dilute sodium with hypotonic saline (0.45%NaCl) or D5W
(3) promote excretion of excess sodium w/diuretics
(3) flushed skin
(4) also may be symptoms of fluid excess or deficit
(2) water excess (sodium dilution)
(2) hypertonic saline solution IV (3% NaCl)
(2) impaired renal excretion of K+ (most common)
(3) shift of K+ from ICF to ECF (e.g. w/ burn or crush injury; inc tissue catabolism; also metabolic acidosis)
(2) weakness, paresthesias
(3) abdominal cramping, diarrhea
(4) irregular pulse, cardiac arrest
(5) ECG changes associated with increased excitability (Vfib, wide QRS, long PR, ST depression)
(2) inc elimination of K+ (kayexalate, dialysis, fluid intake)
(3) IV insulin to force ECF-->ICF movement of K+
(2) shift of K+ from ECF to ICF (e.g. in metabolic acidosis or new cell formation)
(3) rarely, deficient dietary intake of K+
(2) ECG changes: increased P, flattened T, brady, enhanced digoxin toxicity, ventricular arrhythmias
(3) fatigue, weakness, leg cramps
(4) nausea, vomiting, paralytic ileus
(5) paresthesias, decreased reflexes
(6) polyuria, hyperglycemia
- IV fluid should be less than 10-20mEq/hr to prevent cardiac arrest
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