Fluids and Electrolytes


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Oral potassium

The causes of a sodium imbalance include dehydration, excessive sweating, severe burns, and kidney disease. Our doctors recommend keeping your child hydrated to prevent fluid and electrolyte disorders. This is particularly important if your child has a serious underlying medical condition. Skip to main content. Calcium When a child has too much or too little calcium in the body, he or she can develop kidney stones, abdominal pain, weakness, muscle spasms, and a temporary abnormal heart rhythm, called an arrhythmia.

Potassium Children may experience a potassium deficiency as a result of vomiting, diarrhea, sweating, and taking medications, such as diuretics or laxatives.

Electrolyte replacement therapy

We partner with children and families to provide the most advanced care. When autocomplete results are available, use the up and down arrows to navigate the list of options and use enter to select an option. The etiologic factors provided were surgery as the No. Hypernatremia is associated with depressed sensorium and increased mortality 7 times that of age-matched controls, although not correlated with the severity of hypernatremia. The homeostatic limits of potassium excretion have not been defined in older individuals but are almost certainly narrowed with respect to those of younger individuals.

The Boston Collaborative Drug Study demonstrated a progressive age-related increase in hyperkalemia in patients prescribed oral potassium supplementation. Dietary practices may play a role as well. A significant portion of the elderly population is placed on a sodium-restricted diet, which is inherently high in potassium. Such patients may exhibit high-normal serum potassium concentrations on admission but remain asymptomatic overall.

If surgery, trauma, or tissue breakdown occurs, or if other potassium-containing medications are administered, frank hyperkalemia may result, which would be compounded by any concomitant acute renal insufficiency. Hyperkalemia is particularly likely to occur in the elderly diabetic patient who usually has concomitant hypoaldosteronism.

As the prevalence of hypertension and edematous disorders increases with age, older patients are more likely to have been taking diuretics at the onset of surgical intervention. On the other hand, hypervigilance for hypokalemia is warranted in elderly patients. Potassium depletion predisposes to serious tachyarrhythmias, particularly in patients taking digitalis preparations, and in those undergoing a catechol-releasing stress such as surgery.

Furthermore, gastrointestinal losses may result in large deficits in total-body potassium. Therefore, potassium deficits should be recognized and corrected before elective operations. The ability for acid excretion has been studied in healthy elderly individuals and is dramatically impaired as compared with their younger counterparts. As the aging kidney becomes less effective at excreting a hydrogen ion load rapidly, the severity of the metabolic acidosis may be exaggerated, particularly if concomitant pulmonary disease limits compensatory hyperventilation.

The effect of aging on the relationship between the concentrations of blood ionized calcium and of serum parathyroid hormone PTH have been explored.

Serum concentrations of PTH in elderly men were twice those of younger men, whereas blood ionized calcium did not differ between the 2 groups. With intravenous infusion of calcium gluconate, the minimum PTH concentration was 2-fold to 3-fold higher in elderly men. These findings suggest that the relationship between calcium and PTH is altered with aging, such that at any given level of calcium, the concentration of PTH is higher.

However, high-calcium diets may reduce net zinc absorption and balance and ultimately increase zinc requirements.


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The aging critically ill patient is also susceptible to alterations in magnesium and phosphorus homeostasis. Renal insufficiency predisposes to elevated concentrations of these electrolytes. Contrarily, poor dietary intake, use of various medications, and underlying disease can lead to deficiency states. Hypocalcemia cannot be normalized without correcting hypomagnesemia.

Magnesuria secondary to catecholamine shower, intestinal losses, various medications, and the unreliability of serum concentrations even ionized contribute to the true difficulty in defining magnesium deficiency. The most effective approach to fluid and electrolyte management in the elderly surgical patient is prevention.

Knowledge of altered homeostatic mechanisms and side effects of polypharmacy in this population should guide clinicians' care of this population. The prevalence of clinically inapparent fluid and electrolyte disorders in hospitalized elderly patients warrants measurement of electrolytes, serum urea nitrogen, and creatinine and performance of a urinalysis in every patient. Azotemia should prompt the clinician to identify the cause and correct or mitigate prerenal or postrenal factors before surgery. It cannot be overemphasized that the most important risk factor for perioperative acute tubular necrosis is hypovolemia.

Patients with chronic salt-wasting disorders, such as enterocutaneous fistulas or chronic diarrhea, may be electrolyte and volume depleted, with markedly impaired renal perfusion, and not exhibit classic signs of hypovolemia such as postural hypotension and tachycardia. Meticulous attention to volume replacement should be paid to all surgical patients, but particularly to trauma patients and to those subjected to extensive blood loss or fluid shifts common to biliary tract, cardiac, or aortic surgeries. In such patients, central hemodynamic monitoring should be used to guide fluid therapy and optimize renal perfusion.

Shoemaker et al 60 concluded that vital signs, urine output, pH, and PO 2 were not prognostic of patient survival in a population of high-risk surgical patients. Older patients may demonstrate deceptively normal vital signs despite a low cardiac output and mixed venous oxygen saturation. Historical controls averaged 5.

Blood transfusions should be administered on an individual basis, depending on the patient's age, underlying cardiopulmonary disease, symptoms, life expectancy, and expected blood loss. Hemoglobin is an important component in the oxygen delivery equation. A retrospective study of trauma victims older than 60 years demonstrated that survivors had higher hemoglobin levels For the elderly patient who has undergone uncomplicated surgery, early resumption of oral intake is the best approach to maintain fluid and electrolyte balance.

During the immediate postoperative period, ongoing fluid losses from all sites, including insensible losses, should be replaced meticulously. Adequacy of free-water replacement should be guided by the serum sodium concentration. Care to avoid nephrotoxic drugs is imperative. The contribution of age in predicting survival is relatively small compared with the contribution of acute physiology or diagnosis, 65 although it is well documented that mortality and complication rates from major surgical procedures increase with greater age.

To best serve these patients, the health care provider must understand the homeostatic changes that occur in elderly persons and avoid the pitfalls of ageism, where elderly patients' problems are inappropriately attributed to the "natural processes" of aging. The aged kidney undergoes interstitial fibrosis as well as widespread sclerosis of glomeruli and of afferent arterioles. The most crucial functional changes are a decrease in GFR, decreased urinary concentrating ability, and narrowed limits for the excretion of water, sodium, potassium, and hydrogen ion.

Fluid Compartments

Despite these changes, body fluid homeostasis is effectively maintained under normal day-to-day circumstances. Problems may arise when the older patient is placed in a state of fluid deprivation or iatrogenic insult. Attention to age-related limitations of fluid homeostasis can help the physician prevent clinical complications such as hypotonicity and hypertonicity, hyperkalemia, and volume depletion.

Meticulous detail must be paid to salt and water balance and to drug dosing and choices. Corresponding author and reprints: Cyrus J. All Rights Reserved. View Large Download. Clin Geriatr Med. J Am Geriatr Soc. Am J Med. Am J Kidney Dis. Circ Res.

Fluid and Electrolytes easy memorization trick

Int Urol Nephrol. Kidney Int. Anaesth Intensive Care. N Engl J Med. J Gerontol. Arch Gen Psychiatry. J Clin Endocrinol Metab. J Intern Med. Atrial natriuretic peptide suppresses osmostimulated vasopressin release in young and elderly humans. Am J Physiol. Age Ageing. A nephron consists of a glomerulus and a tubule.

The tubule, sometimes convoluted, ends in a collecting duct. The glomerulus is a cluster of capillaries that filters blood. If the body needs more fluid, for instance, it retains more. If it needs less fluid, less is reabsorbed and more is excreted. Electrolytes, such as sodium and potassium, are either filtered or reabsorbed throughout the same area. The resulting filtrate, which eventually becomes urine, flows through the tubule into the collecting ducts and eventually into the bladder as urine. That rate, called the glomerular filtration rate, leads to the production of 1 to 2 L of urine per day.

The nephrons reabsorb the remaining L or more of fluid, an amount equivalent to more than 30 oil changes for the family car! Fluids and electrolytes: A strict conservationist. Perhaps the most important step involves reabsorbing more water from the filtrate, which produces a more concentrated urine. The minimum excretion rate varies with age. The kidneys respond to fluid excesses by excreting a more dilute urine, which rids the body of fluid and conserves electrolytes.

Fluids and electrolytes: Other organs and glands. In addition to the kidneys, other organs and glands are essential to maintaining fluid and electrolyte balance. Sodium, potassium, chloride, and water are lost from the GI tract; however, electrolytes and fluid are also absorbed from the GI tract.

The parathyroid glands also play a role in electrolyte balance, specifically the balance of calcium and phosphorus. Fluids and electrolytes: Antidiuretic hormone. Several hormones affect fluid balance, among them a water retainer called antidiuretic hormone ADH. You may also hear this hormone called vasopressin. The hypothalamus produces ADH, but the posterior pituitary gland stores and releases it.

If you can remember what ADH stands for, you can remember its job: to restore blood volume by reducing diuresis and increasing water retention. Fluids and electrolytes: Sensitive to changes. The increased re-absorption of water results in more concentrated urine. Likewise, decreased serum osmolality or increased blood volume inhibits the release of ADH and causes less water to be reabsorbed, making the urine less concentrated. This up-and-down cycle of ADH release keeps fluid levels in balance all day long. Like a dam on a river, the body holds water when fluid levels drop and releases it when fluid levels rise.

To help maintain a balance of sodium and water in the body as well as to maintain a healthy blood volume and blood pressure, special cells juxtaglomerular cells near each glomerulus secrete an enzyme called renin. Through a complex series of steps, renin leads to the production of angio ten sin II, a powerful vasoconstrictor. Angiotensin II causes peripheral vasoconstriction and stimulates the production of aldo sterone. Both actions raise blood pressure. As soon as the blood pressure reaches a normal level, the body stops releasing renin and this feedback cycle of renin to angio tensin to aldosterone stops.

Fluids and electrolytes: The ups and downs of renin. The amount of renin secreted depends on blood flow and the level of sodium in the bloodstream.

Electrolytes: Definition, Functions, Imbalance and Sources

The renin causes vasoconstriction and a subsequent increase in blood pressure. Conversely, if blood flow to the kidneys increases, or if the amount of sodium reaching the glomerulus increases, juxtaglomerular cells secrete less renin. A drop-off in renin secretion reduces vasoconstriction and helps to normalize blood pressure. The hormone aldosterone also plays a role in maintaining blood pressure and fluid and electrolyte balance. Secreted by the adrenal cortex, aldosterone regulates the reabsorption of sodium and water within the nephron.

Fluids and electrolytes: Triggering active transport. When blood volume drops, aldosterone initiates the active transport of sodium from the distal tubules and the collecting ducts into the bloodstream. That active transport forces sodium back into the bloodstream. When sodium is forced into the bloodstream, more water is reabsorbed and blood volume expands. Fluids and electrolytes: Atrial natriuretic peptide.

Fluid and Electrolytes in Pediatrics

A cardiac hormone called atrial natriuretic peptide ANP also helps keep that balance. Stored in the cells of the atria, ANP is released when atrial pressure increases. The hormone opposes the renin-angiotensin system by decreasing blood pressure and reducing intravascular blood volume. Perhaps the simplest mechanism for maintaining fluid balance is the thirst mechanism. Thirst occurs as a result of even small losses of fluid.

Losing body fluids or eating highly salty foods leads to an increase in ECF osmolality. This increase leads to the drying of mucous membranes in the mouth, which in turn stimulates the thirst center in the hypothalamus. Fluids and electrolytes: Quenching that thirst.


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  4. Usually, when a person is thirsty, he drinks fluid. The ingested fluid is absorbed from the intestine into the bloodstream, where it moves freely between fluid compartments. This movement leads to an increase in the amount of fluid in the body and a decrease in the concentration of solutes, thus balancing fluid levels throughout the body. Fluid and electrolyte balance is essential for health. Even a patient with a minor illness is at risk for fluid and electrolyte imbalance. The body loses water all the time. A person responds to the thirst reflex by drinking fluids and eating foods that contain water.

    This causes dehydration, or fluid volume deficit. The patient may also have an increase in his blood urea nitrogen and hemoglobin levels. Treatment of dehydration involves determining its cause such as diarrhea or decreased fluid intake and replacing lost fluids — either orally or I. Hypervolemia refers to an excess of isotonic fluid water and sodium in ECF.

    The body has compensatory mechanisms to deal with hypervolemia. However, if these fail, signs and symptoms develop. Hypervolemia can occur if a person consumes more fluid than needed, if fluid output is impaired, or if too much sodium is retained. Conditions that may lead to hypervolemia include kidney failure, cirrhosis, heart failure, and steroid therapy.

    Depending on the severity of hypervolemia, signs and symptoms may include:. Treatment involves determining the cause and treating the underlying condition. Typically, patients require fluid and sodium restrictions and diuretic therapy. Fluids and electrolytes: Water intoxication.

    Excessive low-sodium fluid in the ECF is hypotonic to cells; cells are hypertonic to the fluid.

    As a result, fluids shift into the cells, which have comparatively less fluid and more solutes. The fluid shift, in turn, balances the concentrations of fluid between the two spaces. Fluids and electrolytes: Acting inappropriately. Water intoxication may occur in a patient with syndrome of inappropriate antidiuretic hormone, which can result from central nervous system or pulmonary disorders, head trauma, tumors, or the use of certain drugs.

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