Fluids Flow-Sheet

Dehydration
Isotonic (equal sodium and water loss)
Most common type of dehydration ECF only ECF fluid volume (only) deficit

Overhydration
Isotonic (equal sodium and water gain)
Most common type of overhydration ECF only Only the ECF has excessive fluid and the ICF does not have a fluid imbalance

Hypovolemia
Severe can lead to shock Serum electrolytes WNL VS: orthostatic hypotension, tachycardia, tachypnea Hemoconcentration Causes: hemorrhage; fluid loss from GI tract; diuretics Compensatory mechanisms: Aldosterone (will cause both Na+ and H2O to be reabsorbed from renal tubules) Treatment: isotonic IV fluids (NS, LR); blood (if hemorrhage)

Hypervolemia
Serum electrolytes WNL VS: elevated BP, tachypnea Circulatory overload, pitting edema, oliguria Hemodilution Causes: chronic renal failure, heart disease, overadministration of isotonic IV fluids, Aldosterone Compensatory mechanisms: ANP (will cause H2O and Na+); ADH Treatment: osmotic diuretics and fluid restrictions; dialysis (severe)

Hypertonic (more water lost than sodium)

Second most common type ECF, ICF ICF fluid volume deficit and expansion of ECF

Hypertonic

Water-loss hypernatremia
Serum Na+ VS: Low-grade fever; BP & pulse WNL Causes: large insensible losses; hyperventilation; ketoacidosis; fever; DI; watery diarrhea; tube feedings Compensatory mechanisms: ADH, thirst Treatment: hypotonic IV fluids SLOWLY (D5W, 0.45% NaCl)

(more sodium gained than water) Least common, rare ECF, ICF ECF has fluid overload, and ICF is dehydrated

Sodium-gain hypernatremia
Serum Na+ VS: elevated BP, low-grade fever Circulatory overload, pitting edema Causes: excessive sodium intake; hypertonic saline or sodium bicarbonate; salt-water near-drowning Compensatory mechanisms: ANP Treatment: restrict foods and fluids high in sodium Hypotonic (more water gained than sodium) Second most common type Worst overydration state (all compartments expanded) ECF, ICF Both ECF and ICF have excessive fluid Electrolyte dilution and cellular swelling

Hypotonic

(more sodium lost than water) Least common, rare Most serious depletion of intravascular space ECF, ICF ECF fluid volume deficit and expansion of ICF

Hypovolemia most severe Sodium-loss hyponatremia

Serum Na+, serum K+ Excessive loss of Na+ and K+ from ECF VS: hypotension, tachycardia, tachypnea Hemoconcentration Causes: chronic illness, malnutrition, heat stroke Compensatory mechanisms: Aldosterone Treatment: NS (preferred) or hypertonic fluids (with great caution)

Water intoxication Dilutional hyponatremia

Serum Na+ VS: elevated BP Water gain, generalized non-pitting edema. Hemodilution Causes: excessive tap water; SIADH; overadministration of hypotonic IV solutions Compensatory mechanisms: ADH Treatment: restrict fluids, osmotic diuretics