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Natraemia Fluid and Na Balance (Definitions (Hypovoleamia Na and water…
Natraemia
Fluid and Na Balance
Na>145
Hypernatreamia
Low H2O
Water Loss, not replaced
Isovolaemic
Loss of FREE H2O
Fluid shift from ICF to ECF to balance [Na]
non-renal:
Diabetes Insipidus
, Hypothalamus not secreting ADH
Renal:
Nephrogenic Diabetes Insipidis
, Kidney doesn't respond to ADH
Hypervolaemic
Retain more Na than H2O
Fluid Shift from ICF tp ECF to balance [Na].
Renal:
Cushings
Mineralocorticoid excess- High retention of Na and H2O = k+ and H+ excretion, over fluid resus, NaHCO3 admin
Non-Renal:
Hypovolaemic
( Most Common)
lose more water than Na
Fluid shift from ICF to ECF to balance [Na]
Tx:
NS
Non-renal
: Na<10 Sweating,diarrhoea
Renal:
Na>20 Osmotic Diuresis (mannitol)
Na<135
Hyponatreamia
High H20
/
Low sodium
H20 intake, cannot be excreted.
Low Plasma Osmolality
Hypotonic
Low Tonicity - Low Effective Osmolarity
Isovoleamic
FREE H20 increase, Na in ECF remains the same. Na will decrease, fluis shift into cells, few symptoms.
Rx: Fluid restriction
non-renal
Na <10 SIADH - brain trauma, Small cell carcinoma ADH secreting.
Renal
Na >20
Hypovoleamic
Losing more Na than H2O
S/S: Low JVP, Low BP
Rx: Normal Saline
Non-Renal:
urinary Na<10: Low Urine Na: Vomiting, Lose Na more than H2O
Renal
: urinary Na>20 Aldosterone deficiency, Diurettics, lose sodium more than Na.
Hypervleamic
Gaining more H2O than Na
S/S:
High
JVP, High Blood pressure, weight gain, pitting oedema, ascites
Tx: H20 restriction /fluid restriction
Non-renal:
Na<10
Cirrhosis -
low albumin, unable to maintain intravascular pressure,
CCF
, cannot maintain pressure to maintian intravsacular volume,
Nephrotic Disease
- no Na/H20 Balance
Intraarteriolar volume depletion causing retention of H2O and Na triggering aldosterone and AdH.
Renal:
Na>20
Acute Renal Failure
, not maintaing Na and H2o balance - retention
Hypertonic
High Tonicity - High Effective Osmolarity
Osmolar Gap
, other active omoles in the plasma: mannitol, ethanol ethylene glycol
Increased tonicity of ECF, H20 shift from ICF to ECF to dilute solution = low Na
Isotonic
Osmolarity across FLuid Compartments is equal
Water retention in ECF that contains no Na.
Something else is holding the water --> mannitol?
psuedohyponatreamia
,
Lab error (Old machines)- from increased triglycerides and increased protein
Measuring Na in plasma. not the water
Plasma = Na (93%) + Lipids & proteins(7%)
Definitions
Hypovoleamia
Na and water Loss
Oedema
Na and water retention
Hyponatreaemia:
H20 retention, not be excreted
Hypernatreamia
H20 Loss, not replaced