3. Renal Disorders [email_address] FLUIDS and ELECTROLYTES FLUIDS and ELECTROLYTES BODY FLUIDS ICF ECF 40% TBW 20% TBW P IS Distribution of Body Fluids: 50-70% of total body weight; infant [70-80%], elderly [45-50%] 60-kg man TBW = 0.6 x 60 kg = 3.6 L ICF = 0.4 x 60 kg = 24 L ECF =12 L 3L 9L
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5. FLUID EXCHANGE BETWEEN BODY FLUID COMPARTMENTS Osmotic Pressure Gradient Oncotic P (Colloid osmotic P) Capillary P (Hydrostatic P) Renal Disorders [email_address] FLUIDS and ELECTROLYTES ICF ECF P ISF
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13. Renal Disorders [email_address] FLUIDS and ELECTROLYTES Volume Disorders 2° Alteration in Sodium Balance Expansion Isotonic Inc N No net change Isotonic fluid ingestion Hypertonic Inc Dec ICF ECF Sea water ingestion Hypotonic Inc Inc ECF ICF Hypotonic IVF Contraction Isotonic Dec N No net change Diarrhea Hypertonic Dec Dec ICF ECF Diabetes insipidus Hypotonic Dec Inc ECF ICF Addison’s dse Volume ECF ICF Water Conditions Disorder Vol. Vol. Shift
51. ASSESSMENT Burn Evaluation Chart Renal Disorders [email_address] B U R N S 9% 9% 9% Front= 18% Back= 18% 18% 18% 1%
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60. ACID-BASE DISORDERS Renal Disorders [email_address] Disorder Clinical manifestation Compensation Respiratory acidosis ↑ Paco 2 , ↑ or normal HCO 3 - , ↓ pH Kidneys eliminate H + and retain HCO 3 - Respiratory alkalosis ↓ Paco 2 , ↓ or normal HCO 3 - , ↑ pH Kidneys conserve H + and eliminate HCO 3 - Metabolic acidosis ↓ or normal Paco 2 , ↓HCO 3 - , ↓ pH Lungs eliminate CO 2 and conserve HCO 3 - Metabolic alkalosis ↑ or normal Paco 2 , ↑HCO 3 - , ↑ pH Lungs hypoventilate to ↑ Paco 2 , kidneys conserve H + excrete HCO 3 -
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65. Interpretation Renal Disorders [email_address] UC PC FC pH ↓ or ↑ ↓ or ↑ normal HCO 3 - ↓ or ↑ normal ↓ or ↑ ↓ or ↑ Paco 2 ↓ or ↑ normal ↓ or ↑ ↓ or ↑
Again, treatment goals are to ideally restore Na to their normal range – between 135 – 145. The most effective treatment, however, is prevention. Because thirst mechanism is oftentimes altered in ill clients, our role as providers of care is to help encourage appropriate hydration in the ill client. Early detection and treatment is necessary to help avoid serious consequences.