Fluid Assessment

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Fluid Assessment

• Cherelle Fitzclarence
• 2009

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Overview

• Revision
• Cases

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We are approximately two-thirds water
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Fluid shifts / intakes
Kidneys Gut Lungs Skin
Intracellular 30 litres
Interstitial9 litres
IV 3 litres
Extracellular fluid - 12 litres
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Fluid shifts / intakes
Kidneys Gut Lungs Skin
Intracellular 30 litres
Interstitial9 litres
IV 3 litres
Extracellular fluid - 12 litres
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REGULATION OF FLUID VOLUME
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BODY FLUID COMPARTMENTS

• RULE OF THIRDS
• Intracellular 2/3 (40 TBW)
• Extracellular 1/3 (20 TBW)
• Interstitial Lymph 2/3 (15 TBW)
• Intravascular 1/3 (5 TBW)

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Fluid Pressures (Starlings Law)

• ECF and ICF fluid shifts occur related to changes
  in pressure within the compartments
• Fluid flows only when there is a difference in
  pressure
• 3 types of body fluids
• Isotonic
• Hypotonic
• Hypertonic

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Fluid shifting

• 1st space shifting- normal distribution of fluid
  in both the ECF compartment and ICF compartment.
• 2nd space shifting- excess accumulation of
  interstitial fluid (edema)
• 3rd space shifting- fluid accumulation in areas
  that are normally have no or little amounts of
  fluids (ascites)

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FLUID VOLUME DEFICIT

• Hypovolemia isotonic extracellular fluid
  deficit
• Deficiency of both water electrolytes
• Caused by decreased intake, vomiting, diarrhea,
  fluid shift

• Dehydration hypertonic extracellular fluid
  deficit
• Deficiency of water
• Caused by water loss related to high blood
  glucose, inadequate ADH production, high fever,
  excess sweating

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Assessment of Fluid Deficit

• Hypotension
• Weak rapid pulse
• Temperature decreased if hypovolemic, and
  increased in dehydration
• Weight loss
• Skin turgor poor in dehydration and possible
  edema in hypovolemic
• Concentrated urine and blood

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FLUID VOLUME EXCESS

• Extracellular isotonic fluid excess
• Excess of both water and electrolytes
• Caused by retention of water and electrolytes
  related to kidney disease overload with isotonic
  IV fluids

• Intracellular water excess
• Excess of body water without excess electrolytes
• Caused by over-hydration in the presence of renal
  failure administration of D5W

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FLUID VOLUME EXCESS/Assessment

• Isotonic
• Hypertension
• Bounding pulse
• Crackles, dyspnea
• Weight gain
• Edema in extremities
• JVD
• Irritable, confused

• Hypotonic
• Systolic B/P
• Decreased pulse
• Increased respirations
• Weight gain
• Cerebral edema
• Irritable, confused

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FLUID VOLUME EXCESS/ Treatment

• Isotonic
• Correct cause
• Restrict H2O and Na
• Diuretics
• Digitalis
• Possible dialysis

• Hypotonic
• Correct cause
• Restrict H2O intake
• IV fluids with E-lytes

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Dehydration

• Occurs when fluid loss exceeds intake
• sweating vs time
• Fluid lost mostly from ECF
• decreased circulating blood volume
  inadequate tissue perfusion, inefficient
  transport of substrates to muscle, and elevated HR