Fluid Electrolytes Imbalance and Hemodynamic Disorders PCL 301

Fluid, Electrolytes Imbalance and Hemodynamic Disorders PCL 301 (INTRODUCTION TO DISEASE STATES I) Pharm. Akinola Alexander

Objective • Overview of Circulatory System • Fluid and Electrolytes Imbalance/Disorders- Edema, Dehydration, Potassium Imbalance, Acidosis/Alkalosis • Hemodynamics Hemodynamic disorders – Hemorrhage , Embolism, Thrombosis, Infarction, Shock

FLUID AND ELECTROLYTE DISORDERS

Overview • Also known as Cardiovascular System • the system that circulates blood and lymph through the body, consisting of the heart, blood vessels, blood, lymph, and the lymphatic vessels and glands. • The circulatory system is a vast network of organs and vessels that is responsible for the flow of blood, nutrients, hormones, oxygen and other gases to and from cells

FLUID & ELECTROLYTES Water • 45– 60% of the human body is composed of water • It contains electrolytes essential to maintain human life • Found within (Intracellular) and outside (extracellular) the cells.

FLUID COMPARTMENTS • Intracellular (2/3) • Extracellular (1/3) • Intravascular fluid or blood • Interstitial fluid • Cerebrospinal fluid (CSF) • Transcellular fluids present in various secretions - Pericardial cavity (Heart), Synovial (joint)

Causes of Fluid and Electrolyte Imbalances • • Burns Surgery Trauma Diabetes Tumors Alcohol withdrawal Eating disorders

Edema • Refers to “increased or accumulation of fluid in the interstitial tissue spaces. ” • Examples - Hydrothorax, hydropericardium, or hydroperitoneum (ascites) refer to fluid collection in the respective body cavity. • Localized - Any tissue or organ (Cerebral edema, pulmonary edema) • Generalized – Anasarca (↑in body weight)

Sustained edema – may result into • Restriction of arterial blood flow into an area of the body • Prevents normal cell function • Tissue necrosis • Development of ulcers • Varicose veins (dilated veins that have high hydrostatic pressure, Skin breakdown, fatigue, slow healing ulcers)

Mechanism of edema: It involve the movement of fluid between vascular and interstitial spaces, often controlled mainly by the opposing effects of vascular hydrostatic pressure and plasma colloid osmotic pressure. Occurs mostly as a result of increased vascular permeability. The resulting edema fluid may be either a transudate or exudate.

Edema –Clinical Manifestations • Functional Impairment - May restrict movement • Pain - Edema increases the pressure on the local nerves • Pitting edema – • Excess interstitial fluid • moves aside when firm finger pressure placed on surface. • Depression remains after finger is removed. • Rated based on how quickly skin rebounds to original shape.

Dehydration • Also known as “Fluid Deficit” • It is also insufficient body fluid from • Inadequate intake of fluid • Excessive loss of fluid or • Combination of the both. • Dehydration - more serious for infants and elderly who lack fluid reserves and the ability to conserve fluid. • Infants also have a higher metabolic rate.

Etiology • Vomiting & Diarrhea • Loss of fluids and electrolytes and nutrients • Glucose • Water • Excessive sweating • Loss of water and sodium • Insufficient water intake • Elderly and unconscious

EFFECT OF DEHYDRATION The body compensates by • Turgor ü Decreased elasticity in the skin • Lower blood pressure • Weak pulse, fatigue • Confusion • Headache • Lethargy • • • Thirst Increased heart rate Pale cool skin Decreasing urine output Decreased mental function ü loss of water to brain cells

Potassium Imbalances Hypokalemia – result into Hyperkalemia – result into • Cardiac dysrhythmia • Interference with neuromuscular function - muscles become less responsive • Paresthesia develops • Decreased digestive tract motility • Respiratory muscles may become weak • Renal function may become impaired • Cardiac dysrhythmias • Muscle weakness progressing to paralysis • Fatigue, nausea and paresthesias

Acidosis process causing a relative excess of acid in body Respiratory Acidosis Metabolic Acidosis • Results from hypoventilation and retention of carbon dioxide • Examples of diseases COPD, Asthma • Clinical manifestations: headache, SOB, cardiovascular abnormalities, restlessness, confusion. • Result from accumulation of acids or a deficit of bases in blood • Examples of diseases - Renal failure, diarrhea • Clinical manifestations: muscular twitching, weakness, nausea, vomiting, diarrhea, headache

Alkalosis Condition resulting in excess base in the body Respiratory Alkalosis • Hyperventilation: lungs excrete excessive amounts of carbon dioxide • Early stage pulmonary problems • Clinical manifestations: deep, rapid breathing, dizziness, muscle cramps, numbness of extremities Metabolic Alkalosis • Abnormal loss of acid or excess accumulation of bicarbonate ions • Vomiting, gastric suctioning • Diarrhea, excessive use of laxatives • Clinical manifestations: hypoventilating, muscle weakness, irritability, confusion, muscle twitching

HEMODYNAMIC DISORDERS

Hemorrhage loss of blood outside the cardiovascular system External • Loss of blood outside the body • Often results in hypovolemia (>20%) – hemorrhagic shock Internal • Loss of blood into various body cavities. ( internal bleeding) • Causes other complications such as hemothorax, hematomas, hemoptysis, hematemesis, melena ü Hemoptysis (Coughing blood from respiratory tract) ü Hematemesis (Vomiting blood) ü Melena (Black, discolored blood in stool)

Thrombosis formation of a solid or semi-solid mass from the constituents of the blood within the vascular system during life. The mass itself is called a thrombus • Thrombus ü Solid mass of clotted blood ü Pathogenesis involves 3 main factors 1. Endothelial injury 2. Stasis or turbulence of blood flow 3. Blood hypercoagulability ü Often get attached to vessel walls where they grow or obstruct blood flow.

Clinical significance of thrombosis. Thrombi are significant because they cause obstruction of arteries and veins. • Lungs – pulmonary thromboembolism • Heart – myocardial infarction • Legs – Deep vein thrombosis • Brain – Stroke (Ischemic or Hemorrhagic) • Kidneys – Chronic kidney disease

Embolism An embolus is a detached intravascular solid, liquid, or gaseous mass that is carried by the blood to a site distant from its point of origin. Forms of emboli • Thromboemboli- representing a dislodged thrombus and constitutes 99% of all emboli. Fat emboli consisting of fat droplets. • Air emboli - consisting of bubbles of air or nitrogen. • Atherosclerotic emboli - cholesterol emboli • Tumor emboli - made up of fragments of a tumor. • Bone marrow emboli - consist of bits of bone marrow. • Foreign body emboli - bullets or shrapnel

Infarction This is defined as localized area of ischemic cell necrosis in a living organ or tissue, resulting most often from sudden reduction or cessation of its arterial blood supply or occasionally its venous drainage • Nearly 99% of all infarcts result from thrombotic or embolic events, and almost all result from arterial occlusion. • Damage often depends on ü Anatomic site ü Circulation to that site ü Organ’s capacity for repair – Postmitotic cells (brain, heart); Mitotic cells (Liver)

Classification of Infarction By Histopathology - 2 types according to the amount of blood present: • White infarctions (anemic infarcts) affect solid organs such as the spleen, heart and kidneys wherein the solidity of the tissue substantially limits the amount of nutrients (blood/oxygen/glucose/fuel) that can flow into the area of ischaemic necrosis. • Red infarctions (hemorrhagic infarcts), generally affect the lungs or other loose organs (testis, ovary, small intestines). The occlusion consists more of red blood cells and fibrin strands.

By Localization – target site or organ affected • • • Heart – Lungs - Spleen - Limb - Bone Testicles -

Clinical complications or manifestation of an infarction include; • Myocardial infarction • Lung infarction • Splenic infarction • Cerebral infarction (stroke) • Bone infarction

Shock • It is a state of systemic hypoperfusion that is caused either by reduced cardiac output or by reduced effective circulating blood volume. • The end results are hypotension, impaired tissue perfusion, and cellular hypoxia. • It is the final common pathway for a number of potentially lethal clinical events. • Although the hypoxic and metabolic effects of hypoperfusion initially cause only reversible cellular injury, persistence of shock eventually causes irreversible tissue injury and can culminate in the death of the patient

Categories of shock • Cardiogenic – due to myocardial pump failure • Hypovolemic – due to inadequate blood or plasma volume (hemorrhage, vomiting or diarrhea, extensive burns • Septic – due to overwhelming microbial or fungal infection, Endotoxin • Neurogenic – less common (spinal cord injury) • Anaphylactic- less common (drug anaphylaxis)