Edema fluid balance

Potassium-sparing diuretics are often coadministered with thiazide or loop diuretics in the treatment of edema and hypertension. In this way, edema fluid is lost to the urine while K+ ion balance is better maintained. The aldosterone antagonists are particularly useful in the treatment of primary hyperaldosteronism. 

Since the effectiveness of many diuretics ultimately depends on establishing a negative Na balance to mobilize edema fluid, restriction of dietary Na intake is generally an essential part of diuretic therapy. Therefore, one cause of therapeutic failure or apparent patient refractoriness to diuretics could be the patient s continued ingestion of large quantities of NaCl. 

T cell activation and can interfere with cytoskeletal components that prevent interleukin-2 sjmthesis and release. Cytotoxic edema caused by acute cerebral ischemia is associated with reduced diffusion, reflecting the failure of membrane sodium pumps. Altered electrolyte or fluid balance can precede the onset of encephalopathy. This can be shown by fluid-attenuated inversion recovery and diffusion-weighted MRI images (36). 

Albumin has been more extensively studied than any other plasma protein. Among the many reasons for this are the natural abundance of blood plasma, the relatively high stability of albumin, and the early clinical interest in the low plasma albumin levels found in chronic diseases of the kidneys and liver (E5, M32). Prominence was at one time given to the role of albumin as a regulator of tissue fluid balance and an inhibitor of edema... 

Supportive care goals for the critically ill patient with ARF include aggressive fluid management. Cardiac output and blood pressure must be supported to allow for adequate tissue perfusion. However, a fine balance must be struck in this regard. For example, fluids must be typically restricted in anuric and ohguric patients unless the patient is hypovolemic or is able to achieve fluid balance via renal replacement therapy. If fluid intake is not minimized, edema rapidly occurs, especially in hypoalbuminemic patients. In contrast, vasopressors like dopamine >2 mcg/kg per minute or norepinephrine are used to maintain adequate tissue perfusion, but may also induce kidney hypoxia via a reduction in renal blood flow. Consequently, S wan-Ganz monitoring is essential for critically ill patients. 

Systemic analgesics should be given liberally, particularly before manipulation of the burned area. Systemic antipruritics (eg, trimeprazine) may be useful. Fluid balance and electrolytes should be monitored. Fluids are lost into the edematous areas, but fluid replacement is of less magnitude than that required for thermal burns. Medical personnel accustomed to treating patients with thermal burns must resist the temptation to overhydrate mustard burn patients, which could lead to untoward consequences such as pulmonary edema.16... 

The presence of blood protein molecules, such as albumins and globulins, are critical factors in maintaining the proper fluid balance between cells and extracellular space. Proteins are present in the capillary beds, which are one-cell-thick vessels that connect the arterial and venous beds, and they cannot flow outside the capillary beds into the tissue because of their large size. Blood fluid is pulled into the capillary beds from the tissue through the mechanics of oncotic pressure, in which the pressure exerted by the protein molecules counteracts the blood pressure. Therefore, blood proteins are essential in maintaining and regulating fluid balance between the blood and tissue. The lack of blood proteins results in clinical edema, or tissue swelling, because there is insufficient pressure to pull fluid back into the blood from the tissues. The condition of edema is serious and can lead to many medical problems. 

Assessment of fluid balance requires baseline historical data relative to edema present in the extremities prior to any suspected fluid imbalance. 

Fluid balance In two patients undergoing transurethral resection, the bladder was irrigated with large volumes of mannitol 5%, which was absorbed and caused pulmonary edema and severe hyponatremia (serum sodium 99 and 97 mmol/1) [63 ]. Hypertonic saline increased the serum sodium concentration and plasma volume expansion corrected hypotension one patient also required positive-pressure ventilation and intravenous noradrenaline. Both recovered completely. 

Fluid balance Fluid retention has been reported in up to 50% of patients treated with docetaxel, usually after cumulative doses. This commonly manifests as peripheral edema, but pleural effusions and ascites have also been reported [130 ]. As a result. 

Discussion of fluid balance the patients role is the most important factor in the prevention of this problem. Strict fluid intake limitation mitigates the risk of pulmonary edema between dialysis sessions. 

A delicate balance of normal pressure is maintained in the brain and spinal cord by brain, blood, and cerebrospinal fluid (CSF) volume. Since the brain is contained within a confined space (skull), any foreign mass contained within that space causes adverse sequelae. This results in either destruction or displacement of normal brain tissue with associated edema. Most brain metastases occur through hematogenous spread of the primary tumor, and around 80% of patients will have multiple sites of metastases within the brain. 

Fluid and electrolyte balance Monitor fluid and electrolyte balance and body weight. Give with a diuretic to prevent fluid retention and possible CHF a loop diuretic is usually required. If used without a diuretic, retention of several hundred mEq salt and corresponding volumes of water can occur in a few days, leading to increased plasma and interstitial fluid volume and local or generalized edema. 

Severe emesis - Severe emesis should not be treated with an antiemetic drug alone where possible, establish cause of vomiting. Direct primary emphasis toward restoration of body fluids and electrolyte balance, and relief of fever and causative disease process. Avoid overhydration which may result in cerebral edema. 

The ability of certain drugs to increase both fluid and electrolyte loss has led to their use in the clinical management of fluid and electrolyte disorders, for example, edema. Regardless of the cause of the syndrome associated with edema, the common factor is almost invariably an increased retention of Na. The aim of diuretic therapy is to enhance Na+ excretion, thereby promoting negative Na" balance. This net Na" (and fluid) loss leads to contraction of the overexpanded extracellular fluid compartment. 

Individuals with chronic liver disease may have disorders of fluid and electrolyte balance, including ascites, edema, and effusions. Alterations of whole body potassium induced by vomiting and diarrhea, as well as severe secondary aldosteronism, may contribute to muscle weakness and can be worsened by diuretic therapy. The metabolic derangements caused by metabolism of large amounts of ethanol can result in hypoglycemia, as a result of impaired hepatic gluconeogenesis, and in ketosis, caused by excessive lipolytic factors, especially increased cortisol and growth hormone. 

Plasma. Normal blood plasma is a clear, slightly yellowish fluid, which is approximately 55% of the total volume of the blood. The plasma is a water solution in which are transported the digested food materials from rhe walls of the small intestine to the body tissues, as well as the waste materials from the tissues to the kidneys. Consequently, this solution contains several hundred different substances. In addition, the plasma carries antibodies, which are responsible for immunity to disease, and hormones. The plasma transports most of the waste carbon dioxide from the tissues back to the lungs. Plasma consists of about 91% water, 7% piotein material, and 0.9% various mineial salts, The icmaindei consists of substances already mentioned. The salts and proteins are important in keeping the proper balance between the water in the tissues and in the blood, Disturbances in this ratio may result in excessive water in the tissues (swelling or edema). The mineral salts in the plasma all serve... 

Whether an increase in vascular permeability results in mucosal edema depends on the balance between the amount of leakage into the mucosa and the rate of clearance from the mucosa, either through the lymphatics or across the epithelium into the airway lumen. The increase of vascular permeability produced by inflammatory stimuli can result in the bulk flow of plasma into the airway mucosa (Renkin, 1992). The amount of plasma leakage depends upon the number of gaps that form in the endothelium of the leaky vessels, the duration of the gaps and the intravascular pressure that drives the extravasation (Clough, 1991 Taylor and Ballard, 1992). The movement of plasma proteins and other osmotically active solutes into the mucosa can increase the interstitial oncotic pressure, which favors the net movement of fluid out of vessels and further increases the amount of leakage (Taylor and Ballard, 1992). 

Initial treatment of the acute phase of lead intoxication involves supportive measures. Prevention of further exposure is important. Seizures are treated with diazepam or phenytoin (see Chapter 19), fluid and electrolyte balances must be maintained, and cerebral edema is treated with mannitol and dexamethasone or controlled hyperventilation. The concentration of lead in blood should be determined or at least a blood sample obtained for analysis prior to initiation of chelation therapy. Chelation therapy is indicated in symptomatic patients or in patients with a blood lead concentration in excess of 50-60 pg/dL (about 2.5 pM). Four chelators are employed edetate calcium disodium (CaNa EDTA), dimercaprol, D-penicillamine, and succimer (2,3-dimercaptosuccinic acid [DMSA], chemet). CaNa EDTA and dimercaprol usually are used in combination for lead encephalopathy. 

All patients with congestive heart failure do not become edematous. Several investigators obtained evidence that explains why edema develops. They observed that patients with congestive heart failure often have reduced renal blood flow and glomerular filtration rate. If the electrolyte and water balance of the body fluid is to be maintained in the presence of reduced filtration rates, tubular reabsorption must also be reduced. Reduced glomerular filtration with normal tubular reabsorption must lead to water and salt retention. 

The opposite occurs at the venule end of the capillary with fluid flowing in from the tissues into the blood. However, if this balance between the two opposing forces is upset under certain abnormal physiological conditions, fluid accumulates in the interstitial space resulting in a condition known as edema. In this diseased state, a normally negative interstitial fluid pressure becomes positive. This may happen due to cumulative or singular effect of several factors like high blood pressure, increased capillary porosity and/or low plasma protein content. 

Balanced electrolyte sohitians are used to initiate diuresis. Because the administration of fluids may cause overhydration, the animal s central versus pressure should be monitored to avoid pulmonary edema. 

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