Fluids intake/loss

TH E PATIEN T WITH ED EM A. Fhtients with edema caused by heart failure or other causes are weighed daily or as ordered by the primary health care provider. A daily weight is taken to monitor fluid loss. Weight loss of about 2 lb/d is desirable to prevent dehydration and electrolyte imbalances. The nurse carefully measures and records the fluid intake and output every 8 hours. The critically ill patient or the patient with renal disease may require more frequent measurements of urinary output. The nurse obtains the blood pressure, pulse, and respiratory rate every 4 hours or as ordered by the primary health care provider. An acutely ill patient may require more frequent monitoring of the vital signs. 

Fluid restriction is generally unnecessary as long as sodium intake is controlled. The thirst mechanism remains intact in CKD to maintain total body water and plasma osmolality near normal levels. Fluid intake should be maintained at the rate of urine output to replace urine losses, usually fixed at approximately 2 L/day as urine concentrating ability is lost. Significant increases in free water intake orally or intravenously can precipitate volume overload and hyponatremia. Patients with stage 5 CKD require renal replacement therapy to maintain normal volume status. Fluid intake is often limited in patients receiving hemodialysis to prevent fluid overload between dialysis sessions. 

Monitor edema after initiation of diuretic therapy. Monitor fluid intake to ensure obligatory losses are being met and avoid dehydration. If adequate diuresis is not attained with a single agent, consider combination therapy with another diuretic. 

Nausea Loss of appetite without alteration in eating habits Oral intake decreased without significant weight loss, dehydration or malnutrition IV fluids indicated less than 24 hours Inadequate oral caloric or fluid intake IV fluids, tube feedings, or TPN indicated greater than 24 hours Life-threatening consequences Death... 

I.c.2.1. Fluid intake. This includes restriction of fluid intake to less than 1 liter per day if, as in oliguric renal failure, daily urine volumes are 500 ml or less and daily insensible losses are estimated to be 500-700 ml. In non-oliguric renal failure daily urine losses plus insensible losses may be in excess of 2 1/day and daily intake obviously has to be adjusted accordingly. Careful balance of intake and output of fluid and electrolytes is extremely important in ARF patients, both oliguric and non-oliguric. 

A 37-year-old woman with primary enuresis continued her customary daily fluid intake (2 liters) when she started intranasal desmopressin 30 micrograms at night. Within 2 days she became severely hyponatre-mic, with loss of consciousness, generalized seizures, and cerebral edema. 

An 80-year-old woman with a high baseline fluid intake developed severe hyponatremia, with loss of consciousness and seizures, after a single dose of desmopressin 0.2 mg (49). 

The body gains water via food and fluid intake plus the metabolic production of water. Routes of water loss include urine, sweat, faeces and insensible losses via the skin and lung. 

Dehydration with diminished volume (bleeding, large water losses, diuretic therapy, paracentesis, intravasal volume shifting) can lead to prerenal azotaemia. Typically, renal function normalizes again when fluid intake is increased, i.e. in contrast to the hepatorenal syndrome, the intravasal volume can be influenced by therapy. 

When diuretics are abused it is mostly in the course of a misguided attempt to lose weight in the past, various slimming remedies offered for sale outside normal trading channels have been found to contain diuretics, sometimes with components such as thyroid extract. The unnecessary use of diuretics by a healthy individual, perhaps in excessive doses, can lead to dehydration, hypokalemia, and hypotension when furosemide is abused, even tetany can occur because of hypocalcemia (126). The weight loss achieved by using diuretics in this way is purely due to dehydration and will soon be annulled by extra fluid intake. 

Acute on top of chronic poisoning occurs in individuals who have been on a chronic lithium prescription, and who in one way or another ingest an overdose of the lithium, or are given medications that increase lithium levels. Conditions where sodium conservation is stimulated, such as low salt intake, loss of body fluid by way of vomiting, diarrhea, or use of diuretics which decrease hthium clearance (thiazides) are usually the precipitating factors. 

Conditions that result in the loss of large volumes of body fluids, such as high-volume diarrhea and gastric reflux, obviously require aggressive fluid therapy. However, many other horses may require fluid therapy because of prolonged mild-to-moderate fluid losses or prolonged reduced fluid intake. In neonatal foals, reduced fluid intake can rapidly result in hypovolemia and severe dehydration. This section addresses the identification of these horses and foals. 

Biochemical and clinical measurements considered necessary for effective monitoring of patients receiving PN include serum chemistries, vital signs, weight, total daily fluid intake and losses, and nutritional intake. 

Hypovolemia Gastrointestinal fluid losses, osmotic diuresis Increase fluid intake... 

A number of biochemical and clinical measurements are necessary for effective monitoring of patients receiving PN. Important clinical laboratory measurements include serum concentrations of electrolytes, hematologic indices, and biochemical markers for renal function, liver function, and nutrition status. Other important clinical measurements include vital signs, weight, total fluid intake and losses, and nutritional intakes. Weekly height/length and head... 

Insufficient fluid intake or increased water loss With increased body sodium ... 

---