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# Osmolality Goldman.

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Typical BODY COMP WashMan. Aggregate Body Water-Water makes up 60% of body wt in guys (42l in 70kg male)50% in females80% in newborns2/3 is ICF
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﻿Osmolality Goldman A mole of a substance is the mol wt of that substance in grams E.g. the mol wt of NaCl is 23+35.5= 58.5 Therefore 1mole NaCl = 58.5 g. 1 millimole is 1/1000 of a mole Therefore 1millimole of NaCl is 58.5 mg. The heaviness of a salt in mg can be changed over into millimoles by separating the weight in mg by the mol.wt e.g 1g (1000mg) NaCl = 17.1 millimoles Mol wt of NaCl =58.5 Therefore 1000/58.5= 17.1 Mol wt of glucose C6H12O6 = 12x6 +1x12 +16x6 = 72+12+96=180 Osmolality – a Molal arrangement contains a gram mol wt of the substance disintegrated in 1000g of the dissolvable (A Molar arrangement contains a gram mol wt of the substance broke up in 1 Liter of dissolvable) It is dictated by measuring the melancholy of the point of solidification of an answer, contrasted with water,using an osmometer and communicating the esteem in *C underneath 0*C The esteem can likewise be communicated in milliosmoles ,utilizing the variable 1000Osm=186*C or 1*C=538mOsm The typical scope of serum osmolality is 275-290mOsm/kg of serum

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NORMAL BODY COMP WashMan Total Body Water-Water makes up 60% of body wt in guys (42l in 70kg male) half in females 80% in infants 2/3 is ICF – Intracellular Fluid ( 40%-28L in 70kg male) 1/3 is ECF-Extracellular (20% body wt-14I) of which1/4 is Intravascular (plasma 5% body wt-3.5L) and 3/4 Interstitial(10.5L) Total body water is controlled by ADH SODIUM-85-90% is in ECF Change in serum Na (i.e. Intravascular Na) demonstrates bothered water homeostasis and ICF volume Change in sodium content ( add up to body Na) are show as ECF extension (edema) or compression Osmolality or tonicity is the solute or molecule centralization of a liquid. Solutes that are confined to the ICF ( K & natural phosphate esters) or ECF(Na & going with anions) decide the powerful tonicity or osmolality Rule of thumb - Extracellular osmolality = 2x serum Na + 10 Normal body liquid vol and osmolality is kept up by kidneys in spite of wide varieties in salt and water consumption

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NORMAL ELECTROLYTE COMP OF IV &IC mmol/L Schwartz

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GI –NORMAL VALUES Condon/ACS Manual

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ELECTROLYTES/DAY Wash Man Na-as a rule 50-150mmols gave. Renal discharge can tumble to < 5mmols/d without admission K –usually 20-60 mmols when renal capacity typical Rule of thumb - Na/K 1mmol/kg/day CHO-100-150 g as dextrose to minimize-protein catabolism& ketoacidosis 2-3 l of 1/2N Dextrose Saline (90-125ml/hr) with 20mmols K/l

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MAINTAINENCE THERAPY Wash Man 500ml - min measure of water req to discharge day by day solute stack Solute heap of 600mOsm is created every day by the body. Sound individuals can think pee to a maximum of 1200mOsm/L +500ml - apathetic misfortune through skin, lungs & dung - 300ml-water goad from endogenous met Min water required/day=1000-300ml =700ml Rule of thumb ( ROT)- 30 ml/kg/d ordinary water reqd Normally 2-3l water/day to nudge 1-1.5L pee Check day by day weight

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COMP OF COMMONLY USED IV FLUIDS Condon

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ABNORMAL FLUID & ELECTROLYTE LOSSES Wash Manual INSENSIBLE WATER GI RENAL RAPID INTERNAL SHIFTS BLOOD

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INSENSIBLE WATER LOSS Wash Manual From skin and lungs –very variable Inc with inc resp rate,ambient temp and stickiness. Inc by 100-150 ml/*C>37* body temp(2ml/kg/*C) Sweating-variable 100-2000ml/hr dep on physical action and encompassing temp Replacement with 5% dextrose or ¼ NS

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RENAL LOSSES Wash Manual Na misfortunes critical in diuretic period of ATN, diuretic use,GI misfortunes and catabolic states Na maintenance sig in postop state, lack of hydration, steroid utilize K misfortune sig in diuretic utilize, steroid utilize, GI misfortunes esp looseness of the bowels, ( intracellular move with Beta agonists like salbutamol) K maintenance sig in high yield renal disappointment, post injury, blood transfusion

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RAPID INTERNAL FLUID SHIFTS Wash Man Occurs with peritonitis, blazes, intestinal check, sepsis, squash damage Need to supplant sequestered liquid with ordinary saline

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RENAL FUNCTION Condon Assessed by Urine sp.gr, pH & osmolality of 1 st voided pee in the morning-sp.gr ought to be or > 1.016 and pH 5.8 or lower and pee osmolality ought to be 850mOsmol/Kg water and proportion of pee to serum osmolality ought to be no less than 3

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ANION GAP Determination of the anion hole is valuable in surveying the etiology of metabolic acidosis. Mmol Na = mmol Cl-+ mmol HCO3-+ Metabolic acidosis can be separated into 2 bunches 1-with inc Cl ( as in looseness of the bowels with loss of HCO3) 2 with inc of obscure anion as in renal disappointment where there is inc sulfate and phosphate, Diabetes ketoacidosis where there is expanded ketocacids, Salicylate harming where there is inc salicylate Lactic acidosis where there is inc lactic corrosive Na+140mmol/l= Cl 100mmol + HCO3 10mmol + ?

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HYPONATREMIA ACS Caused by supplanting body misfortune by water alone or 5% dextrose eg looseness of the bowels Head harm with wrong emission of ADH Renal infection with improper loss of Na in the pee Starvation where there is breakdown of muscle with creation of salt free water Diuretic utilize particularly thiazides Pseudohyponatremia-The serum Na is dishonestly low on account of High serum lipids or protein – Na falls yet osmolality remains the same If plasma glucose is > 20mmol/L,make a redress Blood is drawn from an arm with a dextrose drip The diminished serum Na causes a fall in the osmolallity of extracelluar comp and there is development of water intracellularly bringing on swelling of cells. This can bring about mind edema with inc intracranial weight This causes edema, inc in weight, perplexity, detachment, shortcoming, sickness and regurgitating. If not rectified the water abundance will advance to muscle jerking, shakings, daze and even passing as serum Na falls < 120mmol/l

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HYPONATREMIA - TREATMENT Dont construct treatment in light of serum Na conc alone Correct the hidden cause if conceivable With pee omolality and sodium conc it is conceivable to go to an analysis

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HYPERNATREMIA Much rarer. Brought about by Fever in septic patients Tube encouraging when not weakened with sufficient water Renal ailment with loss of solute poor water as in high yield renal disappointment where there is dec tubular reaction to ADH Tracheostomy patients Nonketotic hyperosmolar lack of hydration in diabetics optional to serious drying out created by diuresis and glcosuria Clinical appearances is brought about by intracellular parchedness. Pt is parched, crabby, restless,disoriented in the long run prompting to coma,convulsions, and even demise as serum Na ascends to 160mmol/l Brain drying out prompts to dec intracranial weight bringing on migraine, and when serious can prompt to dilatation of intracerebral vessels and inevitable tear/burst cerebral hg is visit finding in pts kicking the bucket of hypernatremia Treatment is giving sufficient volumes of water by mouth or as IV 5% dextrose. Amendment takes 1-2 days

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HYPOKALEMIA The kidney does not monitor K like Na There is a steady urinary loss of 40-60 mmol K/day Normal serum K of 4mmol/l is required for legitimate capacity of muscle-skeletal, cardiovascular and smooth Skeletal-muscle shortcoming, paresthesia, limp loss of motion when K<3 Cardiac-hypotension, bradycardia, arrythmias, ECG-level/reversed T waves, noticeable U waves, dep S-T portion Smooth-diminished intestinal motlity, incapacitated ileus, abd expansion Hypokalemic intermittent loss of motion after work out, substantial CHO dinner A shortage of 4-5mmol/l/kg exists for each 1mmol lessening in serum K Only a crisis when K<2 Can be remedied more than 1-2 days If oral is endured this is most secure – count calories rich in natural products. Check if renal capacity is ordinary IV K ought not surpass 20mmol/hr in through a fringe line at a focus not more noteworthy than 40mmol/L of typical or ½ ordinary saline with ecg monitering

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HYPERKALEMIA ACS/WASH MAN/Currentdiag07 Usually ass with renal impedance Caused by Metabolic acidosis Overaggressive K substitution Transcellular move tumor lysis, rhabdomyolysis Pseudohyperkalemia-because of lysis of RBCs amid venepuncture/transport Affects heart work bradycardia, hypotension, vent fibrillation, heart failure as K achieves 7mmol/l ECG changes-crested T waves, delayed PR interim and augmenting of QRS complex, loss of P waves, Emergency which needs fast treatment-Stop all K Give IV cal gluconate-10ml of 10% soln more than 2 min. Prompt, impact lasts1hr 50ml of half dextrose + 10 units insulin more than 30min K will drop by1mmol/l in 15min and impact endures sev hrs HCO3-3 ampoules in 1litre 5%dextrose if pt not overhydrated Frusemide Salbutamol nebuliser-beta2 agonist treatment. Brings down K by 1mmol in 30min and lasts3 hrs Cation trade saps maintenance purification 50gm in150 ml tapwater or 50gm in 100ml of 20% sorbitol orally. Brings down K by 1mol in 1hr and keeps going 6hrs

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Anion Gap ACS In any natural framework in which particles are available , electrical lack of bias is kept up by the aggregate # of cations with the aggregate # of anions This main is used clinically in patients with suspected corrosive base issue by measuring the serum sodium, chloride and bicarbonate fixations. Ordinarily the extracellular conc of Na+ = the extracellular conc of Cl-+ HCO3-+ a consistent assigned as delta Mmol Na = mmol Cl-+ mmol HCO3-+ Where delta = 8 +/ - 4 mmol/l

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ACID BASE BALANCE ACS Enormous measure of corrosive is created regular from every day digestion system Oxidation of CHO and fats deliver 15,000-20,000 mmols of unstable corrosive as CO2 Breakdown of sulfur containing aminoacids and deficient oxidation of CHO & fats create 60-70 mmols of settled corrosive Normally this H+ delivered does not change in extracellular pH from its typical estimation of 7.4(+/ - 0.2) due to intracellular supports, pneumonic and renal instruments Intracellu

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