Disorders of water balance

There are two fundamentally different disorders of water balance :

dehydration and overhydration. Depending on the extracellular
sodium concentration, one can distinguish hypotonic, isotonic and
hypertonic dehydration and overhydration.
Hypotonic dehydration Fluid deficit associated with sodium
deficiency. The low osmolality of the extracellular space produces a
reduction of the extracellular volume.
Isotonic dehydration Deficiency of sodium and water. The
extracellular volume is reduced and serum osmolality and
intracellular volume are normal.
Hypertonic dehydration Water deficiency with elevation of serum
osmolality and reduction of the extracellular volume. As a result of
diffusion of water, the intracellular volume is also reduced and its
osmolarity increased.
Hypotonic overhydration xcess of water, with elevation of
extracellular and intracellular volumes. The osmolalities of serum and
intracellular space are reduced.
Isotonic overhydration xcess of water and sodium. The serum
osmolality is normal, the extracellular volume is elevated and the
intracellular volume normal.
Hypertonic overhydration !odium and fluid excess. !erum
osmolality and extracellular volume are increased. As a result of
diffusion, the intracellular volume is reduced and its osmolality
elevated.
Table 7a (1-3):
HY!T!"I# D$HYD%&TI!"
#a'ses "nade#uate sodium inta$e after vomiting, diarrhoea,
sweating. "ncreased sodium losses due to adrenal failure,
adrenalectomy, chronic diuretic therapy %thia&ides', diarrhoea,
fistula losses.
(y)pto)s Tiredness, fainting, hypotonia, vomiting, collapse,
fever, muscle cramps, rapid pulse, depressed consciousness level.
Treat)ent Treatment of primary disorder. Administration of: (a)l
*.+,, (a)l -..-,.
I(!T!"I# D$HYD%&TI!"
#a'ses "sotonic fluid losses through vomiting, diarrhoea, fistulae,
diuretics, drainage of ascites, with peritonitis, burns, sedative and
carbon monoxide intoxication, sunstro$e.
(y)pto)s Thirst, tiredness, fainting, collapse, vomiting,
hypotonia, muscle cramps, rapid pulse.
Treat)ent Treatment of primary disorder. Administration of: /inger
0s solution 1artmann0s solution %compound sodium lactate'
HY$%T!"I# D$HYD%&TI!"
#a'ses "nade#uate water inta$e, or increased water losses due to
sweating, osmotic diuretics, hyperventilation, chronic nephropathy,
polyuric phase of acute renal failure, diabetes insipidus.
(y)pto)s Thirst, fever, dryness, restlessness, delirium, coma.
Treat)ent Treatment of primary disorder. Administration
of:2lucose -, %3*,, 4*,',Darrow0s solution " half5strength in
glucose 4.-,.
Table 7b (1-3):
HY!T!"I# !*$%HYD%&TI!"
#a'ses xcessive administration of salt5free solutions, gastric
lavage with water, increased AD1 activity, liver failure.
(y)pto)s Wea$ness, nausea, vomiting, dyspnoea, confusion,
loss of consciousness.
Treat)ent Treatment of primary disorder. Fluid restriction,
6smofundin
7
3-,, possibly dialysis. "f tendency to al$alosis:(a)l
*.+,.
I(!T!"I# !*$%HYD%&TI!"
#a'ses xcessive administration of isotonic infusion solutions in
oliguric or anuric states, cardiac failure, nephrotic syndrome,
chronic uraemia, acute glomerulonephritis, liver cirrhosis, protein5
losing enteropathy.
(y)pto)s 6edema, effusions, hypertension dyspnoea.
Treat)ent Treatment of primary disorder. !odium chloride and
fluid restriction. Diuretics, 6smofundin
7
3-, %see chapter 6smotic
Therapy'.
HY$%T!"I# !*$%HYD%&TI!"
#a'ses xcessive administration of sodium chloride. Drin$ing of
sea water. 6veractivity of renal cortex in )onn0s syndrome,
)ushing0s syndrome, administration of steroids. )erebral sodium
chloride retention syndrome. Drin$ing of sea water after shipwrec$
(y)pto)s 8omiting, diarrhoea, labile blood pressure, pulmonary
oedema, restlessness, changes in central venous pressure.
Treat)ent Treatment of primary disorder. !odium chloride and
fluid restriction. Diuretics %thia&ides' 6smofundin
7
3-, %see
chapter 6smotic Therapy'.