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Chapter 046. Sodium and Water (Part 5)

Hypovolemia: Treatment The therapeutic goals are to restore normovolemia with fluid similar in composition to that lost and to replace ongoing losses. Symptoms and signs, including weight loss, can help estimate the degree of volume contraction and should also be monitored to assess response to treatment. Mild volume contraction can usually be corrected via the oral route. More severe hypovolemia requires intravenous therapy. Isotonic or normal saline (0.9% NaCl or 154 mmol/L Na+) is the solution of choice in normonatremic and most hyponatremic individuals and should be administered initially in patients with hypotension or shock. Hypernatremia reflects a proportionally greater. | Chapter 046. Sodium and Water Part 5 Hypovolemia Treatment The therapeutic goals are to restore normovolemia with fluid similar in composition to that lost and to replace ongoing losses. Symptoms and signs including weight loss can help estimate the degree of volume contraction and should also be monitored to assess response to treatment. Mild volume contraction can usually be corrected via the oral route. More severe hypovolemia requires intravenous therapy. Isotonic or normal saline 0.9 NaCl or 154 mmol L Na is the solution of choice in normonatremic and most hyponatremic individuals and should be administered initially in patients with hypotension or shock. Hypernatremia reflects a proportionally greater deficit of water than Na and its correction will therefore require a hypotonic solution such as half-normal saline 0.45 NaCl or 77 mmol L Na or 5 dextrose in water. Patients with significant hemorrhage anemia or intravascular volume depletion may require blood transfusion or colloid-containing solutions albumin dextran . Hypokalemia may be present initially or may ensue as a result of increased urinary K excretion it should be corrected by adding appropriate amounts of KCl to replacement solutions. Hyponatremia Etiology A plasma Na concentration 135 mmol L usually reflects a hypotonic state. However plasma osmolality may be normal or increased in some cases of hyponatremia. Isotonic or slightly hypotonic hyponatremia may complicate transurethral resection of the prostate or bladder because large volumes of isoosmotic mannitol or hypoosmotic sorbitol or glycine bladder irrigation solution can be absorbed and result in a dilutional hyponatremia. The metabolism of sorbitol and glycine to CO2 and water may lead to hypotonicity if the accumulated fluid and solutes are not rapidly excreted. Hypertonic hyponatremia is usually due to hyperglycemia or occasionally intravenous administration of mannitol. Relative insulin deficiency causes myocytes to become impermeable to