Trastornos hidroelectrolíticos
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Transcript of Trastornos hidroelectrolíticos
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TRASTORNOSHIDROELECTROLÍTICOS
Gonzales Malaver, Kevin Scott
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55-75%
25-40% 75%
25%
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BALANCE HÍDRICO NORMAL
+
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COMPOSICIÓN DE ELECTROLITOS EN LOS LIQUIDOS CORPORALES
UREA:OSMOL
INEFICAZ
no contribuyeal
desplazamiento
del agua
ARRASTRA H2O
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En el plasma es de 280 – 295 mOsm/KgUmbral osmótico de la sed es de 295 mOsm/Kg
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REGULACIÓN FISIOLÓGICA DEL AGUA
-
+
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EQUILIBRIO HIDRICOVASOPRESINA
Vasopresina en respuesta a cambios de osmOrina: 1200 mosm/kg
Orina: 30 mosm/kg
DIABETES INSIPIDA
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HIPOVOLEMIA
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RENAL EXTRARRENAL GLUCOSA Y UREA PERDIDA DE LIQUIDOS POR:MANITOL EXOGENO PIELDIURETICOS TUBO DIGESTIVOATB (Trimetoprim o Pentamidina) APARATO RESPIRATORIODEFECTOS HEREDITARIOS EN PROTEINASNEFRITIS INTERSTICIAL ACUMULACION DE LIQUIDOS EN:UROPATIA OBSTRUCTIVA INTERSTICIOLESION TUBULAR AGUDA PERITONEODIABETES INSIPIDA ( vasopresina) TUBO DIGESTIVODIABETES NEFROGENA (Resistencia a vasopresina)
ETIOLOGIA
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CLINICA:
Fatiga, debilidad, sed, mareo postural, oliguria, cyanosis, dolor toracico y abdominal. Sequedad de piel y mucosas, disminución de PVC, taquicardia e hipotensión ortostática.
TRATAMIENTO:
Solución salina isotónica: ClNa al 0,9%; 154 meq/L
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HIPONATREMIADEF: <135 meq de Na plasmático
Leve:130 – 135 meqModerada:120-130 meq
Grave: <120 meq
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EVALUACION DE ESTADO VOLUMETRICO
HIPOVOLEMIA
UNA >20
RENALES:
EXCESO DE DIURETICO
S
DEFICIENCIA DE
MINERALOCORTICOI
DES
CETONURIA
SINDROME DE
PERDIDA CEREBRAL
DE Na
UNA <20
EXTRARRENALE
S:
VOMITO
DIARREA
EDEMA
QUEMAD
URAS
EUVOLEMIA
UNA >20
DEFICIT DE GLUCOCORTICOIDES
HIPOTIROIDISMO
ESTRES
SINDROME DE SECRECION INAPROPIADA DE
HORMONA ANTIDIURETICA
HIPERVOLEMIA
UNA >20INSUFICIENCIA RENAL AGUDA
CRONICA
UNA <20SINDROME NEFROTICO
INSUFICIENCIA CARDIACA
HIPONATREMIA POR DEFICIT DE CONSUMO:ALCOHOLICOSANCIANOS
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MANIFESTACIONES CLINICAS DE HIPONATREMIA
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HIPONATREMIA GRAVE RAPIDA <120meq/L (coma o convulsiones)
Administración de solución salina al 3% (513 meq/l).
VELOCIDAD INFUSIÓN 25-100 ml/hr.
La elevación del sodio debe ser no mayor de 0.5 a 1.0 meq/L/hr.
Si hay convulsiones se aumenta a 1-2 meq/L/hr.
TRATAMIENTO DE HIPONATREMIA
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DÉFICIT NA+ = 0.6 X PESO (Kg) X (NA+ DESEADO – NA+ REAL)
Sodio deseado: Na < 120 llevarlo a 120.Na 120 – 130 llevarlo a 130. Na 130 – 135 llevarlo a 135.Esto es importante por la MIELINOLISIS PONTINA CENTRAL!!!
TRATAMIENTO DE HIPONATREMIA
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HIPERNATREMIADEF: >145 meq de Na plasmático
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>145
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MANIFESTACIONES CLINICAS DE HIPERNATREMIA
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TRATAMIENTO DE HIPERNATREMIA
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HIPOKALEMIAPOTASIO < 3.5 meq/L
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CAUSAS DE HIPOKALEMIA
OTRAS:• Insulina• Hipertiroidismo• Agonistas B2• Xantinas
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MANIFESTACIONES DE HIPOKALEMIA
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AFECTACIÓN CARDIACA POR HIPOKALEMIA
<2,7 mmoles
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TRATAMIENTO DE HIPOKALEMIA
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TRATAMIENTO DE HIPOKALEMIA
POR INSULINA
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HIPERKALEMIAPOTASIO > 5.5 meq/L
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CAUSAS DE HIPERKALEMIA
PSEUDOHIPERPOTASEMIA
• Post punción venosa• Enfriamiento de la sangre• Trombosis• Eritrocitosis• Leucocitosis
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MANIFESTACIONES DE HIPERKALEMIA
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AFECTACIÓN CARDIACA POR POTASIO
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AFECTACIÓN CARDIACA POR POTASIO
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CARDIOTOXICIDAD DE HIPERKALEMIA
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TRATAMIENTO DE HIPERKALEMIA
1
3
2
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SI ES NECESARIO