ISOTONIC FLUID

VOLUME DEFICIT
HYPOVOLEMIA ISOTONIC
• Fluid volume deficit is characterized by a decrease in the ECF, including the
circulating blood volume.
• The term isotonic fluid volume deficit is used when water and electrolytes are
lost in same proportion as they exist in normal body fluids ; thus the ratio of
serum electrolytes to water remains the same.
• Isotonic fluid volume deficit should not be confused with dehydration ,which
refers to loss of water alone , with increased serum sodium levels .
• Other fluid and electrolyte imbalances may be present but the concentration
of plasma electrolytes remains essentially unchanged.
• When the effective circulating blood volume is compromised, the condition is
often referred to as hypovolemia.
PATHOPHYSIOLOGY
• Isotonic fluid volume deficit occurs as a result of loss of body fluids and occurs
more rapidly when coupled with decreased fluid intake.
• Hypovolemia can also develop with a prolonged period of inadequate intake.
• Causes of hypovolemia include
• A)abnormal fluid losses such as those resulting from vomiting ,diarrhea , GI
suctioning.
• B)decreased intake as in nausea or lack of access to fluids
• C)third space fluid shifts or movement of fluid from vascular system to other
body spaces(e.g with edema formation in burns , ascites with liver dysfunction)
• D) others: diabetes insipidus ,adrenal insufficiency , osmotic diuresis
CAUSES
1)INADEQUATE FLUID INTAKE
• Oral trauma or inability to swallow
• Impaired thirst sensation
• Therapeutic withholding of fluids

2)EXCESSIVE GIT FLUID LOSSES

• Vomiting
• Diarrhea
• Gastrointestinal suction
CAUSES
3)EXCESSIVE RENAL LOSSES
• Diuretic therapy.
• Osmotic diuresis(hyperglycemia)(Glucose in the urine filtrate prevents
reabsorption of water by the renal tubules, causing a loss of sodium and water).
• Adrenal insufficiency(Addisons disease)

4)EXCESSIVE SKIN LOSSES

• Fever
• Exposure to hot environment(sweating)
• Burns(first several days)
CAUSES
5)THIRD SPACE LESIONS
(Because the fluid remains in the body, fluid volume deficit caused by
third spacing does not usually cause weight loss.)
• Intestinal obstruction
• Edema
• Ascites
MANIFESTATIONS
1)ACTE WEIGHT LOSS
• Mild fluid volume deficit:2%
• Moderate fluid volume deficit:2%-5%
• Severe fluid deficit:8%or greater
2)COMPENSATORY INCREASE IN ANTIDIURETIC HORMONE
• Decreased urine output
• Increased osmolality and specific gravity( Although there is an isotonic loss
of fluid from the vascular compartment, the other blood components such
as red blood cells (RBCs) and BUN become more concentrated).
MANIFESTATIONS
3)INCREASED SERUM OSMOLALITY
• Thirst
• Increased hematocrit and BUN
4)DECREASED VASCULAR VOLUME
• Postural hypotension(drop in blood pressure on standing)
• Tachycardia , weak and thready pulse
• increased vein refill time
• Hypotension and shock
MANIFESTATION
5)DECREASED ECF VOLUME
• Depressed fontanelle in an infant(because of decrease in CSF)
• Sunken eyes and soft eyeballs(as the fluid content in the anterior
chamber of the eye is decreased).
6)IMPAIRED TEMPERATURE REGULATION
• Elevated body temperature