Question

3. Determine what fluid disturbance ( overload, deficit) is seen in the following conditions and explain how and why :

a) Diabetes mellitus b) Diabetes insipidus c) Addison’s disease d) Cushing’s disease e) heart failure f) liver failure g) kidney failure h) diarrhea i) vomiting j) burn injury k) bleeding

Answer 1

a)      Diabetes mellitus

This disease can cause electrolyte imbalances like minerals in your body,such as sodium,potassium,that maintain fluid balance in the body.There are two types of diabetes mellilitus.If your condition is severe urine output can be around 19litres.While a healthy adult urinate 1 to 2 litres of urine a day. Diabetes mellitus (DM) is linked to both hypo- and hyper-natremia which is indirectly related to hyperglycemia.The most important  factor of chronic hyperkalemia in diabetic individuals is the syndrome of hyporeninemic hypoaldosteronism. Impaired renal function, potassium-sparing drugs, hypertonicity and insulin deficiency are also involved in the development of hyperkalemia

b)      Diabetes Insipidus

This is  a common disorder caused by imbalance in fluid in the body. Imbalance keeps us always thirsty and produce large amount of urine. When our fluid regulation is normal ,kidney helps to maintain the balance.The kidneys remove fluid from your blood stream and fluid waste is stored in bladder until you urinate. There is no cure of this disease but intensity of thirst and urine output can be reduced.

c)      Addison’s disease

Addison’s disease is a rare and serious adrenal gland disorder in which the body can't produce enough of two critical hormones, cortisol and aldosterone. Patients with Addison's will need hormone replacement therapy., Addison disease affects the balance of water, sodium, and potassium in the body, and body’s ability to control blood pressure and react to stress. Loss of androgens cause a loss of body hair in women and  testosterone from the testes in men more than makes up for this loss.

d)      Cushing’s disease

This is like a fatty hump between our shoulders and pink purple stretchmark on skin.This result in high blood pressure,bone loss and type 2 diabetes.Doesnt have much fluid loss.

e)      Heart failure

Electrolyte abnormalities are frequent and hazardous to people with heart failure. Patients with heart failure may exhibit hyponatremia due to a decrease in water excretion.Electrolytes helps trigger and conduct electrical impulses in heart.If its level is high or low can affect hearts electrical impulses and contribute to arrhythmia development.

f)       Liver Failure

People with liver cirrhosis leads to  hyponatremia, hypokalemia, respiratory alkalosis, and metabolic acidosis, in addition to an excess accumulation of body fluids with edema and ascites formation.

g)      Kidney failure

kidneys are primarily responsible for the regulation of fluid and electrolyte balance, acute or chronic changes in renal function can result in multiple imbalances. In renal failure, acute or chronic, common tendency of patients is  to develop hypervolemia, hyperkalemia, hyperphosphatemia, hypocalcemia, and bicarbonate deficiency (metabolic acidosis). Sodium is generally retained, but may appear normal, or hyponatremic, because of dilution from fluid retention

h)      Diarrhea

      Fluid loss with dehydrations,Electrolyte loss and even vascular collapse.If the condition is sever it better to give fluids externally.

i)        Vomiting

               Excessive vomiting, leads to excess loss of water and electrolytes from the body. Electrolytes such as sodium, potassium, calcium, magnesium, bicarbonates and chloride ions are essential for normal bodily functions. As water is lost during vomiting, the balance of electrolytes also varies, which can lead to severe complications. Expelling the gastric acid contents causes the loss of chloride and hydrogen ions which can lead to hypochloremic metabolic alkalosis.In addition, there may be a low level of potassium (hypokalemia). Vomiting makes patients difficult to eat and consume fluids which indirectly leads to electrolyte loss and worsen the condition.