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The Follow-Up Metabolic Medicine Hospital Consultation
Published in Michael M. Rothkopf, Jennifer C. Johnson, Optimizing Metabolic Status for the Hospitalized Patient, 2023
Michael M. Rothkopf, Jennifer C. Johnson
The resolution of malnutrition and hypoproteinemia can also produce a fluid shift. As the colloid osmotic pressure increases, fluid will draw into the vascular space from the interstitium. This will expand the plasma volume temporarily. With normal renal function, the GFR should increase and allow for clearance of the excess fluid (Batuman et al. 1984).
Body fluids and electrolytes
Published in Peate Ian, Dutton Helen, Acute Nursing Care, 2020
Water intoxication occurs when excess fluid moves from the extracellular space to the intracellular compartment. The fluid shift happens when there is excess fluid, low in sodium, in the intravascular space, so it becomes hypotonic to the cells whilst the cells are hypertonic to the fluid. As a result, the fluid moves by osmosis to the cells, which have comparatively more solutes and less water.
The renal system, hypertension and pre-eclampsia
Published in Judy Bothamley, Maureen Boyle, Medical Conditions Affecting Pregnancy and Childbirth, 2020
Common symptoms of pyelonephritis include lower UTI symptoms, backache, tenderness, high fever, rigors and nausea and vomiting. The right side is more commonly affected (Thorsen and Poole, 2002). There is usually a raised serum CRP (C-reactive protein) and high leukocytes, and screening with blood cultures for septicaemia is also carried out. Urine cultures are positive and pyuria is found – and often seen. Women with pyelonephritis are usually hospitalised, closely monitored and treated with intravenous antibiotics. Acute pyelonephritis can trigger uterine contractions and is a cause of preterm labour (Williams, 2006). Acute respiratory distress syndrome (ARDS) can occur, especially in women who have received tocolysis for threatened premature labour (Gilstrap and Ramin, 2001), so monitoring of the respiratory system should take place. Other complications for the woman include septic shock with an increased risk of pulmonary oedema due to fluid shift.
Intra-dialytic intracranial pressure monitoring in a patient with lumbo-peritoneal shunt for idiopathic intracranial hypertension
Published in British Journal of Neurosurgery, 2023
W. B. Cato-Addison, L. Ferguson, R. D. Strachan, R. Clark, J. S. Murray, I. Moore
Although cerebral oedema is thought to be the underlying pathophysiological mechanism, DDS does not respond to mannitol or steroids. Only one case report showed improvement with intravenous mannitol.8 Other forms of dialysis such as continuous veno-veno haemofiltration (CVVH) and PD have not been shown to cause DDS although Lund et al attribute the magnitude of ICP rise primarily to the initial plasma urea levels.9 Fluid shift occurs at a slower rate with CVVH and therefore reduces the potential for a urea gradient across the blood–brain barrier to occur.3 Much of the evidence for this comes from patients with underlying renal disease who have been admitted to intensive care units for ICP monitoring following traumatic brain injury.10 The use of haemodialysis for these patients has been shown to raise ICP, which does not occur with CVVH.
Outpatient management of severe ovarian hyperstimulation syndrome: a systematic review and a review of existing guidelines
Published in Human Fertility, 2018
Amr Gebril, Haitham Hamoda, Raj Mathur
The clinical features of OHSS reflect this pathophysiology and the condition can present with a varied spectrum of manifestations depending on its severity. Various schemes have been proposed to classify the severity of OHSS. In the UK, the Royal College of Obstetricians and Gynaecologists (2016) accepts the classification proposed by Mathur, Evbuomwan, and Jenkins (2005). Although there is no universally agreed classification, all schemes recognize a category of women with significant fluid shift that is detectable as clinically obvious ascites and haemoconcentration, corresponding to Grade IV (Golan, Ron-El, & Herman, 1989) or severe OHSS (Mathur et al., 2005). In addition, women with the severest form of OHSS and complications relating to thrombo-embolism, renal or pulmonary function are classified as critical OHSS.
The role of extended infusion β-lactams in the treatment of bloodstream infections in patients with liver cirrhosis
Published in Expert Review of Anti-infective Therapy, 2018
Michele Bartoletti, Russell Edward Lewis, Maddalena Giannella, Sara Tedeschi, Pierluigi Viale
Another aspect that contributes to variability to Vd is sepsis and septic shock. During this syndrome vasodilatation and increased vascular permeability leading to capillary leakage [51,53]. This, in turn, allows fluid shift from the intravascular compartment to the interstitial space resulting in tissue edema that is exacerbated by oncotic effects of plasma protein leaking in the third space [54]. The early treatment of vasodilatation consequent to septic shock includes high volume fluid resuscitation in order to restore central venous pressure and perfusion of organ beds. Edema formation and intravenous fluid resuscitation contribute to a vast increase in total body water substantially increasing Vd of hydrophilic antimicrobials [51].