Definition/Description[edit | edit source]Fluid excess can occur in two main ways in the body, water intoxication and edema. [1] Show
[2] Prevalence[edit | edit source]Water intoxication is seen in a variety of situations, but most commonly occurs in:
In a study by Almond et al. of the 2002 Boston Marathon it was found that: [4]
In a study by Speedy et al. of athletes who finished an ultramarathon, it was found that: [4]
Characteristics/Clinical Presentation[edit | edit source]Water Intoxication Clinical S&S: [1] Water intoxication presents with symptoms that are largely neurologic due to the shifting of water into brain tissues and resultant dilution of sodium in the vascular space.
In severe imbalances:
Edema Clinical Signs and Symptoms: [1]
Associated Co-morbidities [1][edit | edit source]
Medications[edit | edit source]
Diagnostic Tests/Lab Tests/Lab Values[edit | edit source]Below are some of the most common laboratory tests that are used to assess a person’s hydration status:
- Osmolality decreases with overhydration [10]
- Hyponatremia (low amounts of sodium in the blood) results from overhydration [10]
- Hematocrit decreases with overhydration [10]
- BUN decreases with overhydration [10] Etiology/Causes[edit | edit source]Due to the etiologic complex, symptoms, and outcomes that are related to the two major forms of fluid excess being substantially different, they will be broken down individually. [1]
Systemic Involvement[edit | edit source]
Medical Management[edit | edit source]
Physical Therapy Management[edit | edit source]Physical therapy management is largely responsible for patient education and edema control in these individuals. Below are some common physical therapy treatment strategies: Education on fluid consumption: [17]
Managing edema: [17] [18]
Note: Some of the strategies to
reduce edema may be contraindicated in CHF Differential Diagnosis[edit | edit source]The following are some of the most common diagnoses that present with similar signs and symptoms of excess fluid/intoxication:
Case Reports/ Case Studies[edit | edit source]Forensic aspects of water intoxication: Four case reports and review of relevant literature Resources[edit | edit source]Hyperhydration? Hyponatremia Caused by Polydipsia Fried or Soaked? Strange but True: Drinking Too Much Water Can Kill References[edit | edit source]
Which assessment would be the most accurate way for the nurse to evaluate fluid balance?Which assessment would be the most accurate way for the nurse to evaluate fluid balance? Daily weight is the most easily obtained and accurate means of assessing volume status. Skin turgor varies considerably with age.
Which clinical manifestations would the nurse identify when assessing a client with hypercalcemia?Hypercalcemia. The signs and symptoms include muscle weakness, constipation, anorexia, nausea and vomiting, dehydration, hypoactive deep tendon reflexes lethargy, calcium stones, flank pain, pathologic fractures, and deep bone pain.
What additional signs would the nurse expect to note in a client with hyponatremia?The signs and symptoms associated with hyponatremia include confusion, vomiting, seizures, muscle weakness, nausea, headaches, loss of energy, fatigue, and restlessness and irritability.
What does the nurse expect will occur in a patient as a result of decreased fluid intake?Signs and Symptoms
Weight loss (depending on the severity of fluid volume deficit) Concentrated urine, decreased urine output. Dry mucous membranes, sunken eyeballs. Weak pulse, tachycardia.
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