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your scenarios here are examples of the three types of fluid volume deficit

(dehydration) that occur. this is fluid and electrolyte theory, to be sure. i happen
to have a very nice table that breaks all the information down on these three
types of dehydration and it's kind of hard to post the information, but i'll try.
this information is coming from page 477 of intravenous therapy: clinical
principles and practice, by judy terry, leslie baranowski, rose anne lonsway and
carolyn hedrick, published by the intravenous nurses society, 1995.

isotonic fluid volume deficit


type of loss: solute and water loss proportional, no change in plasma volume,
serum sodium level is decreased to 125-150 meq/l. the cause of the fluid loss is
gi fluid loss, urine loss and decreased oral intake.
clinical signs: poor skin turgor; cold, dry dusky skin; sunken eyes; dry
mucous membranes; depressed fontanelles in babies; rapid pulse; low b/p;
irritability or lethargy
fluid replacement guidelines: initially, a bolus of 0.9% sodium chloride or
ringer's lactate is given followed by 5% dextrose in water and 0.45% sodium
chloride. half of the deficit should be replaced in the first 8 hours and the
remaining half over the next 16 hours
hypotonic fluid volume deficit
type of loss: more solute is lost than water. plasma volume moves from the ecf
to the icf. serum sodium levels are decreased below 125 meq/l. the cause of the
fluid loss is often a gi fluid loss with hypotonic oral intake.
clinical signs: include very poor skin turgor; cold, clammy, dusky skin; sunken
eyes; slightly dry mucous membranes; depressed fontanelles in babies; rapid
pulse; very low blood pressure; lethargy; coma; seizures
fluid replacement guidelines: initially a bolus of 0.9% sodium chloride or
ringer's lactate followed by 5% dextrose in water and 0.9% sodium chloride. if
the patient is severely symptomatic 3% sodium chloride at 4ml/kg should be
given over 10 minutes with close monitoring. half of the fluid deficit should be
replaced in the first 8 hours and the remaining half over the next 16 hours.

hypertonic fluid volume deficit


type of loss: there is greater water loss than solute loss. volume moves from
the icf to the ecf. sodium levels are maintained at over 150 meq/l. the cause is
gi fluid loss with hypertonic oral intake, diabetes insipidus, fever and
hyperventilation.
clinical signs: include fair skin turgor; cold, thick and doughy skin; sunken
eyes; parched mouth; depressed fontanelles in babies; a moderately rapid
pulse; moderately low blood pressure; hyperirritability; high-pitched crying in
babies; seizures.
fluid replacement guidelines: 5% dextrose in water and 0.225% or 0.45%
sodium chloride. if the patient is hypertensive 0.9% sodium chloride or ringer's
lactate should be given at a rate of 20ml/kg over one hour. fluid replacement
should be given slow and gradual over 48 hours. 2 to 3 meq/kg of potassium
should be given per 24 hours. at least 2 meq/l/hour of sodium should also be
included in the iv fluids that are used.

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