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Hypervolemia 48 Monte Carlo Crescent Kyalami Business Park Kyalami, Johannesburg, 1684, RSA Tel: +27 (0)11 463 3260 Fax: + 27 (0)86 557 2232 Email: [email protected] www.thistle.co.za Please read this bit first The HPCSA and the Med Tech Society have confirmed that this clinical case study, plus your routine review of your EQA reports from Thistle QA, should be documented as a “Journal Club” activity. This means that you must record those attending for CEU purposes. Thistle will not issue a certificate to cover these activities, nor send out “correct” answers to the CEU questions at the end of this case study. The Thistle QA CEU No is: MTS 19/093. Each attendee should claim ONE CEU points for completing this Quality Control Journal Club exercise, and retain a copy of the relevant Thistle QA Participation Certificate as proof of registration on a Thistle QA EQA. CHEMISTRY LEGEND October 2019 Hypervolemia Hypervolemia, also known as fluid overload, is the medical condition where there is too much fluid in the blood. The opposite condition is hypovolemia, which is too little fluid volume in the blood. Fluid volume excess in the intravascular compartment occurs due to an increase in total body sodium content and a consequent increase in extracellular body water. The mechanism usually stems from compromised regulatory mechanisms for sodium handling as seen in congestive heart failure (CHF), kidney failure, and liver failure. It may also be caused by excessive intake of sodium from foods, intravenous (IV) solutions and blood transfusions, medications, or diagnostic contrast dyes. Treatment typically includes administration of diuretics and limit the intake of water, fluids, sodium, and salt. Causes When you have too much sodium in your body, your body starts retaining water to balance it out. Mild hypervolemia or water retention can be perfectly normal from time to time, caused by eating a lot of salty food or by hormonal changes. Hypervolemia is caused by a more serious health issue that affects your body’s ability to regulate sodium and requires immediate attention from a doctor. These conditions may include: Kidney failure. Your kidneys are responsible for removing excess fluid from your body. When your kidneys aren’t working well, fluid can build up. Congestive heart failure. When your heart is not pumping enough blood, your kidneys aren’t able to work as well, leaving excess fluid in your body. Liver failure or cirrhosis. Your liver processes nutrients and filter toxins. When your liver isn’t working as it should, fluid can build up in your abdomen. Hormonal changes. Women may experience mild fluid retention as a normal part of premenstrual syndrome (PMS) or pregnancy. Excessive fluid retention related to hormonal changes may be a sign of high blood pressure and should be checked out by a doctor. IV fluids. Thistle QA is a SANAS accredited organisation, No: PTS0001 Accredited to ISO guide 43 and ILAC G13 Certificate available on request or at www.sanas.co.za 48 Monte Carlo Crescent Kyalami Business Park Kyalami, Johannesburg, 1684, RSA Tel: +27 (0)11 463 3260 Fax: + 27 (0)86 557 2232 Email: [email protected] www.thistle.co.za Receiving too much IV fluid, especially if there are other health conditions present, can lead to fluid overload and swelling. Diagnosis The key diagnostic signs of Hypervolemia include weight gain and swelling. One or more parts of your body may appear swollen, depending on whether or not you have been sitting, lying or standing before your visit. First, your doctor will conduct a physical exam. The key diagnostic signs of hypervolemia include weight gain and swelling. One or more parts of your body may appear swollen, depending on whether or not you have been sitting, lying or standing before your visit. Your doctor is also likely to perform a blood test to check your sodium levels. While your body’s total sodium levels will be increased if you have hypervolemia, your doctor is also likely to perform a blood test to check your sodium levels. While your body’s total sodium levels will be increased if you have hypervolemia, your sodium levels in the blood work may be high, normal, or low. Performing a sodium test on your urine can help determine if your kidneys are causing your hypervolemia or if there is another cause. For renal failure, urinary sodium content is typically greater than 20 milliequivalents per liter (mEq/L), while in cases of heart failure, cirrhosis, and nephrotic syndrome it will be less than 10 mEq/L. Signs and symptoms The signs of hypervolemia include: Swelling, also called edema, most often in the feet, ankles, wrist and face. Discomfort in the body, causing cramping, headache and stomach bloating. High blood pressure caused by excess fluid in the bloodstream. Shortness of breath caused by extra fluid entering your lungs and reducing your ability to breathe normally. Heart problems, because excess fluid can speed up or slow your heartrate, harm your heart muscles and increase the size of your heart. Treatment One of the most common treatments for hypervolemia is diuretics. Diuretics are drugs that increases the amount of urine the body produces. However, any underlying causes must be addressed i.e someone with heart failure may need to take steps to manage their condition in addition to taking diuretics. Diuretics may not work for people with severe kidney problems. Some people will need renal replacement therapies, such as dialysis or hemofiltration. People with heart, kidney or liver conditions may also need to follow a reduced-salt diet. This helps keep sodium levels within normal limits, which helps avoid hypervolemia. Thistle QA is a SANAS accredited organisation, No: PTS0001 Accredited to ISO guide 43 and ILAC G13 Certificate available on request or at www.sanas.co.za 48 Monte Carlo Crescent Kyalami Business Park Kyalami, Johannesburg, 1684, RSA Tel: +27 (0)11 463 3260 Fax: + 27 (0)86 557 2232 Email: [email protected] www.thistle.co.za People with congestive heart failure may need to limit the amount of fluid they drink each day. A doctor can recommend the proper amounts of fluid and salt intake based on an individual’s health history. References 1. https://en.wikipedia.org › wiki › Hypervolemia 2. https://www.healthline.com › health › hypervolemia 3. https://www.medicalnewstoday.com › articles Questions 1. What are the causes of Hypervolemia? 2. Discuss the signs and symptoms of Hypervolemia. 3. Discuss the treatment in patients diagnosed with Hypervolemia. Thistle QA is a SANAS accredited organisation, No: PTS0001 Accredited to ISO guide 43 and ILAC G13 Certificate available on request or at www.sanas.co.za .
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