Fluid Overload

Opposite of dehydration, on the other end of the spectrum, is fluid overload, also known as Extracellular Fluid Volume Excess or ECFVE.  This is when there is too much fluid in the interstitial or vascular spaces.  Too much fluid in the vascular system is called hypervolemia and too much fluid in the interstitial space is called third-spacing.  There are a few things that can cause this.  Giving too much IV fluid or administering it too fast is the first cause.  The second is the body’s failure to excrete fluids.  This can be caused by diseases such as heart failure or renal failure, or altered lymphatic function.  Increased levels of sodium will also cause the body to retain water.

Signs and symptoms to look for can be categorized into body systems.  Pulmonary symptoms include changes in lung sounds (usually crackles), coughing, shortness of breath, pale skin, blue-tinted skin, decreased oxygen saturation levels, and anxiety.  Cardiovascular symptoms include bounding pulses and increased blood pressure.  Sometime an extra heart sound can be heard as well.  Rapid weight gain and swelling of extremities are common signs of fluid overload.  Often, there will be a decrease in urine output.

Treatments of ECFVE include restricting dietary sodium and fluids, and medications to promote urine output and fluid loss.  Watch the patient’s intake and output to ensure they are only receiving the allotted amount of fluid.  Appropriate urine output is greater than 0.5 mL/kg/hour or, generally, 30 mL/hour.  Mild diuretics and medications that increase cardiac output may be given to cause fluid loss.

Remember, with both dehydration and fluid overload, daily weights are extremely important.  Rapid weight loss or gain are classic signs of these fluid imbalances.  It is also important to look at vital signs, as they can tell you a lot as well.

Questions of the day:

Define hypervolemia.

Define third-spacing.

What is the equation used to determine the appropriate amount of fluid output for a patient?

 

References

White, B. (2009). Clients with fluid imbalances. In Black, J. M., & Hawks, J. H. (Eds). Medical-surgical nursing. Clinical management for positive outcomes, (Vol 1., 8th Ed), (pp. 127-150). St. Louis, MO: Elsevier Inc.

McCarthy, M. & Olsen, K. (2011). Clients with fluid imbalances [PowerPoint Slides].

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