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Suggest Treatment For Vascular Dehydration
Question: If you have fluid overload--third space and peripheral fluid accumulation and vascular dehydration. How do you remedy the vascular dehydration? Are IV fluids appropriate.
They can't draw enough blood to do electrolytes.
Thanks
They can't draw enough blood to do electrolytes.
Thanks
Brief Answer:
Finding cause is important before treatment as we may harm.
Detailed Answer:
Hello,
Nature has designed human body in such way that it will try to restore intra vascular volume at all cost. Therefore if 3rd space fluid is more with intravascular deficit there is mostly some problem. Some common reasons are decreased hemoglobin, decreased albumin or a weak heart and liver . Chronically ill kidney may also retain fluid but here intravascular volume is also increased.
In this context where there is vascular deficit as well as third space over load, plain IV fluid will again get into to 3rd space if the intravascular space doesn't retain it resulting in worsening of condition. Therefore instead of plain IV fluid, colloidal solution or albumin 20% or treatment of cause may be more beneficial.
It is important to understand the cause of this issue and treat it appropriate. Detailed history and clinical examination finding will help to make a balanced choice.
As far as drawing blood, if even expert (anaesthetist) cannot take the vein blood, an arterial blood can be considered.
Regards
Dr XXXXXXX mody
Finding cause is important before treatment as we may harm.
Detailed Answer:
Hello,
Nature has designed human body in such way that it will try to restore intra vascular volume at all cost. Therefore if 3rd space fluid is more with intravascular deficit there is mostly some problem. Some common reasons are decreased hemoglobin, decreased albumin or a weak heart and liver . Chronically ill kidney may also retain fluid but here intravascular volume is also increased.
In this context where there is vascular deficit as well as third space over load, plain IV fluid will again get into to 3rd space if the intravascular space doesn't retain it resulting in worsening of condition. Therefore instead of plain IV fluid, colloidal solution or albumin 20% or treatment of cause may be more beneficial.
It is important to understand the cause of this issue and treat it appropriate. Detailed history and clinical examination finding will help to make a balanced choice.
As far as drawing blood, if even expert (anaesthetist) cannot take the vein blood, an arterial blood can be considered.
Regards
Dr XXXXXXX mody
Above answer was peer-reviewed by :
Dr. Prasad
.Thanks
Nutritional deprivation --protein and iron-- caused the incident which was singular and is being treated with duiretics . I'd like to understand how low hemoglobin contributes to third space volume. Is it just because thinner blood leaks. Platelets are also low. Do the low platelets also cause leakage. Or, is this too simplistic an answer Because the hemoglobin remains low, could a case be made for blood transfusion. HGB is 6.4. How low would it be generally before it causes a problem.
Albumin has been used. If the blood levels of albumin are normal, then would you quit giving it, even if the fluid problem is persistent. Could you then give colloidal solution.
Electrolyte imbalance has been causing arrythmia. Part of the problem seems to be that because the blood is concentrated the potassium levels look higher.
Any, all comments are appreciated. XXXXXXX
Nutritional deprivation --protein and iron-- caused the incident which was singular and is being treated with duiretics . I'd like to understand how low hemoglobin contributes to third space volume. Is it just because thinner blood leaks. Platelets are also low. Do the low platelets also cause leakage. Or, is this too simplistic an answer Because the hemoglobin remains low, could a case be made for blood transfusion. HGB is 6.4. How low would it be generally before it causes a problem.
Albumin has been used. If the blood levels of albumin are normal, then would you quit giving it, even if the fluid problem is persistent. Could you then give colloidal solution.
Electrolyte imbalance has been causing arrythmia. Part of the problem seems to be that because the blood is concentrated the potassium levels look higher.
Any, all comments are appreciated. XXXXXXX
Brief Answer:
Dont wait too long , HB -6.4 needs some form of treatment soon . do consult
Detailed Answer:
Hello XXXXXXX ,
Anemia (low hemoglobin) surely causes edema and third space fluid overload , there are multiple mechanism , but the most important is decrease oxygen carrying capacity , so the kidney will sense falsely and with start retaining extra water and salt resulting in edema .
The hemoglobin you describe falls in to severe anemia (HB < 7 )
i will strongly suggest a thorough work up for anemia . to be XXXXXXX i went through your previous query where it is diagnosed as iron def anemia . the reports do suggest the same and i agree with the doctor . however i would like to point out that platelets don't decrease in iron deficiency anemia in most cases(except rare severe one) , so look for co existing B12 deficiency/ folic acid deficiency if nutritional anemia is the diagnosis and supplement your self with b12 and folic acid along with iron along with other healthy diet rich in proteins , green vegetables ,
Now the hemoglobin you mentioned , one can take blood transfusion (if less than 7) and signs of heart failure ( here there is no problem with your heart , just the fluid overload makes is decompensate ) the reason why you were given diuretics.
If your albumin is normal , you don't need iv albumin , similarly colloid solution is temporary measure, and not indicated for your case.
If arrythmias occurred post diuretic mostly it would be decrease in potassium , as most commonly used diuretic cause the same.
Mam again i will emphasize , hb less than 7 is severe anemia , a complete investigation and work up is needed , try finding if you are losing any blood and making less . discuss with your doctor if IV iron or blood transfusion will help . my perspective as a cardiologist would say YES.
PLZ send me your echo report of severity of aortic stenosis
Discuss with your doctor HEYDE's syndrome , where there is gastro intestinal blood loss in patient of aortic stenosis.
Dont wait too long , HB -6.4 needs some form of treatment soon . do consult
Detailed Answer:
Hello XXXXXXX ,
Anemia (low hemoglobin) surely causes edema and third space fluid overload , there are multiple mechanism , but the most important is decrease oxygen carrying capacity , so the kidney will sense falsely and with start retaining extra water and salt resulting in edema .
The hemoglobin you describe falls in to severe anemia (HB < 7 )
i will strongly suggest a thorough work up for anemia . to be XXXXXXX i went through your previous query where it is diagnosed as iron def anemia . the reports do suggest the same and i agree with the doctor . however i would like to point out that platelets don't decrease in iron deficiency anemia in most cases(except rare severe one) , so look for co existing B12 deficiency/ folic acid deficiency if nutritional anemia is the diagnosis and supplement your self with b12 and folic acid along with iron along with other healthy diet rich in proteins , green vegetables ,
Now the hemoglobin you mentioned , one can take blood transfusion (if less than 7) and signs of heart failure ( here there is no problem with your heart , just the fluid overload makes is decompensate ) the reason why you were given diuretics.
If your albumin is normal , you don't need iv albumin , similarly colloid solution is temporary measure, and not indicated for your case.
If arrythmias occurred post diuretic mostly it would be decrease in potassium , as most commonly used diuretic cause the same.
Mam again i will emphasize , hb less than 7 is severe anemia , a complete investigation and work up is needed , try finding if you are losing any blood and making less . discuss with your doctor if IV iron or blood transfusion will help . my perspective as a cardiologist would say YES.
PLZ send me your echo report of severity of aortic stenosis
Discuss with your doctor HEYDE's syndrome , where there is gastro intestinal blood loss in patient of aortic stenosis.
Above answer was peer-reviewed by :
Dr. Vinay Bhardwaj
Dr XXXXXXX Mody,
I sense the urgency of your post, and feel genuine concern. I have requested GI consult and will request capsule endoscopy.
Would there be occult blood. I did have an episode of red blood, which I assumed to be hemerroidal.
I've had negative occult blood smears. Is it useful to request another. When it bleeds in the colon wall does it come out of the colon.
You might be saving me.
Thank you.
I sense the urgency of your post, and feel genuine concern. I have requested GI consult and will request capsule endoscopy.
Would there be occult blood. I did have an episode of red blood, which I assumed to be hemerroidal.
I've had negative occult blood smears. Is it useful to request another. When it bleeds in the colon wall does it come out of the colon.
You might be saving me.
Thank you.
Brief Answer:
Timely treatment may prevent further complications and is indicated
Detailed Answer:
Hello XXXXXXX
Most importantly I would like to know about your aortic stenosis, what is the gradient and severity.
A 2d echo report from your side will be helpful for me to deduce the exact hemodynamic
Why do I need it? severe anemia is poorly tolerated in moderate to severe aortic stenosis. And this makes you a candidate for blood transfusion to maintain hemoglobin more than 10, till your hematologist finds the cause
Why everyone is looking for cause in colon? As you are post menopausal, the most common way you loose so much blood without knowing over a period of time is colon.
Stool for occult is not always reliable way. That is the reason we order three morning samples. However when you are taking iron, it may come false positive, so I do not recommend it at present as it would not be valid test
If the blood was XXXXXXX red, and there is evidence of severe hemorrhoids, than it may be the reason of severe anemia, as I have seen many in my practice presenting with the same.
Colon is a long structure and many a times you may not find XXXXXXX blood is source of bleeding is higher up. You may have black stools., however even with iron you may have black stools, so we won't be able to know the reason just by the colour.
Metoprolol /propranolol is not well tolerated in patients with heart failure and aortic stenosis, so titrate the dose accordingly.
If your doctor strongly suggests blood loss then a capsule endoscopy is justified for sure.
Regards Dr XXXXXXX mody
Timely treatment may prevent further complications and is indicated
Detailed Answer:
Hello XXXXXXX
Most importantly I would like to know about your aortic stenosis, what is the gradient and severity.
A 2d echo report from your side will be helpful for me to deduce the exact hemodynamic
Why do I need it? severe anemia is poorly tolerated in moderate to severe aortic stenosis. And this makes you a candidate for blood transfusion to maintain hemoglobin more than 10, till your hematologist finds the cause
Why everyone is looking for cause in colon? As you are post menopausal, the most common way you loose so much blood without knowing over a period of time is colon.
Stool for occult is not always reliable way. That is the reason we order three morning samples. However when you are taking iron, it may come false positive, so I do not recommend it at present as it would not be valid test
If the blood was XXXXXXX red, and there is evidence of severe hemorrhoids, than it may be the reason of severe anemia, as I have seen many in my practice presenting with the same.
Colon is a long structure and many a times you may not find XXXXXXX blood is source of bleeding is higher up. You may have black stools., however even with iron you may have black stools, so we won't be able to know the reason just by the colour.
Metoprolol /propranolol is not well tolerated in patients with heart failure and aortic stenosis, so titrate the dose accordingly.
If your doctor strongly suggests blood loss then a capsule endoscopy is justified for sure.
Regards Dr XXXXXXX mody
Above answer was peer-reviewed by :
Dr. Shanthi.E
sorry, having trouble uploading my echo
your information has encouraged the into looking for the platelettes
contrast CT no results, yet
my md does't receive suggestions I phrase everything as a question
There is a note in my file saying I refused the metropolol
I have to figure out the echo before I lose you.
your information has encouraged the into looking for the platelettes
contrast CT no results, yet
my md does't receive suggestions I phrase everything as a question
There is a note in my file saying I refused the metropolol
I have to figure out the echo before I lose you.
Brief Answer:
No problem I am always available on HCM for future help. Thank you
Detailed Answer:
Hello, no problem. Your MD doctor would be competent enough to deal with your case, so don't worry for the same.
As I had pointed out due to anemia, the blood was not able to carry enough oxygen, in such senerio it th heart had to pump harder to to its decompensation temporally which your doctor treated with diuretic, now when heart is decompensated it is better to to stop metoprolol for time being. That might be the reason why it was holded. Moreover metoprolol and diuretic both needed to be carefully titrated in aortic stenosis.
When possible you can send me all reports blood investigation and treatment protocol so I can help you with thee management
About platelet your hematologist would be a better person to comment, even though I have pointed common mechanism in the previous answer. .
For future queries you can send a directly send a question to me through HCM.
Do rate our help if you are happy with our effort
Regards Dr Priyank Mody
No problem I am always available on HCM for future help. Thank you
Detailed Answer:
Hello, no problem. Your MD doctor would be competent enough to deal with your case, so don't worry for the same.
As I had pointed out due to anemia, the blood was not able to carry enough oxygen, in such senerio it th heart had to pump harder to to its decompensation temporally which your doctor treated with diuretic, now when heart is decompensated it is better to to stop metoprolol for time being. That might be the reason why it was holded. Moreover metoprolol and diuretic both needed to be carefully titrated in aortic stenosis.
When possible you can send me all reports blood investigation and treatment protocol so I can help you with thee management
About platelet your hematologist would be a better person to comment, even though I have pointed common mechanism in the previous answer. .
For future queries you can send a directly send a question to me through HCM.
Do rate our help if you are happy with our effort
Regards Dr Priyank Mody
Above answer was peer-reviewed by :
Dr. Shanthi.E
I will definitely rate your help ExcellenT. I don't want to close the discussion,as it is valuable to. Now, I have two more days. You say I can reach you, but I'ld probably end up getting someone else.
Brief Answer:
Don't worry I am always on the other side.
Detailed Answer:
Thank you Mam, and don't worry I will always be on the other side whenever you need, just ping me and I would answer as soon as I can. Don't get anxious about your health, everything will be just great.
Take care till than. Dr. Priyank Mody
Don't worry I am always on the other side.
Detailed Answer:
Thank you Mam, and don't worry I will always be on the other side whenever you need, just ping me and I would answer as soon as I can. Don't get anxious about your health, everything will be just great.
Take care till than. Dr. Priyank Mody
Above answer was peer-reviewed by :
Dr. Yogesh D
Mean gradient of the aortic valve is 36mmHg. peak instantaneous gradient of the aortic valve is 72mmHg The aortic valve area by VTIs is caculated at 1.34cm2. Mild aortic regurgitation is present. Well, it was in November 2014. There is a problem with the disc for the latest echo. I'll get that tomorrow.
Brief Answer:
The echo fits into Moderate aortic stenosis. Improve Hb to atleast 9-10
Detailed Answer:
Hello, good to hear from you
As per your Nov 2D echo, you are categorised into Moderate aortic stenosis. If no echo is done get a fresh echo on your next visit.
I stick to my advice of improving hemoglobin by blood transfusion or Iv iron and atleast bring it to 9-10 and than continue oral supplements . However great care to be taken during transfusion and it should be done very slowly and under the cover of diuretic to prevent sudden volume overload. Also metoprolol and diuretic should be used judiciously .
What I have recommended is standard practice over USA, Europe and XXXXXXX (we follow XXXXXXX guidelines in practice) . Do discuss it with your MD or cardiologist.
Regards Dr. Priyank Mody
The echo fits into Moderate aortic stenosis. Improve Hb to atleast 9-10
Detailed Answer:
Hello, good to hear from you
As per your Nov 2D echo, you are categorised into Moderate aortic stenosis. If no echo is done get a fresh echo on your next visit.
I stick to my advice of improving hemoglobin by blood transfusion or Iv iron and atleast bring it to 9-10 and than continue oral supplements . However great care to be taken during transfusion and it should be done very slowly and under the cover of diuretic to prevent sudden volume overload. Also metoprolol and diuretic should be used judiciously .
What I have recommended is standard practice over USA, Europe and XXXXXXX (we follow XXXXXXX guidelines in practice) . Do discuss it with your MD or cardiologist.
Regards Dr. Priyank Mody
Note: For further queries related to coronary artery disease and prevention, click here.
Above answer was peer-reviewed by :
Dr. Yogesh D
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