References:
- Saunders Comprehensive Review for the NCLEX-RN Examination, 9th Edition, ISBN 978-032-37-9530-2, by Linda Anne Silvestri, Angela E. Silvestri, and Jessica Grimm (Ch. 8, pp. 88-105)
“Overhydration” or fluid overload. The goal of treatment is to restore fluid balance, correct electrolyte imbalances (if present), and eliminate or control the underlying cause of the overload. The types are the same as in a deficit, but reversed:
| Type | Description | Result |
|---|---|---|
| Isotonic Overhydration | Excessive fluid in the extracellular fluid compartment. Also known as “hypervolemia”. This may be caused by poorly regulated IV therapy, kidney disease, and long-term corticosteroid therapy. | Circulatory overload and interstitial edema occurs; this can cause poor cardiac function, heart failure, and pulmonary edema in severe cases. |
| Hypertonic Overhydration | Excessive electrolytes (mainly sodium) in extracellular fluid. This rarely occurs, and is caused by excessive sodium consumption, rapid hypertonic saline infusion, and excessive sodium bicarbonate therapy. | High solute concentration in extracellular fluid pulls fluid from intracellular space, leading to contraction of intracellular fluid. |
| Hypotonic Overhydration | Water intoxication, where excessive fluid enters extracellular space. This may be caused by early kidney disease, heart failure, SIADH, inadequately controlled IV therapy, isotonic fluid loss treated with hypotonic fluids, and irrigation of wounds and body cavities with hypotonic fluids. | Fluid then enters intracellular space (because it now has higher electrolyte concentration), and all body fluid compartments expand. Electrolytes become imbalanced. |
Assessment
A client with AKI, CKD, or HF is at high risk for FVE.
- Cardiovascular:
- Bounding, increased pulse
- Elevated blood pressure
- Distended neck and hand veins
- Elevated central venous pressure
- Dysrhythmias
- Respiratory:
- Increased respiratory rate with shallow respirations
- Dyspnea
- Moist crackles upon auscultation
- Neuromuscular:
- Altered level of consciousness
- Skeletal muscle weakness
- Headache, visual disturbances
- Paresthesias
- Renal: increased urine output (if compensation is present). If the cause of overload is from kidney damage, then urine output is decreased.
- Integumentary:
- Pale, cool skin
- Pitting edema in dependent areas
- Gastrointestinal:
- Increased motility
- Diarrhea
- Increased body weight
- Liver enlargement
- Ascites
- Laboratory Findings: decreased serum osmolality, hematocrit, BUN, sodium, and specific gravity.
Interventions
Prevent further fluid overload and restore normal fluid balance.
- Administer diuretics; osmotic diuretics may be initially used to prevent severe electrolyte imbalances.
- Restrict fluid and sodium intake as prescribed.
- Monitor intake and output; monitor weight.
- Monitor electrolyte values and prepare to administer medication if an imbalance is present.