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  • • Volume overload

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Epidemiology

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  • • Postoperative patients

    • Heart failure

    • Liver disease

    • Renal failure

    • Hypoalbuminuria

    • Head injury (syndrome of inappropriate antidiuretic hormone [SIADH])

    • Burns (SIADH)

    • Cancer (SIADH)

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Symptoms and Signs

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  • • Sacral edema

    • Extremity edema

    • Jugular venous distention

    • Tachypnea

    • Increased body weight

    • Elevated central pressures

    • Gallop rhythm

    • Confusion (SIADH)

    • Lethargy (SIADH)

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Laboratory Findings

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  • • Hyponatremia (SIADH)

    • Concentrated urine (SIADH)

    • Elevated urine sodium (SIADH)

    • Low urine sodium

    • High urine potassium

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  • • May be concurrent with myocardial failure or ischemia

    • Evaluation should include cardiac evaluation

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  • • Serum electrolytes

    • UA (SIADH)

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When to Refer

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  • • Cardiology consult if primary cardiogenic failure

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  • • Sodium restriction

    • Water restriction if low sodium

    • Diuretics if severe

    • Diuretics (SIADH)

    • IV isotonic saline to match urinary output (SIADH)

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Medications

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  • • Diuretics

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Treatment Monitoring

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  • • Serum sodium

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Complications

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  • • Pulmonary edema

    • Congestive heart failure

    • Prerenal azotemia

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Prognosis

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  • • Excellent

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Prevention

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  • • Monitor daily weights

    • Judicious IV hydration

    • Monitor sodium intake

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References

Chang MC et al. Redefining cardiovascular performance during resuscitation: ventricular stroke work, power, and the pressure-volume diagram. J Trauma. 1998;45:470.  [PubMed: 9751535]

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