Definition:

• Fluid volume excess (FVE) refers to an isotonic expansion of ECF (Extra cellular fluid) caused by the abnormal retention of water and sodium in approximately the same proportions in which they normally exist in the ECF
• It is always secondary to an increase in the total body sodium content which lead an increase to total body water, due to there is isotonic retention of body substances the serum sodium concentration remains essentially normal

Pathophysiology

• FVE may be related to simple fluid overload or diminished functions of the homeostatic mechanisms responsible for regulating fluid balance

Contributing factors include

• Heart failure
• Renal failure
• Cirrhosis of liver
• Other contributing factors are
• Consumption of excessive amount of table or other sodium salts
• Administration of excessive sodium containing fluid to patient with impaired regulatory mechanisms (Beck – 2000)

Clinical Manifestation

• Clinical manifestation of FVE start from expansion of the extra cellular fluid (ECF) and include
• Edema
• Distended Neck Veins
• And Crackles (abnormal lung sound) Other manifestations include
• Tachycardia
• Increased blood pressure
• Increased pulse pressure
• Increased central venous pressure
• Increased Wt
• Increased urine output
• Shortness of breath (SOB) and wheezing

Diagnosis

• Laboratory data useful in diagnosing FVE include BUN and hematocrit level
• In both FVE both of these values may be decreased because of plasma dilution
• Other causes include low protein intake and anemia
• In chronic renal failure both serum osmolality and sodium level are decreased due to excessive retention of water
• x- ray chest reveal pulmonary congestion
• LFT
• RFT

Medical Management

• Treat the cause
• If the fluid excess is related to excessive administration of sodium containing fluids, discontinuing the infusion may be all that is needed
• Symptomatic treatment consist of diuretics and restriction fluids and sodium
• Hemodialysis
• Nutritional therapy – restrict sodium in diet
• Pure water may be used

Nursing Management

• To asses for FVE
• The nurse measure intake and output at regular intervals to identify excessive fluid retention
• Daily Wt of patient
• To assess breath sounds at regular intervals
• The nurse monitors degree of edema in most depending parts of body as feet, ankles, sacral region bed ridden patient
• The degree of pitting edema is assessed
• Preventing FVE
• Detecting and controlling FVE
• Teaching, patients about edema