Monday, August 11, 2014

Just saw a heart failure patient in follow-up

We had a patient, who had been healthy until he ran into some a-fib. He then began a months long descent into the depths of decompensated heart failure. His dry weight prior to decompensation was 208. On admission to the hospital he was 262.

It took over a month of acute and sub-acute care, a failed cardioversion, a pacer, and a cardiac ablation, but he ultimately emerged from his heart failure. He is now back to his dry weight. He went from 208 to 262 pounds to 208 pounds'  That is 54 pounds of water weight. My understanding of heart failure is this excess fluid is almost entirely extracellular.

Think about how much water and sodium that is:

  • 54 pounds = 24.5 kg of 24 liters of water
    • Total body water of an average adult is 42 liters
    • Extracellular volume is a third of that, or 14 liters
    • at 208 pounds his total body water is only 47 liters
  • 24.5 kg of water with a sodium concentration of 140 = 3,430 mmol of sodium. 
    • For comparison the total body sodium for a 70 kg man is around 2,200 mmol
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