FLUID AND ELECTROLYTES NCM 109 4.

Magnesium (Hypo and hypermagnesia)

(APA) 5. Chloride (hypo and hyperchloremia)
6. Phosphate (hypo and hyperphosphatemia)
Electrolytes are minerals in your body that have an
electric charge. They are in your blood, urine,
C. Acid-Base Imbalance
tissues, and other body fluids.
1. Respiratory Acidosis
Electrolytes are important because they help: 2. Respiratory Alkalosis
3. Metabolic Acidosis
 Balance the amount of water in your body 4. Metabolic Alkalosis
 Balance your body's acid/base (pH) level
 Move nutrients into your cells DISTURBANCES IN FLUID VOLUME,
 Move wastes out of your cells ELECTROLYTE, AND ACID-BASE
 Make sure that your nerves, muscles, the heart, BALANCES
and the brain work the way they should
A. Fluid Imbalance
Fluid imbalances are of two basic types: isotonic
 Sodium, calcium, potassium, chloride,
and osmolar.
phosphate, and magnesium are all electrolytes.
You get them from the foods eat and the fluids
 Isotonic Imbalances occur when water and
you drink.
electrolytes are lost or gained in equal
 The levels of electrolytes in your body can
proportions, so that the osmolality of body
become too low or too high. This can happen
fluids remains constant.
when the amount of water in your body changes.
 Osmolality – the concentration of a solution
The amount of water that you take in should
expressed as the total number of solute particles
equal the amount you lose. If something upsets
per kilogram.
this balance, you may have too little water
(dehydration) or too much water Definitions
(overdehydration).
 Some medicines, vomiting, diarrhea, sweating, • Solute: a particle, usually a salt
and liver or kidney problems can all upset your • Solvent: liquid, usually water
water balance. • Solution: solute and solvent mixed together
• Osmolarity: the concentration of a solution
FACTORS AFFECTING BODY FLUID, expressed as the total number of solutes particles
ELECTROLYTES, AND ACID-BASE per liter
BALANCE: • Osmolality: the concentration of a solution
 Age expressed as the total number of solute particles
 Sex and Body Shape per kilogram
 Environmental Temperature • Tonicity: is a measurement of the effective
 Lifestyle osmotic pressure gradient, as defined by the
water potential of two solutions separated by a
DISTURBANCES IN FLUID VOLUME, partially-permeable cell membrane.
ELECTROLYTE, AND ACID-BASE
BALANCES
A. Fluid Imbalance
1. Volume Deficit Isotonic
2. Fluid Volume Excess
3. Edema • Iso: same or equal
4. Dehydration • Tonic: concentration of a solution
5. Overhydration • Cell has the same concentration in the inside and
outside as normal condition.
B. Electrolyte Imbalance • Isotonic solutions are used to increase
1. Sodium (Hypo and hypernatremia) extracellular fluid volume due to:
2. Potassium (Hypo and hyperkalemia) - Blood loss
3. Calcium (Hypo and hypercalcemia) - Surgery
 - Dehydration 80% of potassium is excreted by the
• Isotonic Fluids kidneys.
- 0.9% NaCl (Normal Saline) - Potassium must be replaced daily to
- Lactated Ringer's maintain its balance, which normally hap-
pens through food intake.
Hypotonic
• Hypo: "under" 3. CALCIUM
• Tonic: concentration of a solution - Regulating the level of calcium (Ca2+) in
• Hypotonic solution has a lower solute the body is more complex than the other
concentration compared to the intracellular major electrolytes, so calcium balance can
solute concentration. be affected by many factors.
• Hypotonic Solutions - Imbalances of this electrolyte are relatively
- D5W common.
- 0.45% NaCl - Two signs Indicate hypocalcemia:
- 0.3% NaCl Chvostek's sign – is a contraction of the
facial muscles in response to tapping the
Hypertonic facial nerve in front of the ear; Trousseau's
sign – is a carpal spasm in response to
• Hyper: excessive
inflating a blood pressure cuff on the upper
• Tonic: concentration of a solution
arm to 20 mmHg greater than the systolic
• Most commonly used osseous cerebral edema
pressure for 2 to 5 minutes.
• Hypertonic Solutions
- 3% Saline 4. MAGNESIUM
- Magnesium (Mg2+) imbalances are
B. Electrolyte Imbalances relatively common in hospitalized clients,
The most common and clinically significant although they may be unrecognized.
electrolyte imbalances involve sodium,
potassium, calcium, magnesium, chloride, and 5. CHLORIDE
phosphate. Because of the relationship between sodium and
chloride ions (Cl-), imbalances of chloride
1. SODIUM commonly occur in conjunction with sodium
- Sodium (Na+), the most abundant cat-ion in imbalances.
the extracellular fluid, not only moves into
and out of the body but also moves in 6. PHOSPHATE
careful balance among the three fluid - Phosphate (PO43-) is found in both
compartments. intracellular and extracellular fluid. Most of
- It is found in most body secretions, for the phosphorus (P+) in the body exists as
example, saliva, gastric and intestinal PO43-
secretions, bile, and pancreatic fluid. - Phosphate is critical for cellular metabolism
- Therefore, continuous or excessive because it is a major component of
excretion of any of these fluids can result in adenosine triphosphate (ATP).
a sodium deficit. Because of its role in - Phosphate imbalances frequently are related
regulating water balance, sodium to therapeutic interventions for other
imbalances usually are accompanied by disorders.
water imbalances.
C. Acid-Base Imbalances
2. POTASSIUM Acid-base imbalances are usually classified as
- Although the amount of potassium (K+) in respiratory or metabolic by the general or
extracellular fluid is small, it is vital to underlying cause of the disorder.
normal neuromuscular and cardiac
function. 1. Respiratory Acidosis
- Normal renal function is important for 2. Respiratory Alkalosis
maintenance of potassium balance, because 3. Metabolic Acidosis
4. Metabolic Alkalosis  When your body fluids contain too much acid, it
means that your body is either not getting rid of
Respiratory Acidosis
enough making too much acid, or cannot
 when breathing out does not remove enough balance the acid in your body.
carbon dioxide from the body, and the leftover  metabolic acidosis may occur due to a primary
carbon dioxide mixes with water in the body, disease or as a result of secondary complications
causing high levels of acid in the blood. in patients with critical conditions.
 refers to high levels vels of acid in due to the  Metabolic acidosis is a pathological process
blood increased levels of carbon dioxide (CO₂) defined by a decrease in the serum bicarbonate
in the body. (HCO3-), an increase in the hydrogen ion (H+)
 The symptoms of chronic respiratory acidosis concentration, and a secondary decrease in the
- headache partial pressure of carbon dioxide (PaCO2).
- memory loss  Causes:
- sleep disturbance - Healthy kidneys have many jobs. One of
- anxiety these jobs is to keep the right balance of
- personality changes acids in the body. The kidneys do this by
removing acid from the body through urine.
 In people with acute respiratory acidosis or - Metabolic acidosis is caused by a build-up
chronic respiratory acidosis that worsens over of too many acids in the blood. This
time, the effects of raised CO₂ in the brain happens when your kidneys are unable to
become more severe. remove enough acid from your blood.
 Symptoms can include:  Signs and symptoms
- confusion Not everyone will have signs or symptoms.
- drowsiness However, you may experience:
- stupor - Long and deep breaths
- muscle jerking - Fast heartbeat
- Headache and/or confusion
Respiratory Alkalosis - Weakness
 Breathing too fast can cause a person to into - Feeling very tired
respiratory alkalosis. This occurs when a - Vomiting and/or feeling sick to your
person's pH level is higher than 7.45 on arterial stomach (nausea)
blood ags determination. - Loss of appetite
 As a result of this carbon dioxide loss, the If you experience, any of these, it is important
body's pH becomes more alkaline, the opposite to let healthcare provider know immediately.
of acidic.
 As a result of this carbon dioxide loss, the Clinical Manifestations in Children
body's pH becomes more alkaline, the opposite
 Acute Metabolioc Acidosis
of acidic.
- Tachypnea and hypernea
 Symptoms of respiratory alkalosis:
- Neurologic findings (mental confusion and
The rate of respiration can be one of the most
lethargy)
apparent symptoms of respiratory alkalosis.
- Laboratory findings (partial pressure of
- chest pain
CO2 and hyperkalemia)
- lightheadedness
- Cardiac effect (myocardial depression and
- muscle stiffness
arrythmias)
- numbness around the mouth
 Chronics metabolic acidosis
- tremors
- Poor growth and skeletal muscle wasting
- anxiety
- Decreased bone mineral content
- Nephrolithiasis and nephrocalcinosis

Metabolic Acidosis
 The buildup of acid in the body due to kidney
disease or Kidney failure .