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Fluid Electrolyte Imbalance n132 160210135651
Fluid Electrolyte Imbalance n132 160210135651
temperature and
cell shape
Helps transport
nutrients gases
and wastes
The desirable amount of fluid intake and loss in adults ranges from
1500 to 3500 mL each 24 hours. Ave= 2500 mL
Normally INTAKE = OUTPUT
FLUID IMBALANCE
• Changes in ECF volume = alterations in sodium balance
• Change in sodium/water ratio = either hypoosmolarity or hyperosmolarity
• Fluid excess or deficit = loss of fluid balance
• As with all clinical problems, the same pathophysiologic change is not of
equal significance to all people
• For example, consider two persons who have the same viral syndrome with
associated nausea and vomiting
It is an abnormally decreased or
increased fluid volume or rapid shift
from one compartment of body fluid
to another
Hypovolemia
Hypervolemia
• May occur as a result of:
• Reduced fluid intake
• Loss of body fluids
• Sequestration (compartmentalizing) of body fluids
Pathophysiology
supine)
crackles
Pharmacological therapy
Diuretics such as thiazide diuretics and loop
diuretics
Thiazide diuretics: hydrochlorothiazide
Loop diuretics: furosemide, torsemide
Potassium supplement
I/O chart at regular intervals to identify
excessive fluid retention
Breath sound are assessed at regular
intervals in at risk patient particularly if
parenteral fluid are being administered
Monitor the degree of edema in most
dependent parts of body such as feet &
ankles
If renal function is so severely impaired
that pharmacologic agents cannot act
efficiently, other modalities are
considered to remove sodium and fluid
from the body. Haemodialysis or
peritoneal dialysis may be used to remove
nitrogenous wastes and control potassium
and acid base balance and to remove
sodium and fluid. Continuous renal
replacement therapy may also be
required
IF it is important to detect FVE before the
condition become severe. Intervention
include promoting rest, restricting sodium
intake , monitoring parenteral fluid therapy
and administering appropriate medications
Regular rest periods may be beneficial
because bed rest favours diuresis of fluid
Sodium and fluid restriction should be
instituted as indicated
Fowlers position should be maintain to
promote lung expansion
• Controls and regulates volume of body fluids
• Its concentration is the major determinant of ECF volume
•Participates in the generation and transmission of nerve
impulses
• Eliminated primarily by the kidneys, smaller in feces
• Salt intake affects sodium concentrations
• Sodium is conserved through reabsorption in the kidneys, a
process stimulated by aldosterone
• Normal value: 135-145 mEq/L
Refers to the serum sodium concentration less than 135 mEq/L
Common with thiazide diuretic use, but may also be seen with
loop and potassium-sparing diuretics as well
Occurs with marked sodium restriction, vomiting and diarrhea,
SIADH, etc. The etiology may be mulfactorial
May also occur postop due to temporary alteration in
hypothalamic function, loss of GI fluids by vomiting or suction,
or hydration with nonelectrolyte solutions
Postoperative hyponatremia is a more serious complication in
premenopausal women. The reasons behind this is unknown
Therefore monitoring serum levels is critical and careful
assessment for symptoms of hyponatremia is important for all
postoperative patients
Sodium loss from the intravascular compartment
CLINICAL SYMPTOMS
Muscle APATHY
Weakness
Plasma osmolality:
2Na + glucose/18 + BUN/2.8
Interventions/Treatment
Restore Na levels to normal and prevent further
decreases in Na.
Drug Therapy –
(FVD) - IV therapy to restore both fluid and Na.
Osmolarity rises
CLINICAL SYMPTOMS
DEATH
Tachycardia
Manic excitement
Assessment findings:
Neuro - Spontaneous muscle twitches.
Irregular contractions. Skeletal muscle
wkness. Diminished deep tendon reflexes
Resp. – Pulmonary edema
CV – Diminished CO. HR and BP depend on
vascular volume.
GU – Dec. urine output. Inc. specific gravity
Potassium is excreted