FLUIDS AND ELECTROLYTES

To understand FLUIDS AND ELECTROLYTES balance is to understand a concept basic to health and life; the balance affected by the movement, replacement, transformation, retention, and or excretion of various materials essential to life

WATER is important because all biochemicals are bathed in water and nearly all reactions take place in aqueous medium.

Materials dissolved in, or carried in, WATER MUST BE IN THE RIGHT CONCENTRATION.

Gains and Losses

Water and electrolytes move in a variety of ways
Kidneys Skin Lungs GI tract

Body fluids are divided between two major compartments:

INTRACELLULAR FLUID (ICF) fluids found inside the cell EXTRACELLULAR FLUID (ECF) fluids found outside the cell

The EXTRACELLULAR compartment has two components:

INTRAVASCULAR FLUID or PLASMA which is the liquid portion of blood, plasma INSTERSTITIAL FLUIDS which surrounds the cell

INTRACELLULAR

INTERSTITIAL

INTRAVASCULAR

For the ADULT, most fluids approximately 60%, are in the Intracellular Compartment.

Additional fluid is found in small amounts in other parts of the body.

HOW MUCH FLUID DO WE HAVE?

On average, we have 40 liters of fluid which make up 60% of body weight.

INTRACELLULAR FLUIDS makeup 40% body weight

20% ECF

40% ICF

EXTRACELLULAR FLUIDS account for the remaining 20%

An important clinical concept is that these amounts may change with AGE, GENDER, or OBESITY

INFANT

ADULT

OLDER ADULT

70-80%

50-60%

45-55%

ELECTROLYTES
work with fluids to maintain health and well-being.

These are crucial for nearly all cellular reactions and functions.

ELECTROLYTES
helps regulate water distribution, govern acid base balance, and transmit nerve impulses. It also contribute to energy generation and blood clotting.

ELECTROLYTES
POTASSIUM (K) MAGNESIUM (Mg) PHOSPORUS (P)

SODIUM (Na)
CHLORIDE (Cl) CALCIUM (Ca) BICARBONATE (HC0 )

POTASSIUM
- is the dominant/main intracellular fluid (ICF) cation. It is the primary buffer in the cell

-regulates cell excitability -permeates cell membranes, thereby affecting the cells electrical status
NORMAL VALUE : 3.5 - 5.0mEq/L

MAGNESIUM
- a leading ICF cation

-contributes too many enzymatic and metabolic processes, particularly protein synthesis -Modifies nerve impulse transmission and skeletal muscle response
NORMAL VALUE : 1.3-2.3mEq/L

PHOSPORUS
- main ICF anion

-promotes energy storage and carbohydrate, protein, and fat metabolism -Acts as a hydrogen buffer
NORMAL VALUE : 2.5-4.5mg/dL

SODIUM
- main extracellular fluid (ECF) cation

-helps govern normal ECF osmolality

-helps maintain acid-base balance -activates nerve muscle cells -influences water distribution (with chloride) NORMAL VALUE : 135-145mEq/L

CHLORIDE
- main ECF anion -helps maintain normal ECF osmolality -affects body pH -plays a vital role in maintaining acidbase balance; combines with hydrogen ions to produce hydrochloric acid NORMAL VALUE : 97-107mEq/L

CALCIUM
-a major cation in teeth and bones; found in fairly equal concentrations in ICF and ECF

-acts as an enzyme activator within cells

NORMAL VALUE : 8.6-10.2mg/dL

BICARBONATE
-present in ECF

-primary function is regulating acidbase balance

ANIONS
-are electrolytes that generate a negative charge

CATIONS
-are electrolytes that produce a positive charge

CATIONS
-sodium

ANIONS

-chloride
-bicarbonate -phosphate

-potassium
-calcium -magnesium

-sulfate

Fluids and solutes move constantly within the body. That movement allows the body to maintain homeostasis.

Solutes within the body move through the membranes separating those compartments in different ways The membranes are SEMIPERMEABLE, meaning that they allow some solutes to pass through, but not others

DIFFUSION: solutes move from an area of higher concentration to an area of lower concentration

which eventually results in an equal distribution of solutes within the two areas

OSMOSIS: refers to the passive

movement of fluid across a membrane from an area of lower solute concentration and comparatively more fluid into an area of higher solute concentration and comparatively less fluid.

LABORATORY TEST FOR MAINTAINING FLUID STATUS

OSMOSIS is the concentration of fluid that affects the movement of water between fluid compartments by osmosis NORMAL SERUM OSMOLALITY 275-300mOsm/kg NORMAL URINE OSMOLALITY 250-900mOsm/kg

MAINTAINING BALANCE

KIDNEYS
-play a vital role in fluid and electrolyte balance. If the kidneys dont work properly, the body has great difficulty controlling fluid balance. NEPHRON, the workhorse of the kidneys, which forms urines

NEPHRON consists of a glomerulus and a tubule TUBULE sometimes convoluted, ends in a collecting duct GLOMERULUS is a cluster of capillaries that filters blood

Major Functions of the KIDNEYS in maintaining fluid balance:

Regulation of ECF volume and osmolality by selective retention and excretion of body fluids

Regulation of electrolyte levels in the ECF by selective retention of needed substances and excretion of unneeded substance

Major Functions of the KIDNEYS in maintaining fluid balance:

Regulation of pH of the ECF by retention of hydrogen ions Excretion of metabolic wastes and toxic substances

If the body loses even 1-2% of its fluid, the kidneys take steps to conserve water. The most important step involves reabsorbing more water from the filtrate, which produces a more concentrated urine

LUNGS
-vital in maintaining homeostasis. Through exhalation, the lungs remove approximately 300mL of water daily in the normal adult. The lungs also play a major role in maintaining acid-base balance.

OTHER ORGANS AND GLANDS

-PARATHYROID GLANDS play a role in electrolyte balance, specially the balance of calcium and phosphate

THYROID GLAND is also involved by balancing the bodys calcium level

Pituitary Function ANTIDIURETIC HORMONE

-a water retainer

-maintaining the osmotic pressure of the cells by controlling the retention or excretion of water by the kidneys and by regulating blood volume.

THIRST
-simplest mechanism for maintaining fluid balance is the THIRST MECHANISM Losing body fluids or eating highly salty foods leads to an increase in ECF osmolality.

IV FLUID REPLACEMENT

IV FLUID REPLACEMENT
TYPES OF SOLUTIONS CRYSTALLOIDS which maybe isotonic, hypotonic, hypertonic COLLOIDS which are always hypertonic

CRYSTALLOIDS are solutions with small molecules that flow easily from the blood stream into cells and tissues

ISOTONIC SOLUTIONS have an osmolality (or concentration) of 275 to 295 mOsm/kg -Example: NORMAL SALINE SOLUTION -have a concentration of dissolved particles or tonicity, equal to that of ICF

-Osmotic pressure is therefore the same inside and outside the cells, so they neither shrink nor swell with fluid movement

ISOTONIC
NORMAL CELL

HYPERTONIC SOLUTIONS has a tonicity greater than that of ICF, so osmotic pressure is unequal inside and outside the cells -Example: 3% SALINE, 50% DEXTROSE -draws water out of the cells into the more highly concentrated ECF

HYPERTONIC
CELL SHRINKS

HYPOTONIC SOLUTIONS have a tonicity less than that of ICF, so osmotic pressure draws water into the cells from the ECF -Example: HALF NORMAL SALINE SOLUTION -severe electrolyte losses or inappropriate use of IV FLUIDS can make body fluids hypotonic

HYPOTONIC
CELL SWELLS

COLLOID SOLUTIONS use as plasma/volume expander for intravascular part of ECF -Example: DEXTRAN in NORMAL SALINE or 5%D5W

FLUID AND ELECTROLYTE IMBALANCES

DEHYDRATION
-a fluid loss of 1% or more of body weight

SIGNS AND SYMPTOMS: -extreme thirst, dry skin and mucous membranes, poor skin turgor, increased heart rate, falling blood pressure, decreased urine output

LAB VALUES: Serum Sodium Level above 150mEq/L and serum osmolality above 305 mOsm/kg

TREATMENT -Determine its cause (diarrhea, decreased fluid intake) -Replacement of fluid loss (orally, IV) mostly HYPOTONIC SOLUTIONS

HYPOVOLEMIA
-fluid volume deficit or hypovolemia, occurs when loss of ECF volume exceeds the intake of fluid -it occurs when water and electrolytes are lost in the same proportion as they exist in normal body fluids, so that the ratio of serum electrolytes to water remains the same

CAUSES:
-abnormal fluid losses (vomiting, diarrhea, GI suctioning, sweating, decrease intake) -RISK FACTORS- diabetes insipidus, adrenal insufficiency, hemorrhage, coma -edema formation in burns, ascites with liver dysfunction

SIGNS AND SYMPTOMS: -acute weight loss -decreased skin turgor -oliguria; concentrated urine -postural hypotension
-weak, rapid heart rate -increased temperature; cool, clammy skin; thirst, anorexia; muscle weakness, cramps

TREATMENT & MANAGEMENT -if not severe ORAL intake -ACUTE or SEVERE- IV Route (Isotonic Electrolyte Solutions Lactated Ringers solution, 0.9% Sodium Chloride -If becomes normotensive hypotonic electrolyte solution

TREATMENT -Assessment of Intake and Output, weight, vital signs, CVP, LOC, breath sounds, and skin color

NURSING MANAGEMENT -Monitor Intake and Output -Daily weight

-Monitor vital signs

-Monitor skin turgor

HYPERVOLEMIA
-FLUID VOLUME EXCESS, it refers to an excess of isotonic fluid (water and sodium) in ECF. CAUSES: -can occur if a person consumes more fluid than needed -if fluid output is impaired, or too much sodium is retained

CAUSES: -conditions such as: kidney failure, cirrhosis, heart failure, steroid therapy SIGNS AND SYMPTOMS: -edema -distended neck and hand veins -initially, rising blood pressure and cardiac output; later falling values

LAB VALUES: Serum Sodium Level above 135mEq/L and serum osmolality above 275 mOsm/kg

TREATMENT -Determine its cause, treat underlying condition -Fluid and sodium restrictions and diuretic therapy

-Diuretics if dietary restriction of sodium is insufficient to reduce edema

NURSING MANAGEMENT -Monitor Intake and Output -Monitor weight daily

-Monitor breath sounds

-Monitor degree of edema

ELECTROLYTE IMBALANCES

SODIUM IMBALANCES
SODIUM DEFICIT (HYPONATREMIA)
SODIUM EXCESS (HYPERNATREMIA)

HYPONATREMIA
-refers to a serum sodium level that is below normal

CAUSES:
-vomiting, diarrhea, -

Effect of extracellular sodium level on all cell size