FLUID

 Introduction
 Review of Fundamental concepts
 Functions of Body water
 Transporting nutrients, electrolytes, oxygen
to the cells
 Carrying waste products from the cells
 Regulation of temperature
 Lubricate membranes & joints
 Good medium for digestion
 Maintain vascular volume
 Adult 60% of body weight

 Water content vary according to

gender,bodymass & age

 Fat cells contains less water

 Factors affecting body fluids

 Age, infants, elderly

 Gender, body size
 Environmental temperature: high temperature
increases fluid loss eg: heat stroke.
 Lifestyles: Diet, exercise, stress; increases
ADH and increases urine production.
Fluid compartments :
 Two major compartments.
 Intra cellular fluid
 Extra cellular fluid :-
i) Interstitial
ii) Intravascular
iii) Trans cellular
 Intracellular body fluids:
Body fluid located with in the cells.
Constitutes approximately two thirds of the
body water and 42% Of the body weight.
 Extra cellular fluid:
Water found outside the cell
1. Interstitial space
2. Intravascular space eg:- plasma
3.
Transcellular space eg:- CSF

Interstitial fluid:- Lies outside the vascular

fluid and cells and constitutes 28% of the
Body water also known as tissue space. This
is collected and transported by the lymphatic
System. Provides external medium and necessary
For the cellular metabolism.
Transcellular space:- Third small but important
Fluid compartment
Constitutes 1-3% of the body weight.
Eg-CSF, synovial and peritoneal fluid.
Calculation of body fluid gain or loss
1liter of water=1kg
Adult patient fasting may loss approximately
1-2 pound/day. If a patient drinks 240ml of
Water the weight gain will be 0.24 kg.
Composition of body fluids
Water
Salts are called
Minerals electrolytes
crystalloids
Routes of gains and loss:-
kidney 1ml/hr/kg body weight
Skin:- sweating loss can vary 0-1000ml according
to the environmental changes.
lungs:-300-400ml/day
GI tract:-100-200/day.
Average daily intake and output in
adult

INTAKE OUTPUT

Oral liquids 1300 ml Urine 1500 ml

Water in food 1000 ml Stool 200 ml

Metabolism 300ml Insensible loss 900 ml

Total 2600ml Total 2600 ml

Mechanisms controlling fluid
movements
 Osmotic pressure

 Hydrostatic pressure

 Oncotic pressure

Osmotic pressure:- Amount of pressure

required to stop the osmotic flow of water.

Normal plasma osmolarity 275-295mosm/kg

Urine osmolarity 50-1,400mos m/kg
 Hydrostatic pressure:- Pressure within fluid
compartment

Oncotic pressure:- Osmotic pressure exerted by

colloids in the solution

Fluid movement between extra cellular fluid

and intra cellular fluid
Changes in osmolarity of the extra cellular fluid
after the volume of cells.Increased extra cellular
fluid osmolarity pulls water out of cells until the
two compartments have equal osmolarity.
Fluid spacing:- This is the term used to describe the
distribution of body water

First space:- describe the normal fluid distribution

Between ECF and ICF.

Second spacing:- abnormal accumulation of

interstitial
fluid (edema)

Third spacing:- Occurs when fluid accumulation in a

portion of the body which is not easily exchanged with
The rest of the extra cellular fluid.
Eg:- Ascites, Peritonitis
Regulation of fluid balance:-
 Thirst:- hypothalamus is activated by the
increase in ECF osmolarity.Thirst leads to
drink water.ADH acts on renal distal and
collecting tubules causes water reabsorption

 Hormonal influence:- Antidirectic hormone

and aldosterone influence body water
 Renal regulation:- Kidneys are primary organ
by regulating urine volume

 GI regulation:- Small amount of water is

eliminated in stool but diarrhea and vomiting
cause significant fluid and electrolyte balance

 Lymphatic influence:- Assist in returning the

excess fluid and protein from the interstitial
space to blood
 Nerologic influence:- Balance sodium and
water with increase of ECF the
chemoreceptors in left atrium stretches and
cardiac stroke volume increases

 Insensible water loss:- This is the invisible

vaporization from the lungs and skin, assist in
regulating the body temperature normally
about 900 ml/day is lost
Laboratory tests for evaluating fluid
status

 Osmolarity
 Urine specific gravity

 Blood urine nitrogen

 Creatinine

 Haematocrit

 Urine sodium levels

Fluid imbalance:-
Fluid and electrolyte imbalances are
Common problems for a majority of patients
in all settings.

The five types of fluid imbalances are:

 Extracellular fluid volume deficit-ECFVD
 Extracellular fluid volume excess-ECFVE
 Intracellular fluid volume deficit-ICFVD
 Intracellular fluid volume excess-ICFVE
 Entracellular fluid volume deficit:-ECFVD
Extracellular fluid volume deficit:-

 Commonly called dehydration

 Dehydration is the state in which the body fluid

intake is not sufficient to meet the fluid needs of
the body, resulting in a fluid volume deficit

 Results in vascular fluid volume loss

hypovolemia
ECFVD can be classified into three
types:-

 Isotonic dehydradation

 Hypotonic dehydradation

 Hypertonic dehydradation
Isotonic dehydration:-

 There is equal portion of body fluid and

electrolyte loss is the most common type

 The overall result of isotonic

dehydration is inadequate circulatory
volume. Compensatory mechanisms
attempts to maintain adequate perfusion
 Hypotonic dehydration:-
 Loss of electrolyte is greater than the fluid
loss.
 Decreased osmolarity leads to lower osmotic
pressure of ECF that ICF.
 Water moves from ECF to ICF and
simultaneously create vascular volume deficit
and swelling of the cells.
 Less common type.
 Hypertonic dehydration:-
 Water loss is greater than the electrolyte
loss
 Increase the osmolarity of the remaining
vascular fluid making it hypertonic to
to normal
 Brain cells are more sensitive to ICF
changes than other cells of Neurologic
dysfunction occur hyponatremia, hypokalemia
occur.
 Clinical manifestation of dehydration
Manifestation in general:-
 Cardiovascular:- High respiratory rate,
low blood pressure, postural hypotension

 Respiratory:- High respiratory rate, high

depth of respiration

 Neuromuscular:- Low CNS system activity

 Renal:- Low urine output and high
specific gravity

 Integumentary:- High temperature,

poor turgor, mouth dry fissure

 Gastro intestinal:- Low motility,

decreased bowel sounds, constipation,
thirst
 Laboratory diagnostic findings:-

 Increase in osmolarity > 295 msom/kg

 Increase/normal serum Na levels > 145

meq/l

 Increase BUN > 25 mg/dl

 Hyperglycomia > 120 mg/dl

 Elevated haematocrit > 55%

 Increased specific gravity >1.035

 Elevated level haemoglobin > 12 gm%

Risk factors for dehydration

Illness:- Vomiting, diarrhea, burns, large

drainage wounds, renal diseases,
hemorrhage

Therapies:- Surgery, diuretics, excessive

hypertonic enemas, NPO, nasogastric
suction
Electrolyte imbalance

Electrolytes are various chemicals that can

carry positive or negative electrical charges.

Important electrolytes in our body:-

 Sodium
 Potassium
 Calcium
 Phosphorous
 Magnesium
Significance of electrolytes in our
body:-
sodium:-It controls the water distribution
throughout the body.It is a regulator of ECF
volume.
potassium:-It is important in
neuromuscular activity.It influences both
skeletal &cardiac muscle activity.
calcium:-Play a major role in transmission
of nerve impulses.
Phosphorus:-It helps in the function of
muscle and red blood cells & the formation
of ATP.Helps in maintaining acid
balance,nervous system & metabolism.

Magnesium:-It is a activator for many

enzyme & helps in CHO and protein
metabolism.
 HPYONEATRAEMIA

Sodium deficit of Sr.Na level is <135meq/lt.

a)Risk factors:
use of diuretics
loss of GI fluids
renal disease
adrenal insufficiency
excessive administration of dextrose
b)Signs & symptoms:
anorexia, nausea
vomiting, headache
lethargy, confusion
muscle cramp
weakness, seizures
papilloedema
dry skin,
tachycardia, hypotension.
c)Assessment and diagnostic findings:-

history physical examination

Investigation:- Sr.Na Below 135 meq/lt
Urine specific gravity <1.010
d)Management:

Sodium replacement hypertonic saline 3%

to 5% I.V

Water restriction 800ml/24 hrs

E)Nursing management:
 Monitor fluid intake and output

 Check body weight daily

 Vital signs monitoring

 Monitor the sodium level

 Monitor the signs and symptoms of

complication
 Check urine specific gravity

 Identify the patients at risk

 If patient is able to take orally encourage foods

and fluids with high sodium content
 HYPERNATRAEMIA
Serum sodium level > 140 meq/lt

 Risk factors
i) Water deprivation
ii) Increased sensible and insensible
water loss
iii) Ingestion of large amount of salt
iv) Hypertonic tube feeding
v) Diabetes insipidus
vi) Profuse sweating
vii) Heat stroke
 Signs and symptoms:-

Thirst
Elevated body temperature
Swollen dry tongue
Hallucination
Lethargy
Restless
Irritable seizure
Hyperactive
 Assessment and diagnostic findings

Sr. sodium >145 meq/lt

Urine specific gravity >1.015
 Management:-
Infusion of a hypotonic solution or
isotonic solutin
Diuretics
Decompression in case of diabetic
insipidus
 Nursing management:-
Intake and output monitoring
Avoid taking high sodium content
food
Treat hyperthermia
Careful administration of I.V fluids
monitor the changes in behavior
monitor sodium level
Give sufficient water with tube
feedings
Check urine specific gravity
 HYPOKALAEMIA
serum potassium level below 3.5 meq/lt

 Risk factors
Diarrhea, vomiting
Gastric suction
Corticosteroid administration
hyperaldosteronism
Bulimia, osmotic diuresis
Steroid administration
Polyuria, poor intake
 Signs and symptoms:-
Fatigue, anorexia,
Nausea, vomiting,
Muscle weakness,
Decreased bowel motility,
Cardiac arrhythmias,
Increased sensitivity to digitalis,
Leg cramps, hypotension,
Polyuria, nocturia,
ECG changes, paresthesia.
 Assessment and diagnostic findings:-
Sr. potassium <3.5 meq/lt

 Management:-
Intake and output monitoring
Observe for excessive intake of high
potassium
Oral or intravenous replacement
therapy
 Nursing management.
Assess the patient condition
Monitor patients at risk
Monitor ECG
Monitor potassium level
administer potassium. I.V
 HYPERKALEMIA

Serum potassium level >5.5meq/lit.

 Risk factors.
oliguric renal failure
potassium sparing diuretics
Hypoaldosteronism
High potassium intake.
 Signs and symptoms.
vague muscular weakness,
cardiac arrhythmias,
Flaccid paralysis,
paraesthesia, irritability,
ECG changes, nausea,
Intestinal colic,
Diarrhea.
 Assessment and diagnostic findings:-

Sr.potassium> 5.5meq/lit.
ECG, ABG
Management:-
obtain ECG
Restrict potassium containing diet.
Monitor blood pressure.
Administer calcium gluconate.
Administer sodium bicarbonate, insulin
and hypertonic dextrose.
 Nursing management.
 Observe the signs and symptoms and assess.
 Serum K levels should be monitored.
 Prolonged use of tourniquet should be avoided.
 Advise the patient not to exercise the extremities
before the blood drawn.
 Administer IV fluids.
 Potassium should be mixed nicely with IV fluids.
 Restrict potassium containing diet.
 Hypocalcaemia :-

Sr. calcium level <4.5 meq /lt.

 Risk factors.

hypoparathyroidism, malabsorption,
pancreatitis, Vit D deficiency
alkalosis, excessive administration of
citrated blood
 Signs and symptoms:-
 Numbness, tingling sensation,
mental changes,
seizures,spasm of laryngeal muscle,
ECG changes, muscle cramps.
 Assessment and diagnostic findings:-
Sr.calcium< 4.5meq/lt
Sr.albumin level.
ECG.
 Management.
 Severe deficiency –IV administration of
calcium.
Vitamin D therapy.
Aluminum hydroxide
calcium supplement through diet.
 Nursing management.
Identify the risk patient and monitor calcium.
Seizure precaution to be provided
Airway should be closely monitored.
dietary advise.
Avoid alcohol, caffeine and smoking.
 Hypercalcemia:-
Sr.calcium level >5.5meq/lit.
 Risk factors:

Hyper parathyroidism, prolonged

immobilization
Malignant neoplastic disease,
large doses of VIT D,
thiazide diuretics,
over dose of calcium supplement.
 Signs and Symptoms:-
 Constipation, anorexia,
muscular weakness, polyuria,
polydipsia, decreased attention span,
decreased memory, renal stones,
neurotic behavior, cardiac arrest.
Assessment and diagnostic findings:-

 Sr.calcium >5.5meq/lt.
ECG,
X-ray presence of osteoporosis,
urinary calculi,
Sulcowich urine test:- checking calcium in the
urine.
 Management:-
 Aim:- decrease the serum calcium level and
reversing the process causing hypocalcaemia.
Treatment for underlying cause
Administration of IV fluids eg:NACL.
Mobilize the patient.
restrict the dietary calcium.
Administration of IV phosphate can cause
reciprocal drop in serum calcium.
 Frusemide with fluid administration
administration of calcitonin –especially
cardiac patient cannot tolerate sodium load.
 Nursing Management.
 Monitor the patient who are at risk.
 Increase the patient’s mobility and encourage
fluids.
 Administer drug and IV fluids.

 Discourage Ca rich diet.

 Monitor ECG, vital sign.

 Hypophosphatemia.
When phosphorous level <2.8 mg/dl.
 Risk factors
 Anorexia, nervosa, alcoholism, diabetic keto
acidosis, respiratory alkalosis, hypo
parathyroidism, elderly patient who are unable
to eat, prolonged hyperventilation, thermal
burn VIT D deficiency.
 Signs and symptoms.
 paresthesia, muscle weakness,
bone pain, chest pain,
confusion, cardiomyopathy,
respiratory failure, apprehension
numbness, seizures,
coma.
 Assessment and Diagnostic
findings:-

Sr. phosphorous <2.8mg/dl.

X-ray shows skeletal change.
 Management.
 Monitor sr. phosphate level.
oral supplements.
IV phosphorus administration for severe deficit
 Nursing management.
 Identify and assess the patient at risk.
monitor vital signs.
take measures to prevent infection.
IV administration of phosphorous.
monitor hypocalcaemia.
monitor Sr. phosphorous level.
 Hyperphosphatemia:-
 Phosphorous level exceeds> 4.5mg/dl.
RISK FACTORS.
acute and chronic failure,
chemotherapy,
hypoparathyroidism, DKA,
Excessive intake of phosphorous,
vitamin D excess,
respiratory acidosis.
 Assessment and Diagnostic
findings:-
 Sr.phosphorous exceeds > 4.5mg/dl.
signs and symptoms.
Tetany ,tachycardia.
precipitation of calcium
phosphate in organs.muscle
weakness,tingling sensation,signs of
hypocalcemia.
 Management:-

 Administer allopurinol.To prevent

nephropathy.
 Restrict dietary phosphate
 Dialysis.
 Monitor for hypocalcaemia.
 Nursing management:-
 Identify and assess the patient at risk.
 Prescribe low phosphorous diet.
 Monitor urine output.
 Avoid phosphate containing contents Eg-
laxatives.
 Teach about signs of hypocalcaemia.
 Hypomagnesaemia:-
 Sr.level<1.5mg/dl.
 Risk factors.
chronic alcoholism,
hyperparathyroidism, hyperaldosteronism,
malabsorption syndrome,
nasogastric suction, thiazide diuretics,
aminoglycoside antibiotic,
excessive use of vit-D.
 Signs and symptoms:-
 Neuromuscular irritability, insomnia,
mood changes, disorientation,
anorexia, vomiting,
increased reflexes, tremors,
convulsion, tachyarrythmias.
Assessment and diagnostic findings:-
Sr. magnesium level<1.5mg/dl.
 Management:-
 Administer Mg salts orally.
 IV Mag for severe deficiency.
 Monitor vital signs.
 Monitor cardiac function.
 Monitor urine output.
 Nursing management
 Mild deficit corrected by diet.
 Provide safety precautions.
 Monitor condition of airway and ability to
swallow.
 Educate the patient if abuse of diuretics &
laxatives.
 Dietary advice.
 Hypermagnesemia:-

 Sr.> 2.5 mg/dl.

 Risk factors.
oliguric phase of renal failure,
adrenal insufficiency,
excessive IV mag administration,
hemodialysis with hard water or
diasylate high in MAG, excessive use
of antacids.
 Signs and symptoms:-
 Flushing, hypotension,
drowsiness , hypo active reflexes,
depressed respiration,
cardiac arrest, coma,
muscular weakness,
Assessment and diagnostic findings:-
Sr. magnesium >2.5 mg/dl.
 Management:-
 Avoid administration of magnesium to patients
with renal failure
 Discontinue administering Mg if patient
develops hyper magnesium
 Hemo dialysis with Mg free dialysis
 administer loop diuretics and normal saline,
Ca gluconate
 Nursing Management
 Identify the patient at risk and assess
 Avoid giving Mg containing medication
 Educate the patient about abuse of drugs eg:-
renal failure
 Monitor vital signs.
 Hydrogen ion concentration:-
 Acid base balance means homeostasis of the
hydrogen ion concentration in body fluid.
 Increase in concentration of hydrogen ions(H+)makes
solution more acid a decrease makes it more alkaline.
 PH value falls as the hydrogen ion concentration rise
and as concentration falls as the concentration PH
raises
 The most important buffer in the body is the
carbonate system.
Respiratory system.
 Carbon dioxide formed continuously in the
body by the different intracellular metabolic
process.
 If metabolism decreases carbon dioxide
concentration in body fluids will decreases.
 If the respiratory rate is decreased the amount
of carbon dioxide in the extra cellular fluid
will increase.
 Renal system

 PH of extra cellular fluid goes down kidneys

will eliminate more Hydrogen ions.

 If extra cellular fluid PH goes up kidneys

eliminate more bicarbonate ions.
 Respiratory system
 Respiratory acidosis:-
 The kidneys conserve base bicarbonate and
excrete hydrogen ions. Urine becomes acidic
PH in extra cellular fluid is 7.35-7.45
Pco2 is from 35-46 mmHg
respiratory acidosis PH low
Pco2 high.
 Respiratory alkalosis.
 PH high.
 PCO2 low.
Metabolic alkalosis:-
Retain co2
Kidneys excrete bicarbonate ion.
Retain hydrogen ion.
 Metabolic acidosis.
Because of the high acid content of the
blood, which causes loss of Na bicarbonate.
Uncompensated metabolic acidosis.
PH low, PCO2normal, CO2 low When
compensation occurs,PHrises, slightly but may
remain below normal.
PCO2 falls because of hyperventilation.
 Nutritional problems.

 Protein calorie malnutrition.

 Nutritional anemia.
 Endemic goiter.

Kwashiorkar
Marasmus.
 Protein energy malnutrition
 Causes
 Inadequate intake of food both in quantity and quality.
 Infection, diarrhoea,respiratory, measles,intestinal
worms.
 Contributory factors are
 Poor environmental condition, large family size, poor
maternal health, failure of lactation,premature
termination of breast feeding adverse cultural practices
relating to child,rearing and wearing.
Marasmus:- Kwashiorkar.
Muscle wasting:-
obvious sometimes hidden by oedema
Fat wasting and fat.
severe loss of sub cutaneous Fat often retained but not firm
fat.
Oedema
none. Present in lower legs, usually
in
Weight for height:-
Face and lower arms.
very low.
low but may be masks by
Mental changes:-
oedema.
Sometimes quiet and apathetic. Irritable, moaning, apathetic.
Appetite.
usually good. poor.
Diarrhoea. Often current and past
Often current and past
Skin changes. sometimes flaky paint and
Usually none. dermatosis
Hair changes
Sparse, silky, easily pulled
seldom
Out
Hepatic enlargement
Sometimes due to
none accumulation of fat
 Biochemical changes.
Serum albumin.
Normally or slightly Low (3G/100 ml blood)
decreased
Urinary urea Per g
Creatinine Low.
Normal or decreased
Hydroxyproline-creatinine low
ratio
Low
Plasma/ amino acid ratio elevated
normal
 Nutritional anaemia:-
 Affect 2/3 of pregnant and ½ of non pregnant
women in developing countries.
 Detrimental effects:-
pregnancy:- in India 20-40% of maternal
deaths are due to anaemia.
Infection:- parasitic disease eg malaria
Iron deficiency may impair cellular responses
immune function and increase susceptability
to infection.
 Work capacity:-significant impairment of
maximal work capacity
severe anaemia greater reduction in work
performance and there by less productivity.
 Intervention:-
iron and folic acid supplementation
Dosage mothers:-100mg of elemental iron
300 mg of ferrous sulphate +0.5mg of folic
acid.
dosage for children:- 20 mg of elemental
iron 60mg of ferrous sulphate +0.1 mg of folic
acid.
 Iron fortification:- fortification of salt with
iron has been accepted by Govt of India
 Other strategies:- Changing dietary habits
Control of parasitic infection
Nutrition education
 Water soluble vitamins deficiencies:-
 Vitamin B1 thiamine:-
Function:- in CHO METABOLISM
thiamine is necessary for oxidative
decarboxylation (removal of CO2) of pyruvate
and alpha- ketogluconate which are
metabolized to acetyl co-enzyme A and
succinyl co-enzyme A.
 Food sources:- rich in bread & cereals, dry
yeast, wheat germ etc.
 Absorption:-absorbed from the small intestine
& under goes phosphorylation in the intestinal
mucosa.
 Deficiencies:-
wet beri-beri.
dry beri-beri.
infantile beri-beri.
 Vitamin B2 riboflavin:-
 Function:- as a part of a group of enzymes
called flavo proteins which are involved in the
metabolism of CHO protein & fat.
 Food sources:- organ meat,milk & green leafy
vegetables.
 Absorption:- absorbed through the walls of
small intestine where it is phosphorylated
before entering the blood stream
 Deficiencies:- photophobia, loss of visual
activity angular stomatitis, peripheral
neuropathy.
 Vitamin B3 niacin:-
 Function:- niacin like thiamine and riboflavin
also function as co-enzyme in energy
metabolism.
 Storage:- stored in the liver.
 Deficiencies:- pellagra.
 Vitamin B6 pyridoxine:-
 Function:- associated closely with the
synthesis & metabolism of amino acids.
 Food sources:- animal foods pork are the
richest. Milk & eggs are fair sources.
 Deficiencies:-dermatologic & neurologic
problem.
 Folacin, folic acid:-
 Function:- synthesis of purines and pyrimadines of
DNA & RNA and in amino acid interconversion.
 Food sources:- green leaves, liver meat, fish, nuts,
legumen & whole grains.
 Absorption :- absorbed along the entire length of the
small intestine.
 Deficiencies:- megaloblastic macrocytic anaemia,
birth defects.
 VitaminB12 :- Cyanocobalamine
 Function:- as a co- enzyme. It is particularly
important in the bone marrow where the red
blood cells are formed in nerve tissue.
 Food sources:- sea foods, meat, dairy products.

. Absorption:- active absorption requires the

presence in the gastric secretion of even larger
molecule.
Deficiencies :-progressive neuropathy tingling,
burning feet, pernicious anemia.
 Vitamin C:-
 Functions :- formation of collagen the protein
that connects the cells together.
 Food sources:-

fruits & vegetables.

Defeciencies:-
scurvy swollen & bleeding gums
 Fat soluble vitamins :-
 Vitamin A :-
 Function :-
constituents of visual pigments.
maintenance of epithelial tissue.
maintenance of bone growth.
growth & reproduction.
Food sources :- fish liver oils. Milk products, butter, full
cream cheese.
Absorption :- Hydrolyzed in the gastro intestinal tract to
retinal and as such is absorbed across the mucosal cell
membrane
Liver stores of VIT A.
Deficiencies :- xerophthalmia, night blindness,
conjunctival xerosis,corneal xerosis, kerato malacia.
 Vitamin D :-
 Function :-increased absorption of calcium &
phosphorous from the gastro intestinal tract.
 Bone metabolism.
 Sources:-cod liver oil,fatty tissue, egg yolk,
peanuts,legumes.
 Absorption :- absorbed in the presence of bile
from the jejunum.
 Deficiencies:- rickets, osteomalacia.
 Vitamin K :-
 Function:- essential in blood coagulation
 Sources:- cabbage, cauliflower ,pork,
soyabean oil.
 Absorption:- intestine.
 Deficiencies:- decrease in clotting time.
hemorrhagic disease of newborn.
 Minerals :-
Calcium:- formation of bones & teeth
coagulation of blood, contraction of muscles,
cardiac action, milk production, relay of
electrical & chemical messages arrive at a
cells surface membrane.
Sources:-milk products, eggs, fish.
Litre of cows milk provides about 1200 mg of
calcium.
human milk about 300 mg.
 Absorption :- enhanced by VIT D and
decreased by the presence of phytates, oxalates
& fatty acids.
 Deficiencies :- rickets, osteo malacia & tetany.
 Requirement:- 400-500 mg.
 Phosphorous :-
 Function :- essential for the formation of bones
& teeth.
 Deficiency :- neural, muscular,skeletal & renal
abnormalities.
 Requirement:- 400-700 gm.
 Iron :-
 Function :- formation of haemoglobin, brain
development, regulation of body temperature, muscle
activity & catecholamine metabolism.
 Sources:-

food rich in haem- iron are liver ,meat, poultry &

fish.
non haem are cereals, green leafy vegetables
,legumes, nuts, oil seeds, jaggery & dried fruits.
Absorption:- absorbed from duodenum & upper small
intestine.
Deficiency:- hypothyroidism, retarded physical
development, microcytic hypochromic anemia.
Requirement:- 2-4 mg.
 Iodine :-
 Function:- required for the synthesis of thyroid
hormone.
 Sources:- sea fish, cod liver oil,milk,meat &
vegetable.
 Deficiency:-hypothyroidism, myxedematous
cretinism,impaired mental function.
 Requirement:- 150 microgram/day.
 Flourine:-
 Function:-mineralization of bones & formation
of dental enamel.
 Sources:- drinking water, cheese & tea.
 Deficiency:- dental caries.
 Zinc:-
 Function:- active in the metabolism of glucides,
protein & required for synthesis of insulin by
the pancreas & for immunity function.
 Sources:- meat, milk, fish.
 Deficiency:- growth failure, sexual infantilism,
loss of taste, delayed wound healing,
pernicious anaemia, thalasaemia & myocardial
infarction.
Endemic fluorosis:-
fluorosis of dental enamel due to more
ingestion of fluoride.
charaterised by mottling of dental.
Skeletal fluorosis:-
Heavy fluoride deposition in the skeleton
Daily in take of 3-6 mg/L
 Genu valgam is osteoporosis of the lower
limbs
 Intervention:- changing the water source
chemical treatment
fluoride supplements should not be
prescribed for children who drink fluoridated
water.
 Lathyrism:- it is a paralysing disease of human
and animals.it is referred to as neurolathyrism
because it affects the nervous system.
In animals as osteolathyrism because the
pathological changes occur in the bones
resulting in skeletal deformities.
 Interventions:-
vitamin C prophylaxis.
banning the crop.
removal of toxin.
 XEROPHTHALMIA:- Refers to all the ocular
manifestations of Vit Adeficiency
 Common in 1-3 yrs
 Risk factors:- poorest families
ignorance
faulty feeding practices
infection
 PREVENTION AND CONTROL:-
 Short term action
Administration of VIT-A
Long term action
VIT A rich foods
Promotion of breast feeding
Immunization
Prompt treatment of diarrhoea
Improved health services
Social and health education.