FLUID AND ELECTROLYTES

Dr.Roshini MS(Ay)
 Normal Physiology
Human body consists of about 50-70% of water
Directly related to muscle mass
Inversely proportional to fat content
Thin individuals have greater Total Body Water (TBW)
TBW – 50% in women and 60% in men
Situated in different compartments
 Body
compartments

Extracellular(ECF) – Intracellular (ICF) –

20% (1/3rd of TBW) 40% (2/3rd of TBW)

Interstitial
Plasma – 5%
fluid – 15%
• This fluid contains dissolved particles or Solutes
• Electrolytes are the charged particles in the body
Positively charged particles – Cation (Na+,K+, Mg+..)
Negatively charged particle – Anion (Cl-, bicarbonate..)
• These are maintained in certain concentration in the ICF
and ECF and this has to be balanced in a healthy
individual.
• These compartments are seperated by membrane that are permeable to
water (Semipermeable membrane)
• Movement of water across this membrane is maintained by hydrostatic
pressure (pressure of fluid in an enclosed space) and osmotic pressure
(water moves from high concentration of solute to low concentation)
• Sodium controls the movement of body fluids – “Where sodium goes,
water follows”
INTRACELLULAR FLUID
• Fluid within the cells
• About 30-40% of TBW
• Largest portion is seen within the skeletal muscle mass
• Female possess small muscle mass, hence % of ICF is
lower in females
• Main cations – Pottassium and Magnesium
Main Anions – Phosphates and Proteins
 EXTRACELLULAR FLUID
• About 20-30% of TBW
• Seen in 3 areas
- Intravascular : within the blood vessels
- Interstitial : around and in between the cells
- Transcellular : Non functional e.g., CSF, Urine, Fluid
in ducts of glands, eye, ear etc
• Main cation : Sodium
• Main anion : Chloride and Bicarbonate
Normal plasma ranges of Electrolytes
CATIONS
• Sodium – 135-145mEq/L
• Potassium – 3.5 -5 mEq/L
• Calcium – 8-10.5 mEq/L
• Magnesium – 1.5 -2.5 mEq/L
ANIONS
• Chloride – 95-105mEq/L
• Bicarbonate – 24-30 mEq/L
• Phosphate – 2.5-4.5 mEq/L
• Total protein conc – 6.0-8.4 mEq/L
 Electrolyte Imbalance
SODIUM
1. Hyponatremia
2. Hypernatremia

POTASSIUM
1. Hypokalemia
2. Hyperkalemia
Hypernatremia
• Increased Sodium concentration
• Due to increased Na+ or decreased water content
• Water moves from ICF to ECF
• Cells dehydrate
Causes
- Hypertonic IV solutions
- Over secretion of aldosterone
- Loss of pure water
- Polyuria in DM
- Hypodipsia
C/f
- Thirst
- Lethargy
- Neurological dysfuntion
- Decreased Vascular volume

Treatment
Isotonic salt free IV fluid
Oral solutions
Hyponatremia
Decreased Na+ conc in ECF
2 types
- Depletion HypoN
- Dilution HypoN
Causes
• Diuretics, Chronic vomiting and Diarrhoea
• Decreased sodium intake
• Impaired renal excretion of water
C/f’s
• Neurological symptoms like lethargy, headache,
confusion, seizures, coma etc
• Muscle cramps, weakness and fatigue
• GI symptom – Nausea, vomiting and diarrhoea

Treatment
Limited fluid intake
IV hypertonic saline
ACID – BASE DISORDERS
Basic definitions
Acid : A compound which releases H+
Base : Which accepts H+

pH : A measure of H+ activity. This tells how acidic,

alkaline or neutral is the solution
Normal pH of Blood – 7.35 to 7.45 (Acid and alkali are
balanced so pH is stable)
Normal blood pH is important for normal cell functions
• Excess acid or less alkali in the blood– Acidosis (Low pH )
• Excess alkali or less acid– Alkalosis (Increased pH)

Increase in pH means H+ ion is decreasing

Decrease in pH means H+ ions is increasing
BUFFERS
Extra acid or alkali in the body is immediately
neutralized (buffered) by certain substances in the blood
and then excreted. These substances are called
BUFFERS e.g., HCO3
H+ + HCO3 H2CO3 H2O + CO2
Factors which control the pH
• Chemical Buffers
• Renal control of pH
• Respiratory control of pH (PaCo2)
Types of Acid Base disorders

METABOLIC RESPIRATORY

ACIDOSIS ACIDOSIS

ALKALOSIS ALKALOSIS
1. Acidosis:
- Metabolic :
METABOLIC ACIDOSIS
• Excessive acid or base deficit
• Hco3 level below 21 mmol/L

Causes
- Diabetic ketoacidosis
- Lactic acidosis
- Intestinal fistula
- Renal insufficiency
- Diarrhoea
C/f’s
• Rapid deep and noisy breathing (air hunger) – Decreased pH
stimulates the resp centres to initiate the compensatory mechanism
and causes hyperventillation and increased elimination of CO2 from
the body (H2Co3 reduces)
• Cold and clammy skin
• Tachycardia
• Strongly acidic urine
• Low Hco3 level

Treatment
- Correction of Hypoxia
- IV sodium bicarbonate infusion
METABOLIC ALKALOSIS
• Excess primary base HCo3 or loss of acid
• Bicarbonate level above 27mmol/L

Causes
- Excess alkali ingesion (Antacids)
- Excess cortisol
- Excess loss of H+ from kidneys in exchange for K+ in
severe hypokalemia
- Repeated vomiting which leads to loss of gastric HCL
Compensatory mechanism: By lungs via inhibition of
respiration which leads to inc PCo2

C/f’s
- Cheyne stokes breathing with period of apnoea of 5-30
sec
- Tetany

Treatment
Nacl IV infusion with slow IV KCL 40mmol/L in saline
RESPIRATORY ACIDOSIS
A feature of respiratory failure with high arterial PCo2
causing fall in pH. An increase in Co2 levels increases the
plasma H+ or decrease the pH
Causes
• During and after anaesthesia
• Chronic bronchitis, emphysema and respiratory disorders
• Thoracic diseases
• Myasthenia gravis, Poliomyelitis
C/f’s
• Hypoxia
• Tachycardia
• Hypertension
• Confusion and drowsiness
• Arrhythmias

Treatment
Maintenance of oxygenation and ventillation using
mechanical ventilatory support
 RESPIRATORY ALKALOSIS
• Arterial PCo2 below normal (Due to excessive washing out of
Co2)
• Can lead to tetany

Causes
• Pain
• Anxiety
• Hysteria
• High altitudes
C/f’s
- Severe hypocarbia causes cerebral vasoconstriction,
reduced cerebral blood flow, confusion, seizures and
tetany

Treatment
Co2 supplimentation
 FLUID THERAPY
Indications
• Rapid restoration of fluid and electrolytes in dehydration
due to vomiting and diarrhoea
• To correct hypovolemic shock due to haemorrhage
• Total parenteral nutrition – NBO, Ventilator support,
Coma…
• Cardiac arrest
• Post Gastrointestinal surgeries
 Types of IV fluids
COLLOIDS
Solutions of large molecules which remains in the
intravascular compartment. e.g., Gelatin, Dextran 40,
Dextran 70.

CRYSTALLOIDS
Solutions of electrolytes in water. E.g., Ringer lactate, NS.
They vary in the content of different electrolytes
They are classified acc to their tonicity
ISOTONIC
Tonicity equal to the plasma in the body. This fluid will
distribute evenly between the intravascular space and cells.
e.g., 5% dextrose in H2O

HYPOTONIC
Have a tonicity lower than the plasma.
Shifts from intravascular space to extravascular space and
eventually into the cells
Useful in dehydration
HYPERTONIC
Have a tonicity higher than plasma
Administration of hypertonic crystalloid causes water to
shift from the extravascular spaces into the blood stream
and increases the intravascular volume.
e.g., 5% dextrose in 0.45% NaCl