Fluid and Electrolyte

Replacement
Manuel V. Immaculata, MAN, RN
Asst. Professor
 Important Terminologies
Osmosis
- is the movement of water (a solvent) across a
selectively permeable membrane, such as the plasma
membrane.
Diffusion
- is the movement of a solute from an area of higher
concentration to an area of lower concentration within a
solvent. At equilibrium, there is a uniform distribution of
molecules.
 Important Terminologies
Osmolality
- It is the concentration of solutes in 1 liter of solution
Osmotic Pressure
- is the force required to prevent the movement of water
by osmosis across a selectively permeable membrane.
Hydrostatic Pressure
- It is the pressure exerted against the wall of the blood
vessel by the blood inside it.
 AMOUNT AND COMPOSITION OF
BODY FLUIDS

Approximately 60%
of a typical adult
weight consist of
fluids (water and
electrolytes).
 Water Distribution in the Body
Three compartments:
1. Intracellular (inside the cell)
2. Intravascular (arteries, veins, capillaries)
3. Interstitial (spaces between the cells, outside of the
vascular compartment)
EXTRACELLULAR: Intravascular and Interstitial.
o Contains about 1/3 of total body water.
INTRACELLULAR:
o Contains about 2/3 of total body water.
 Body fluids are located in
two fluid compartments:
1. The intracellular space (fluid in the cells)- located
primarily in the skeletal muscle mass.
2. The extracellular space (fluid outside the cells).
a. Intravascular space (15%)- fluid inside the blood
vessel containing plasma; about 3L.
b. Interstitial space (5%)- contains the fluid that
surrounds the cell; about 11 to 12 L.
E.g.: Lymph
c. Trancellular space (1-2%)
E.g.: Cerebrospinal, pericardial, synovial,
intraocular, and pleural fluids; digestive enzymes
 Body fluids are located in
two fluid compartments:
Body fluid normally shifts between the two major compartments
in an effort to maintain an equilibrium between the spaces.

Third-space fluid shift refers to loss of fluid into a space that

does not contribute to equilibrium between the ICF or ECF.

An early clue of a third-space fluid shift is a decrease in urine

output despite adequate fluid intake (occurs in ascites,
peritonitis, bowel obstruction, and massive bleeding into a
joint of body cavity).
 Electrolytes
Active chemicals (cations which carry positive charge, and anions which carry negative charge)
 AMOUNT AND COMPOSITION OF
BODY FLUIDS
Sodium has the greatest concentration in the ECF,
and it regulates the volume of body fluid.
Retention of sodium is associated with fluid retention,
and excessive loss of sodium is usually associated
with decreased volume of body fluid.
ECF has a low concentration of potassium and can
tolerate only small changes in its concentration.
Therefore release of large stores of intracellular
potassium typically caused by trauma to the cells
and tissues, can be extremely dangerous.
Factor that influence body fluids:

1. Age (younger people have a higher

percentage of body fluids than older people).
2. Gender (men have approximately more body
fluid than female).
3. Body fat (obese people have less fluid than thin
people because fat cells contain little water).
 Percentages of Body Water
Age(weight) Extracellular W % Intracellular W % TB W%

Premature (1.5kg) 60 40 83

Full-term (3.5 kg) 56 44 74

6 months (7 kg) 50 50 60

1 year (10kg) 40 60 59

Adult male 40 60 60

(Data from Friis-Hansen B: Body composition during growth during growth,

Pediatrics 47:264, 1971)
Source: Tate, Principles of Anatomy and Physiology 2nd Ed 2012
 Water and Electrolytes
• Under normal healthy conditions, the body loses
water and electrolytes daily through urine,
perspiration, feces.
• Fluids are replenished by absorption of water in
the GI tract from the liquids and foods that are
consumed.
• In many disease states (e.g., vomiting, diarrhea,
GI suctioning, hemorrhage, drainage from a
wound, nausea, anorexia, fever, excess loss from
a disease e.g., uncontrolled DM)
 Routes of Gains and Losses

• Gain Loss
– Dietary intake  Kidney: urine output
 Skin loss: sensible,
of fluid, food
insensible losses
or enteral  Lungs
feeding  GI tract
– Parenteral  Other
fluids

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Intravenous (I.V) administration
• Refers to the introduction of fluids directly
into the venous bloodstream.
• Large volumes of fluids can be rapidly
administered into the vein and there is
usually less irritation.
• The most rapid of all parenteral routes
because it bypasses all barriers to drug
absorption.
Intravenous (I.V) administration
• Drugs may be given direct injection with a
needle in the vein.
• More commonly administered intermittently
or by continuous infusion through an
established peripheral or central I.V line
 Intravenous (I.V) administration

Peripheral line Central line

I.V site selection
Parenteral Nutrition
 Intravenous (IV) solutions
o Consist of water (the solvent) containing one or more types of dissolved
particles (solutes).
o Most commonly dissolved solutes in IV solutions are: sodium chloride,
dextrose, and potassium chloride.
o The solutes that dissolve in water and dissociate into ion particles are
called Electrolytes. These ions give water the ability to conduct electricity.
o The solutes: Na+, and Cl- , K+, and Cl-
 Osmosis
Fluid shifts through
the membrane from
the region of low
solute concentration
to the region of high
solute concentration
until the solutions
are of equal
concentration.
 Diffusion
The natural
tendency of a
substance to move
from an area of
higher
concentration to
one of lower
concentration.
E.g.: Exchange of
oxygen and carbon
dioxide between the
pulmonary capillaries
and alveoli;
movement of sodium
from the ECF to the
ICF.
 Types of Intravenous solutions
1. Isotonic solution
If I.V solution and the blood have approximately the same
osmolality.
2. Hypotonic solution
Solutions that have fewer dissolved particles than the blood.
3. Hypertonic solution
Solutions that have higher dissolved particles than the
blood.
Normal blood serum osmolality = 295 to 310 milliosmoles/L (mOsm/L)
Osmolality
• It is the concentration of solutes in 1 liter of
solution. (Clayton)
• The solute or particle concentration of a fluid
(Fauci)
Normal blood serum osmolality
295 to 310 milliosmoles/L (Clayton).
275–290 mOsmol/kg (Fauci)
 Isotonic solutions
0.9 % sodium Used as Replacement
chloride fluids for:
(Na Cl) 1. the patient with
(Osmolality of 308
intravascular fluid deficit
mOsm/L) (e.g., acute blood loss
from hemorrhage, GI
Lactated bleeding, or from an
Ringer’s (LR) accident).
D5%0.2 Na Cl (initial) 2. hypovolemic, hypotensive
patients to increase
vascular volume to support
blood pressure.
Monitoring:
o Fluid overload (potentially
pulmonary edema),
especially if the patient has
CHF.
 Hypotonic solutions
Used as Replacement fluids for:
0.2 % or 0.45 % sodium
chloride 1. conditions of cellular dehydration.
(Na Cl)

Precautions:
o Administering them too rapidly might
cause a shift of fluids being drawn
from the intravascular space to the
other compartments.
If there is no available stock?
How to prepare 0.45 sodium chloride?
0.2 sodium chloride?
 Hypertonic solutions
Parenteral To meet the caloric requirements (must
nutrition solutions be administered into central veins so
D5 % 0.45 sodium that they can be diluted by rapid
chloride blood flow).
D5 % 0.9 sodium Precautions:
chloride o Have the potential to pull fluid from the
(Na Cl) intracellular and interstitial
Dextrose 50% compartments  cellular DHN and
(D50 vascular volume overload.
o Causing phlebitis and spasm with
infiltration and extravasation in
peripheral veins. Generally > than
approximately 600 to 700 mOsm/L
should NOT be administered in
peripheral veins.
Intravenous solutions, Electrolytes concentrations, and Osmolality

SOLUTION Na + (mEq/L) Cl - (mEq/L)c GLUCOSE Osmolality

(g/L) (mOsm/L)
0.2 NS 34 34 0 77

0.45 NS 77 77 0 154

0.9 NS 154 154 0 308

D5/0.2 34 34 50 320

D5/0.45 77 77 50 405

D5/0.9 154 154 50 560

Lactated 130 109 0 273

Ringer’s
solution
K+ = 4, Lactate = 28, Ca++ = 3
 FLUID & ELECTROLYTE REPLACEMENT

IV Solutions
1. Crystalloids
-include dextrose,
saline, lactated
Ringer's solution
-used for replacement
and maintenance fluid
therapy
2. Colloids
-volume expanders
 FLUID & ELECTROLYTE
REPLACEMENT
a. Dextran – not a substitute
for whole blood because it
does not have any products
that carry oxygen
b. Hetastarch- nonantigenic
volume expander
-can decrease platelet &
hematocrit count
c. Plasmanate-
commercially prepared, used
instead of plasma or albumin
to replace body protein
 FLUID & ELECTROLYTE
REPLACEMENT
3. Blood Products
a. Packed RBCs – contain
whole blood without plasma
Advantages:
-less chance of circulatory
overload
-less risk of reaction to
plasma antigen
-possible decrease in risk in
transmitting serum hepatitis
 Red Blood Cells, Packed
(PRBC)
• Used to treat symptomatic
anemia and routine blood
loss during surgery
• Hematocrit is
approximately 80% for non-
additive (CPD), 60% for
additive (ADSOL).
• Allow WB to sediment or
centrifuge WB, remove
supernatant plasma.
 FLUID & ELECTROLYTE
REPLACEMENT
b. Whole blood
-used in acute blood
loss
-not used in anemia
unless severe
4. Lipids
-used to balance
nutritional needs
Washed Red Blood Cells (W-RBCs)

• Washing removes plasma proteins, platelets, WBCs

and micro aggregates which may cause febrile or
urticarial reactions.
• Patient requiring this product is the IgA deficient
patient with anti-IgA antibodies.
• Prepared by using a machine which washes the cells 3
times with saline to remove and WBCs.
• Two types of labels:
– Washed RBCs - do not need to QC for WBCs.
– Leukocyte Poor WRBCs, QC must be done to guarantee
removal of 85% of WBCs. No longer considered effective
method for leukoreduction.
• e. Expires 24 hours after unit is entered.
Cell Washer to Prepare Washed
Cells
Platelets (PLTS), Platelet Concentrate (PC) or Random
Donor Platelet Concentrate (RD-PC)
• Used to prevent spontaneous bleeding or
stop established bleeding in
thrombocytopenic patients.
• Prepared from a single unit of whole
blood.
• Due to storage at RT it is the most likely
component to be contaminated with
bacteria.
• Therapeutic dose for adults is 6 to 10
units.
• Some patients become "refractory" to
platelet therapy.
• Expiration is 5 days as a single unit, 4
hours if pooled.
• Store at 20-24 C (RT) with constant
agitation.
• D negative patients should be transfused
with D negative platelets due to the
presence of a small number of RBCs.
 Preparation of platelet
concentrate

Plasma

RBCs PRP

Platelet
concentrate
Platelets (PLTS), Platelet Concentrate (PC) or Random
Donor Platelet Concentrate (RD-PC)

• One bag from ONE donor

• Need 6-10 for therapeutic dose
 Pooling Platelets
• 6-10 units transferred into one bag
• Expiration = 4 hours
 Fresh Frozen Plasma (FFP)
• Used to replace labile and non-labile Fresh Frozen Plasma –
coagulation factors in massively Volume 200-250cc
bleeding patients OR treat bleeding
associated with clotting factor
deficiencies when factor concentrate is
not available.
• Must be frozen within 8 hours of
collection.
• Expiration
– frozen - 1 year stored at <-18 C.
– frozen - 7 years stored at <-65
C.thawed - 24 hours
 Cryoprecipitate (CRYO), Factor VIII or
Anti-Hemophilic Factor (AHF)
• Storage Temperature Cryoprecipitate – volume
15ccs
– Frozen -18 C or lower
– Thawed - room
temperature
• Expiration:
– Frozen 1 year
– Thawed 6 hours
– Pooled 4 hours
• Best to be ABO
compatible but not
important due to small
volume
 Nursing Interventions
1. Monitor vital signs and report abnormal
findings
2. Monitor urine output
3. Monitor weight daily
4. Check for signs and symptoms of fluid
volume deficit (dehydration: thirst, dry
mucous membrane, poor skin turgor)
 Nursing Interventions
5. Check for manifestations of fluid excess:
cough, moist rales
6. Monitor laboratory results
7. Monitor type of fluid given
8. Monitor IV injection site
Potassium (3.5-5.3 mEq/L)
 Hypokalemia
Functions  Hyperkalemia
a. Necessary for Drugs Used to Correct
transmission- Hyperkalemia
conduction of 1. IV Sodium Bicarbonate
nerve Impulses & - increases serum pH
for the contraction 2. 10% Calcium gluconate
of skeletal, cardiac -decreases irritability of
& smooth muscles
myocardium
3. Insulin and glucose
b. Promotes glycogen - moves potassium
storage in the liver back into the cells
c. Helps regulate 4. Sodium polystyrene
osmolality of sulfonate (kayexaIate)
cellular fluids - cation exchanger

44
Potassium Chloride, Sodium Bicarbonate

40 meq/20 ml 50 meq/50 ml
or 2meq/ml or 1meq/ml
 Nursing Interventions- Potassium
1. Give oral potassium with sufficient amount
of water or juice
2. Dilute I.V Potassium Chloride(KCl) in the
IV bag and mix thoroughly; DO NOT give
via IM or give as IV bolus or push
3. Monitor urine output, serum potassium and
ECG
4. Check IV site for infiltration.
5. Prepare and administer Kayexalate.
6. Instruct clients taking potassium-wasting
diuretics or cortisone preparation to eat
potassium rich -foods (banana, citrus fruits,
vegetables, nuts)

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 Sodium (135- 145 mEq/L)

• Major cation in the ECF

Functions
a. Major electrolyte that regulates body fluids
b. Promotes transmission and conduction of
nerves
o Hyponatremia
o Hypernatremia

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 Calcium (4.5-5.5 mEq/L)
Functions
a. Promote normal nerve and muscle activity
b. lncrease cardiac contraction
c. Maintains normal permeability and
promotes blood clotting (converts
Prothrombin to Thrombin)
d. Needed for formation of bone and teeth
o Hypocalcemia
o Hypercalcemia
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 Nursing Interventions
Calcium
1. Monitor VS: Monitor pulse rate if client is
taking Digoxin. Bradycardia is a sign of
Digitalis toxicity
2. Administer IV fluid with Calcium slowly.
Diluent: D5W and Saline solution.

49
 Nursing Interventions Calcium
3. Check IV for infiltration. Calcium may
cause necrosis
4. Monitor ECG.
5. Instruct client to avoid overuse of
antacids/ laxatives.
6. Take oral calcium with meals or after
meals to increase absorption.
7. Suggest that the client consume foods
high in calcium (milk and milk products).

50
 Magnesium (1.5-2.5 mEq/L)
• Sister cation to potassium
Functions
a. Promotes transmission of neuromuscular
activity
b. Mediator of neural transmission in CNS
c. For metabolism of carbohydrates and
protein
o Hypomagnesemia
o Hypermagnesemia 51
 Can you calculate?
Do you know the formula for
I.V flow rate?

Do you know the formula for

Drug dosage?
Activity: Practice Computation
Activity: Practice Computation
Activity: Practice Computation
 End of
Pharmacology Nursing I Discussion

THANK YOU
MVI 2020