FLUID, ELECTROLYTE, AND ACID-BASE BALANCE

Anatomy and Composition of Fluid Compartments

Total Body Water (TBW) adult

45-70% of body weight lowest in aged & obese highest in very lean & young

TBW

60% -- male 70kg 50-55% female

Anatomy and Composition of Fluid Compartments The composition of body fluid: Two compartments

Intracellular Space -- 2/3 -- 40% Extracellular Space -- 1/3 -- 20%

Body fluids

Extracellular fluids (ECF)

Interstitial fluid - fills the spaces

between most cells of the body

Intravascular fluid - plasma

(WBC, RBC and platelets
in this fluid) 5% of body weight

15% of body weight

Body fluids

Intracellular fluids (ICF)

Liquids within cell membranes 40% of body weight

Amount and composition of body fluids

Actual amount of body water differs according to Age Sex Body composition

Physiology of Body Water Balance

Newborn

70% 0f WT water 1-year-old 60% of WT water Men: higher water content due to greater muscle mass

Physiology of Body Water Balance

Obese:

less water because fat cells have minimal ICF

Use ideal body weight when

estimating TBW for obese

Elderly:

less water due to less muscle mass

Fluid Shifts Third Spacing Refers to loss of ECF into a space that does not contribute to equilibrium between ICF and ECF
between cells [edema] or Excess fluid in potential spaces [effusion]

Excess fluid in interstitial spaces and connective tissues

peritoneal cavity pericardial sac synovial cavities of joints alveoli or intra-pleural space

Fluid Shifts Third Spacing

Etiology

Caused by an increase in filtration

and/or decrease in reabsorption due to altered capillary forces

Fluid Shifts Third Spacing

Mechanisms causing third spacing & edema massive inflammation venous obstruction increased blood volume low serum albumin

Components in body fluids

Electrolyte

an element that when dissolved can carry an

electrical current Cations - (+) ; Anions - (-) neuromuscular function acid-base balance

Components of body fluids

Minerals

ingested compounds serve as catalysts in nerve response, muscle

contraction, and metabolism of nutrients in foods, regulate electrolyte balance

Movement of body fluids

Diffusion

Area of higher concentration to an area of

lower concentration till even distribution

Osmosis

Movement of a pure solvent, e.g. water

through a semipermeable membrane from a solution that has a lower solute concentration to one that has a higher solute concentration

Osmotic pressure

Drawing power of water (dependent on the number or molecules in solution)

Isotonic Hypotonic Hypertonic

Movement of body fluids

Filtration

Water and diffusible substances move

together in response to fluid pressure

Active transport

Requires energy Able to move larger molecules and go from

less to greater concentration

Fluid Intake

Hypothalamus - thirst control center Oral fluid intake requires an alert state Osmoreceptors - monitor osmolality

Fluid Output

Loss through the kidneys and GI tract Insensible Sensible

Cations

Sodium (Na+)

Most abundant in the extracellular fluid Maintains water balance, transmits nerve

impulses, contracts muscles Values - 135-145 mEq/L

Cation

Potassium (K+)

Major intracellular cation Regulates neuromuscular excitability,

muscular contraction, and acid-base Value - 3.5 -5.3 mEq/L

Cation

Calcium (Ca2+)

Cardiac conduction, blood

coagulation, bone growth and formation, & muscular relaxation Value - 4 - 5 mEq/L

Cation

Magnesium (Mg2+)

Second most important of intracellular fluids Enzyme activities, muscular excitability Value - 1.5 - 2.5 mEq/L

Electrolyte Imbalances

Hyponatremia

GI losses, sweating, & diuretics S/S: N/V/D, abd cramps, personality change Ingestion of large amounts S/S: Dry tongue and mucous membranes,
restlessness, convulsions, thirst, dry skin

Hypernatremia

Electrolyte imbalances

Hypokalemia Causes: K+ wasting diuretics N/V/D polyuria S/S: weak, irregular pulse

hypotension weakness

Electrolyte imbalances

Hyperkalemia

Causes: Renal failure S/S: irregular slow pulse, weakness, irritability

Electrolyte Imbalances

Hypocalcemia

Causes: Vitamin D deficiency S/S: Numb and tingling fingers and circumoral
region, muscle cramps

Hypercalcemia

Causes: osteoporosis, prolonged

immobilization S/S: decreased muscle tone, weakness, lethargy, kidney stones

Electrolyte imbalances

Hypomagnesemia

Causes: malnutrition and alcoholism polyuria S/S: muscular tremors, hyperactive deep
tendon reflexes

Hypermagnesemia

Causes: Renal failure S/S: hypoactive deep tendon reflexes, shallow

and slow respirations

Acid - Base Balance

Blood pH - 7.35 - 7.45 paCO2 - 35 - 45 Bicarbonate (HCO3) - 22-26 mEq/L

Respiratory Acidosis

pH < 7.35 paCO2 > 45 mm Hg Causes: Respiratory failure Hypoventilation Resp muscles paralysis Airway obstruction

Respiratory Alkalosis

pH > 7.45 paCO2 < 35 mm Hg Causes: excessive exhalation of CO2 (hyperventilation)

Metabolic Acidosis

pH < 7.35 bicarbonate - < 22 mEq/L Causes: Starvation, DKA, Diarrhea, drug use

Metabolic Alkalosis

pH > 7.45 bicarbonate > 26 mEq/L Causes: excessive vomiting, prolonged gastric suctioning

Fluid & Electrolyte Imbalances

Burns - body fluid loss Renal D/O - abnormal retention of Na, Cl, K GI Disturbances - Loss of fluid, potassium, and chloride Exercise

S/S electrolyte imbalance

Head: irritability Fontanels: depressed, bulging Eyes: sunken periorbital edema Mouth: mucous membranes CV: neck veins, edema, blood pressure Resp: Crackles

Imbalances

GI: abdomen, V/D Renal: Oliguria or anuria (FVD, FE) Diuresis (FVE) Increased urine spec. gravity (FVD) Skin (Temp)

increased - met acidosis, hypernatremia decreased - FVD

Replacement of fluids and electrolytes

Types of IV fluids Isotonic Hypertonic Hypotonic

IV complications

Infiltration Phlebitis

IVF enter SQ space

vein inflammation S/S: pain, redness, warmth Fluids given too rapidly

Fluid overload Bleeding

Discontinuing an IV

Stop infusion Remove tape 1 - 2 minute pressure

Blood transfusions

Large bore catheter (18 ga or larger) Give with normal saline Baseline vital signs Double check with two RNs Begin transfusion slowly Observe closely for first 15 min

Transfusion Reactions

Caused by:

blood incompatibility allergic sensitivity S/S: fever, chills, rash, hypotension, shock

Treatment: stop transfusion, give NS, save tubing, prepare for emergency drugs