FLUID & ELECTROLYTE IMBALANCES

The body undergoes continuous dynamic change. The proper

amount of body fluid is needed to support these changes and to
transport building and waste materials. Our body fluids contain
water and solutes (some are electrolytes and some are non-
electrolytes).
Approximately 60 of a young adult`s body weight is
water.
Less than 50 in elderly people.
Between 70-80 in infants.
Fluids are located both inside the cells (INTRACELLULAR
FLUIDS) and outside the cells (EXTRACELLULAR FLUIDS) -
Interstitial fluids, Intravascular fluids, and Transcellular fluids.
Interstitial fluids
Is the water that surrounds the body`s cells and includes
lymph.
Intravascular fluids
Is in the plasma of blood
Transcellular fluids
Are those that are in specific compartments of the body
such as cerebrospinal fluid, digestive juices, and synovial
fluid in joints.
The primary control of water in the body is through pressure
sensors in the vascular system which stimulate or inhibit the
release of ANTIDIURETIC HORMONE (ADH) from the
pituitary gland.
The movement of fluids and electrolytes in the body is through
(1) Active and (2) Passive Transport Systems. Active Transport
depends on the presence of adequate cellular ATP for energy.
Passive Transport includes diffusion, filtration, and osmosis.
FLUID IMBALANCES
POPULATION AT RISK: Elderly, Children, Infants
FLUID DEFICIT (DEHYDRATION)
It occurs when there is not enough fluid in the body,
especially in the blood (intravascular area).
It commonly results to HYPOVOLEMIA which occurs
when the patient is hemorrhaging or when fluids from other
parts of the body are lost. It could also occur when fluid
from the intravascular space moves into the interstitial fluid
space (THIRD SPACING) such as in burns and liver
cirrhosis.
CAUSES: Long-term NPO, Hemorrhage, Profuse
diaphoresis, Diuretic therapy, Diarrhea, Vomiting, GI
suction, Fever, Frequent enemas, Diabetes insipidus.
SIGNS & SYMPTOMS:
Thirst, Decreased BP, Rapid & weak pulse, Decreased tear
formation, Dry skin & mucus membranes, Poor skin turgor,
Increased body temperature, Decreased urine output,
Concentrated urine, Constipation, Weight loss
COMPLICATIONS: Organ Failure, Death
THERAPEUTIC MANAGEMENT: Replace fluids loss
typically isotonic fluids.
FLUID EXCESS (OVERHYDRATION)
Is a condition in which the patient has too much fluid in the
body.
It commonly results to HYPERVOLEMIA in which there is
excess fluid in the intravascular space.
CAUSES: Poorly controlled IV therapy, Excessive
irrigation of wounds or body cavities, Excessive ingestion of
water, Renal failure, Heart failure
SIGNS & SYMPTOMS:
Elevated BP, Rebounding pulse, Respirations are increased
& shallow, Skin is pale and cool, Increased urine output,
Diluted urine, Distended neck veins, Edema in the
extremities, Ascites, Crackles in the lungs, Dyspnea, Rapid
weight gain
COMPLICATIONS: Congestive Heart Failure, Pulmonary
Edema, Organ Failure, Death
DIAGNOSTIC TESTS: Decreased BUN & hematocrit levels
from hemodilution, Low specific gravity of urine
THERAPEUTIC MANAGEMENT:
Place in a semi-Fowler`s or high-Fowler`s Position
Provide adequate oxygenation
MEDICATIONS: Diuretics - Furosemide (Lasix)
Limit fluid intake
DIET: Sodium-restricted diet
ELECTROLYTE IMBALANCES
SODIUM
Normal Level: 135-145 mEq/L
It is the major cation in the blood, and it helps maintain
serum osmolarity. It is important in the cell function
especially in the central nervous system.
HYPONATREMIA
CAUSE: Inadequate intake of sodium or excessive sodium
loss from the body, Increase of plasma volume causing
dilution.
RISK FACTORS: NPO, Excessive diaphoresis, Diuretics,
GI suction, Sydrome of inappropriate antidiuretic hormone,
Excessive ingestion of hypotonic fluids, Freshwater near-
drowning, Decreased aldosterone
SIGNS & SYMPTOMS:
For patient with sodium and fluid deficit, signs and
symptoms of dehydration.
For patient with sodium deficit and fluid excess, signs and
symptoms associated with fluid overload.
In addition, mental status and personality changes,
weakness, nausea, vomiting, diarrhea.
COMPLICATIONS: Pulmonary edema, Respiratory arrest,
Coma, Death
DIAGNOSTIC TESTS: Decreased Serum Sodium & Serum
Chloride Levels
THERAPEUTIC INTERVENTIONS:
Saline IVF for hyponatremia without fluid excess
Fluid restriction for fluid excess
Strictly monitor I & O
Daily weights
Steroids for cerebral edema
HYPERNATREMIA
CAUSE: Intake of too much sodium, Inability to excrete
sodium as in renal failure, Decrease in the amount of fluid
in the intravascular space.
SIGNS & SYMPTOMS:
Thirst, Irritability, Tremors, Other signs and symptoms of
hypernatremia are vague and nonspecific until severe excess
is present, Mental status changes such as agitation,
confusion, and personality changes, Seizures
COMPLICATIONS: Respiratory arrest, Coma
DIAGNOSTIC TEST: Serum sodium level
THERAPEUTIC INTERVENTIONS: Fluid imbalance
should be treated first if it accompanies hypernatremia,
Diuretics, Dialysis, I & O, Monitoring of daily weights,
Sodium-restricted diet
POTASSIUM
Is the most common electrolyte in the ICF compartment.
Only a small amount is found in the blood stream, 3.5-5.0
mEq/L because minimal changes cause major changes in
the body.
Is especially important for cardiac muscle, skeletal muscle,
and smooth muscle function.
HYPOKALEMIA
When serum potassium levels fall, the body attempts to
compensate by moving potassium from the cells into the
bloodstream.
CAUSE:
Inadequate intake of potassium, Severe vomiting, diarrhea,
prolonged GI suction, Hemorrhage, Use of medications such
as Potassium-losing diuretics (Furosemide), Digitalis
(Digoxin), and Corticosteroids (Prednisone)
SIGNS & SYMPTOMS:
Muscle cramps, Respirations that are ineffective and
shallow, Pulse is weak, irregular, and thread, Dysrhythmia,
Orthostatic hypotension, Lethargy, Slowed GI motility
resulting nausea, vomiting, abdominal distention, and
constipation
COMPLICATIONS: Respiratory failure, Cardiac arrest,
Coma, Death
DIAGNOSTIC TESTS: Serum potassium level, ECG shows
cardiac dysrhythmia, Increase serum pH of blood
(Metabolic Alkalosis)
THERAPEUTIC INTERVENTIONS: Potassium
replacement - Oral supplements for mild to moderate
hypokalemia and IV Potassium for severe hypokalemia (DO
NOT GIVE IV PUSH), Monitor laboratory values, Increase
intake of potassium-rich foods
HYPERKALEMIA
It rarely occurs in a person with healthy kidneys.
CAUSE: Excessive intake of oral or IV potassium
supplements, Use of potassium-sparing diuretics, Renal
failure, Massive tissue trauma, Metabolic acidosis such as in
uncontrolled Diabetes Mellitus
SIGNS & SYMPTOMS:
Muscle twitching, cramps, profound muscular weakness,
increased GI motility, slow, irregular heart rate, decreased
BP
COMPLICATIONS: Cardiac dysrhythmias, Respiratory
failure, Death
DIAGNOSTIC TESTS: Serum potassium level, irregular
ECG, Serum pH falls below 7.35 (Metabolic acidosis)
THERAPEUTIC INTERVENTIONS:
Dietary limitation of potassium-rich foods, Discontinue
potassium supplements, Potassium-losing diuretics (for
those with healthy kidneys), Administer Sodium polysterene
sulfonate (Kayexalate) to release sodium and absorb
potassium for excretion through the feces, Cardiac
monitoring
CALCIUM
Is primarily stored in bones and teeth, and small amount is
found in ECF.
NORMAL VALUE: 9 to 11 mg/dL or 4.5 to 5.5 mEq/L
Is needed for the proper function of excitable tissues
especially cardiac muscle, and is required for adequate
blood clotting.
HYPOCALCEMIA
CAUSE: Poor intake of calcium-containing foods,
Decreased estrogen level such those in Postmenopausal
women, Crohn`s disease, Insufficient intake of vitamin D,
Partial or complete surgical removal of the thyroid or
parathyroid glands, Hyperphosphatemia usually in those
with renal failure
SIGNS & SYMPTOMS:
Increased and irregular heart rate, Mental status changes,
Hyperactive deep tendon reflexes, Increased GI motility
including diarrhea and abdominal cramping.
Two Classic Signs:
TROUSSEAU`S SIGN
Is confirmed when the patient`s hand & fingers become
spastic and go into palmar flexion when an blood pressure
cuff is inflated in patient`s arm for 1 to 4 minutes.
CHVOSTEK`S SIGN
Is positive when the patient has a facial twitching when the
examiner tap`s the face just below and in front of the ear.
COMPLICATIONS: Seizures, Laryngospasms, Respiratory
failure, Cardiac failure, Death
DIAGNOSTIC TESTS: Serum calcium levels, Abnormal
ECG, Increased parathyroid hormone levels.
THERAPEUTIC INTERVENTIONS:
Oral calcium supplements with or without vitamin D to be
administered 1-2 hours after meals.
For severe hypocalcemia, IV Calcium Gluconate or Calcium
Chloride
For those with hyperphosphatemia, administer Aluminum
Hydroxide to bind the excess phosphate for elimination via
the GI tract.
Increase intake of calcium-rich foods.
HYPERCALCEMIA`
CAUSE: Excessive intake of calcium or vitamin D, Renal
failure, Hyperparathyroidism, Metastatic Cancer, Overuse
or prolonged use of Thiazide Diuretics
SIGNS & SYMPTOMS: Increased heart rate and blood
pressure, Skeletal muscle weakness, Decreased GI motility,
Decreased blood clotting capacity
COMPLICATIONS: Renal calculi, Respiratory failure,
Dysrhytmia, Cardiac failure
THERAPEUTIC INTERVENTIONS:
Increase intake of fluid, Saline IV infusions
Discontinue thiazide diuretics. Give Furosemide (Lasix)
instead.
Administer drugs that bind with calcium to lower calcium
levels may also be used such as Plicamycin (Mithramycin)
If hypercalcemia is so severe, hemodialysis can be
performed.
MAGNESIUM
It works together with calcium for the proper functioning of
excitable cells such as cardiac muscle and nerve cells.
Therefore, imbalance of magnesium is usually accompanied
by an imbalance of calcium.
NORMAL VALUE: 1.3 to 2.1 mEq/L
HYPOMAGNESEMIA
CAUSE: Decreased intake of magnesium, Excessive loss of
magnesium due to renal failure, Malnutrition, Starvation
diets, Severe diarrhea, Crohn`s Disease, Alcoholism,
Overuse of drugs that can increase renal excretion of
magnesium such as Loop and osmotic diuretics and
Aminoglycosides
SIGNS & SYMPTOMS: Similar to that of hypocalcemia.
COMPLICATIONS: Dysrhythmia, Cardiac failure
THERAPEUTIC INTERVENTIONS: Administer
Magnesium sulfate intravenously. If serum calcium level is
also low, Calcium replacement is prescribed
HYPERMAGNESEMIA
CAUSE: Increase intake of magnesium, Decreased renal
excretion caused by renal failure
SIGNS & SYMPTOMS: (Signs and symptoms are not
apparent until the serum level is greater than 4 m!"#$
Bradycardia, dysrhythmia, hypotension, lethargy,
drowsiness, skeletal muscle weakness
COMPLICATIONS: Respiratory failure, Cardiac failure,
Coma
THERAPEUTIC INTERVENTIONS:
Administer Loop Diuretics such as Furosemide (Lasix),
Provide IV fluids, Dialysis