Bulacan State University

COLLEGE OF NURSING
City of Malolos, Bulacan

NCM 102B (RLE):

FLUIDS AND ELECTROLYTES
BLOOD TRANSFUSION COMPONENTS

I. Amount and Composition of Body Fluids

A. Body Fluids Per Compartments
1. Intracellular Fluids (ICF) 70%; fluids inside the cells
2. Extracellular Fluids 30%; fluids outside the cells, between cells,
and cavities
a. Interstitial Fluids (ISF) fluids between cells
b. Intravascular Fluids (IVF) blood plasma
c. Transcellular Fluids (TF) CSF, serosa, synovial fluids, humors
of the eyeball, digestive juices, urine
B. Body Water Distribution According to Age and Sex
1. Infant 80% of body weight
2. Male adult 60% of body weight
3. Female adult 50% of body weight
4. Old 45-55% of body weight
C. Functions of Body Water
ECF maintains blood volume; transport system to and from the
cell
ICF internal aqueous medium for cellular chemical function
Maintenance of normal body temperature
Elimination of waste products
D. Factors that Affects Total Body Water
1. Age
2. Gender
3. Input and Output
Ways for Fluid Output:
i. Sensible fluid loss
ii. Insensible fluid loss
II. Organs for Fluid Loss
1. Kidney
1-2 L of urine output in adults
General rule : 1ml of urine/kg/hr
E.g. 70 kg=70ml
2. Skin Accounts on insensible fluid loss via sweat; 600ml/day
3. Lungs Water vapor from respiration; 300ml/day
4. GIT 100-200ml/day
INTAKE OUTPUT
Oral Fluid 1,200mL Urine output 1,500mL
Water on foods 1000mL Stool 200mL
Water in 300mL Skin 500mL
Metabolism
Total 2,500mL Lungs 300mL
 Total 2,500mL

III. Fluid Movements Between Compartments

1. Passive Transport Mechanism
a. Diffusion transport of solutes from area of concentration to
area of concentration across a semi-permeable membrane
b. Osmosis transport of solvent from area of concentration to
area of concentration across a semi-permeable membrane
c. Facilitated Diffusion diffusion possible for water-soluble
particles only. E.g. Vitamin C, glucose, amino acids
2. Active Transport Mechanism
a. Sodium Potassium Pump transport of Na+ and K+ into and out
of the cell requiring an energy (ATP) to cause the movement
3. Hydrostatic Pressure
- The pushing force of the blood pressing against the blood
vessels walls.
4. Oncotic pressure/colloid osmotic pressure
- Pressure needed to overcome the pull of CHON. E.g. albumin
- Pull or absorb fluid from interstitial spaces

IV. Fluid Movements Between Compartments

5. Passive Transport Mechanism
d. Diffusion transport of solutes from area of concentration to
area of concentration across a semi-permeable membrane
e. Osmosis transport of solvent from area of concentration to
area of concentration across a semi-permeable membrane
f. Facilitated Diffusion diffusion possible for water-soluble
particles only. E.g. Vitamin C, glucose, amino acids
6. Active Transport Mechanism
b. Sodium Potassium Pump transport of Na+ and K+ into and out
of the cell requiring an energy (ATP) to cause the movement
7. Hydrostatic Pressure
- The pushing force of the blood pressing against the blood
vessels walls.
8. Oncotic pressure/colloid osmotic pressure
- Pressure needed to overcome the pull of CHON. E.g. albumin
- Pull or absorb fluid from interstitial spaces

V. Fluid Concentration
Osmolarity concentration of solute per liter of solution
Osmolality concentration of solute per kg of solution; concentration of
particles
- 275 295mOsm/kg
Serum osmolality concentration of particles in the plasma
Tonicity the effect of water/solution on the waters osmotic pressure
1. Osmotic Pressure the power of a solution to draw water across a
semi-permeable membrane (e.g. cell membrane)
- osmotic pressure : pulling force
- Cell shrinks if on osmotic pressure (hypertonic)
- Cell swells if on osmotic pressure (hypotonic)
 - E.g. Red blood cell: if exposed on hypotonic solution will swell
If exposed on hypertonic solution will shrink
2. Tonic Solution
a. Isotonic solution
No fluid movement or change in volume within the cell
No change on the cell size
E.g. Plain NSS or 0.9 NaCl, D5W
Indication: for intravenous dehydration
b. Hypotonic solution
solute concentration than the blood plasma
When exposed to hypotonic solution, cells will swell
E.g. 0.45 NaCl, Plain LR
Indication: for intracellular dehydration
c. Hypertonic solution
solute concentration than plasma
When exposed to hypertonic solution, cells will shrink
E.g. D5LR, D10W, D5NSS
Indication: for intracellular overload

VI. Mechanisms That Control Body Fluids

1. Thirst
2. Kidneys
3. ADH
4. RAAS (Renin Angiotensin Aldosterone - System)
5. Atrial Natriuretic Hormone, Baroreceptors, Osmoreceptors

VII. Fluid Imbalances

Two Types
1. Fluid Volume Deficit
2. Fluid Volume Excess
 (Must Familiarize and
Common IV Fluids
Remember!!!)
 VIII. Electrolytes
Chemical compounds in solution that have the ability to conduct an
electrical current
Break into charged particles called ions
Positively charged ions (CATIONS); negatively charged ions
(ANIONS)
Major Extracellular Cation Na+ (Sodium); Major Intracellular Anion
Cl- (Chloride)
Major Intracellular Cation K+ (Potassium); Major Extracellular Anion
HPO4- (Phosphate)

NORMAL LABORATORY VALUES FOR ELECTROLYTES

Na (Sodium) 135 145 mEq/L
K (Potassium) 3.5 5mEq/L
Ca (Calcium) 4.5 5.5 mEq/L
HPO4 (Phosphate) 1.7 2.6 mEq/L
Cl (Chloride) 98 108mEq/L
Mg (Magnesium) 1.5 2.5 mg/dL

General Functions of Electrolytes

1. Promote neuromuscular activity
2. Maintain body fluid volume and osmolality
3. Distribute body water between fluid compartments
4. Regulate acid base balance

IX. Blood Transfusion Components

Indication for Treatment with Blood Components

Component Volume Infusion Time Indications

Packed Red Blood 200-250 mL 2-4hr Anemia ;

Cells (PRBCs) hemoglobin <6
g/dL, 6-10 g/dL,
depending on the
symptoms

Washed Red Blood 200 Ml 2-4hr History of allergic

Cells (WBC-poor transfusion
PRBCs) reactions; Bone
marrow transplant
clients

Platelets (Pooled) Approximately 300 15-30 min Thrombocytopenia;

mL platelet count
<20,000

Whole Blood 350 - 450 mL 4 hr (less in high Emergent

 ambient restoration of
temperature) circulating volume;
massively bleeding
patient

Fresh Frozen 200 mL 15-30 min Deficiency in

Plasma plasma coagulation
factors;

Prothrombin or
partial
thromboplastin
time 1.5 times
normal

Cryoprecipitate 10-20 mL/unit 15-30min Hemophilia VIII or

von Willebrands
disease; Fibrinogen
levels < 100mg/dL

White Blood Cells 400mL 1 hr Sepsis, neutropenic

infection not
responding to
antibiotic therapy

Prepared by:

John Paul E Mendoza RN MAN