Presentation

Topic
Body Fluids and Electrolytes
by

Rashid Hussain
Post R.N Bsc Nursing

Khyber Medical University

Post Graduate Nursing College Hayatabad Peshawar.

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 Introduction
A cell, together with its environment in any part of
the body, is primarily composed of FLUID.

The cells of our bodies live in a pond, most of the

weight of the human body is water. All of a cell’s
operations rely on water as a diffusion medium for
the distribution of electrolytes, gases, nutrients,
and waste products.

Thus fluid & electrolyte balance must be maintained

to promote normal body functions. Any imbalance
can affect homeostasis. 2
 AIM: To share the knowledge among the
participants about Fluid and Electrolytes
balance
OBJECTIVES:
At the end of presentation the participants will be able
to:

 Describe the different body fluid compartments

(ICF,ECF,IVF).
 Explain movement of body fluids between the
compartments.
 Enlist the normal electrolytes.
 Discuss the imbalance of electrolytes.
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 Body fluid compartments
60% of adult total body weight is fluid

 Intra-cellular  Extra-cellular
 65% of all body  35% of all body
fluid. fluid Three extra-
cellular
compartments.
 1. Intra-vascular
 Special note 8%
 80% TBW infants.  2. Interstitial 25%
 50% TBW  3. Third space
geriatrics. (eyes, joints,plural
space,etc.)2% 4
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 Fluid compartments are separated by
membranes that are freely permeable to
water.
 Movement of fluids due to:
• Hydrostatic pressure
• Osmotic pressure
 Capillary filtration (hydrostatic pressure)
 Capillary colloid osmotic pressure
 Interstitial hydrostatic pressure
 Tissue colloid osmotic pressure
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Regulation of Water Intake

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Tonicity refers to the concentration of particles in
a solution
The normal tonicity or osmolarity of body fluids is
250-300 mOsm/L

•Isotonic Same as plasma

•Hypertonic higher or greater concentration of
solutes

•Hypotonic have a lesser or lowers solute

concentration than plasma

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Cell in a
hypertonic
solution

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Cell in a
hypotonic
solution

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 Movement of body fluids (a.)
Natural movement no energy required.

Osmosis Diffusion
 Movement of solvent,  Movement of solute
H2O across a semi-
permeable (particles) from an
membrane, from an area of higher
area of lesser solute concentration to an
(particle)
area of lower
concentration to an
area of higher solute concentration.
concentration.
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 Movement of body fluids (b.)
Movement requiring energy
(Biochemical Processes)
Active transport Facilitated diffusion
 Movement of a  A Biochemical process
substance across a cell
in which a substance
membrane, through
is selectively
special portals in the
cell wall, from an area transported across a
of less concentration cell membrane using a
to an area of high carrier molecule and
concentration. energy.
 Na+/K+ pump  Insulin/glucose 17
 Electrolytes
Ions = Charged particles

 Cation: Positively  Anion: Negatively

Charged particles.
charged particles.

 Sodium ( Na +)
 Potassium ( K+)
 Calcium (Ca++)
 Magnesium (Mg++)
 Chloride (Cl-)
 Bicarbonate (HCO3-)
 Phosphate (HPO4 -)

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 Serum Values of Electrolytes

Cations Concentration, mEq/L

Sodium 135 - 145

Potassium 3.5 - 4.5
Calcium 4.0 - 5.5
Magnesium 1.5 - 2.5

Anions
Chloride 95 - 105
Bicarbonate 23 - 30
Phosphate 2.5 - 4.5

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 Sodium
 Most abundant extracellular cation.
 Regulates body water distribution.
 Aids nerve impulse transmission.
 Aids transfer of POTASSIUM into cells.
 Sodium levels are controlled by the
kidneys

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 Electrolyte balance

 Na +
(Sodium)
• 90 % of total ECF cations

• 136 -145 mEq / L

• Pairs with Cl- , HCO3- to neutralize charge

• Low in ICF

• Most important ion in regulating water balance

• Important in nerve and muscle function

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 Regulation of Sodium

 Renal tubule reabsorption affected by

hormones:

• Aldosterone

• Renin/angiotensin

• Atrial Natriuretic Peptide (ANP)

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Renin-Angiotensin-Aldosterone System

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 summary

water volume sodium osmolality

Thirst ↑Intake ↑ - ↓
center
ADH ↓Output ↑ - ↓

RAAS ↓Output ↑ ↑reabsorption normal

ANP ↑output ↓ ↓ reabsorption normal

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 Electrolyte imbalances: Sodium

 Hypernatremia (high levels of sodium)

• Plasma Na+ > 145 mEq / L

• Due to ↑ Na + or ↓ water

• Water moves from ICF → ECF

• Cells dehydrate
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 Hypernatremia Due to:
• Hypertonic IV soln.

• Oversecretion of aldosterone

• Loss of pure water

 Long term sweating with chronic fever
 Respiratory infection → water vapor loss
 Diabetes – polyuria

• Insufficient intake of water (hypodipsia)

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 Clinical manifestations
of Hypernatremia

 Thirst
 Lethargy
 Neurological dysfunction due to
dehydration of brain cells
 Decreased vascular volume

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 Treatment of Hypernatremia

 Lower serum Na+

• Isotonic salt-free IV fluid

• Oral solutions preferable

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 Hyponatremia
 Overall decrease in Na+ in ECF
 Two types: depletional and dilutional
 Depletional Hyponatremia
Na+ loss:

• diuretics, chronic vomiting

• Chronic diarrhea

• Decreased aldosterone

• Decreased Na+ intake

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 Clinical manifestations of
Hyponatremia
 Neurological symptoms
• Lethargy, headache, confusion, apprehension,
depressed reflexes, seizures and coma

 Muscle symptoms
• Cramps, weakness, fatigue

 Gastrointestinal symptoms
• Nausea, vomiting, abdominal cramps, and diarrhea

 Tx – limit water intake or discontinue meds 32 32

 Potassium

 Most abundant intracellular cation.

 Necessary for transmission and conduction
of nerve impulses.
 Maintenance of normal cardiac rhythm.
 Necessary for smooth and skeletal muscle
contraction.

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 Hyperkalemia

 Serum K+ > 5.5 mEq / L

 Check for renal disease
 Massive cellular trauma
 Insulin deficiency
 Potassium sparing diuretics
 Decreased blood pH
 Exercise causes K+ to move out of cells
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 Clinical manifestations of
Hyperkalemia
 Early – hyperactive muscles , paresthesia
 Late - Muscle weakness, flaccid paralysis
 Change in ECG pattern
 Dysrhythmias
 Bradycardia , heart block, cardiac arrest

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Changes in ECG due to
Hyperkalemia

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 Treatment of Hyperkalemia

 If time, decrease intake and increase renal

excretion
 Insulin + glucose
 Bicarbonate
 Dialysis

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 Hypokalemia

 Serum K+ < 3.5 mEq /L

 Beware if diabetic

• Insulin gets K+ into cell

• Ketoacidosis – H+ replaces K+,

which is lost in urine

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 Causes of Hypokalemia

 Decreased intake of K+
 Increased K+ loss

• Chronic diuretics

• Acid/base imbalance

• Trauma and stress

• Increased aldosterone
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Clinical manifestations of Hypokalemia
 Neuromuscular disorders

• Weakness, flaccid paralysis, respiratory arrest,

constipation
 Dysrhythmias, appearance of U wave
 Postural hypotension
 Cardiac arrest
 Treatment-

• Increase K+ intake, but slowly, preferably by

foods 40
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 Calcium

 Extracellular cation
 Plays role in nerve impulse transmission.
 Increases force of muscle contractions.
 Functions as an enzyme co-factor in blood
clotting.
 Necessary for structure of bone and teeth.
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 Calcium Imbalances
 Most in ECF
 Regulated by:

• Parathyroid hormone
 ↑Blood Ca++ by stimulating osteoclasts
 ↑GI absorption and renal retention

• Calcitonin from the thyroid gland

 Promotes bone formation
 ↑ renal excretion
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 Hypercalcemia
 Results from:
• Hyperparathyroidism

• Hypothyroid states

• Renal disease

• Excessive intake of vitamin D

• Certain drugs

• Malignant tumors – hypercalcemia of malignancy

 Tumor products promote bone breakdown
 Tumor growth in bone causing Ca++ release 43
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 Hypercalcemia
 Usually also see hypophosphatemia
 Effects:
• Many nonspecific – fatigue, weakness, lethargy
• Increases formation of kidney stones and pancreatic
stones
• Muscle cramps
• Bradycardia, cardiac arrest
• GI activity also common
 Nausea, abdominal cramps
 Diarrhea / constipation

• Metastatic calcification 44
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 Hypocalcemia
 Hyperactive neuromuscular reflexes and
tetany differentiate it from hypercalcemia
 Convulsions in severe cases
 Caused by:
• Renal failure
• Lack of vitamin D
• Suppression of parathyroid function
• Hypersecretion of calcitonin
• Malabsorption states
• Abnormal intestinal acidity and acid/ base bal.
• Widespread infection or peritoneal inflammation45
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 Hypocalcemia
 Diagnosis:
• Chvostek’s sign

• Trousseau’s sign

 Treatment:
• IV calcium for acute

• Oral calcium and vitamin D for chronic

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 Bicarbonate
 Principle buffer of body pH. (extracellular)
 Neutralizes acids.
 Plays important role in acid / base balance.
 Acts as chemical sponge to soak up Hydrogen
ions. (Acidic metabolic waste) For every one
Hydrogen ion twenty bicarbonate ions are
released to maintain balance.

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 Phosphate

 Plays an important role in ATP

storage.
 Chief intracellular buffer acts to
maintain intracellular pH.

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 References

 Martini,H.Frederic; Fundamental of Anatomy and

Physiology, Thrid edtion, 1995.
 http://www.scribd.com/doc/5525384/Fluids-and-
Electrolytes
 http://www.scribd.com/doc/13016483/phathophy
siology2Water-and-Electrolytes-balance-and-
imbalance

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Teach those who
want to learn
but Learn from
everyone
(Rashid)
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 Success is never
permanent, and Failure
is never final. So don’t
stop effort until your
“VICTORY” makes
“HISTORY”
(Hitler)
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