Fluid

And
Electrolyte
Imbalance

Introduction
primary component .

Functions of body water

Water helps regulate the bodys
environment.
Water helps kidneys eliminate
waste.
Water helps keep joints lubricated.
Water helps with oxygenation.
Water helps with digestion.

BODY FLUID COMPARTMENTS

IC
F
EC
F

FLUID
COMPARTMEN
TS

Homeostasis

osmosis

Diffusion

Osmolarity & osmolality

Osmolarity is the number of
moles per liter of solution
(moles/L)
Osmolality is the number of moles
per kg
of solvent (moles/kg)

 When solvent is measure in

LITER OSMOLARITY
When solvent is measure inKILOGRAM - OSMOLALITY

REGULATION OF WATER BALANCE

HYPOTHALAMIC REGULATION
PITUITARY REGULATION
ADRENAL CORTICAL REGULATION
RENAL REGULATION
CARDIAC REGULATION
GASTROINTESTINAL REGULATION
INSENSIBLE WATER LOSS

solutions

Isotonic

Hypotonic

Hypertonic

Isotonic solution
A solution that has the same salt concentration
as the normal cells of the body and the blood.
Ex:
1- 0.9% NaCl .
2- Ringer Lactate .
3- Blood Component .

Hypotonic solution
A solution with a lower salts concentration
than in normal cells of the body and the
blood.
EX:
1-0.45% NaCl.
2- 5% dextrose.

Hypertonic solution
A solution with a higher salts concentration
than in normal cells of the body and the blood.
Ex:
1- D5W in normal
Saline solution .
2-D5W in half normal
Saline .
3- D10W

FLUID
IMBALANCES
DEFICIT
S

EXCESS
ES

Hypovolemia
Abnormal loss of body
fluids and electrolytes.

Causes
Insensible water loss or perspiration.
Diabetes insipidus.
Osmotic diuresis.
Hemorrhage .
GI losses.
Inadequate fluid intake.
Third space fluid shift .

Clinical manifestations
Restlessness, drowsiness , lethargy ,
confusion.
thirst , dry mouth.
skin turgor, capillary refill.
postural hypotension, pulse, CVP.
respiratory rate.
weakness, dizziness.
weight loss , seizures, coma.

Interventions

Prevent further fluid loss

Oral rehydration therapy
IV therapy
Medications; antiemetic, antidiarrheal
Monitor CV, Respiration, Renal, GI status
Monitor electrolytes possible
supplement Rx
Monitor weight and I & O

Hypervolemia
It is increased fluid retention in
the intravascular and interstitial
spaces.

CAUSES
Excessive isotonic and hypotonic IV
fluids.
Heart failure.
Renal failure.
Primary polydipsia.
SIADH.
Cushing syndrome.
long- term use of corticosteroids.

Clinical manifestations
Headache , confusion , lethargy.
Peripheral edema.
Distended neck veins.
Bounding pulse.
Increased BP, CVP.
Polyuria.
Pulmonary edema.
Weight gain .
Muscle spasms.

Interventions
Restore normal fluid balance, prevent
further overload
Drug therapy; diuretics
Diet therapy; decrease Na & fluids
Monitor intake and output (I & O)
Monitor weights
Monitor electrolytes
Monitor CV, Resp, Renal systems

Sodium..

135-145mEq/L
Major Cation
Chief electrolyte of the ECF
Regulates volume of body fluids
Needed for nerve impulse & muscle fiber
transmission (Na/K pump)
Regulated by kidneys/ hormones

Question .
Hyper and Hypo natremia are the most
common electrolyte disturbances. Why do
you think that is?
It is most abundant in the
EXTRACELLULAR FLUID and
therefore more prone to fluctuation.

Hypernatremia
Serum Na+> 145mEq/L
Results from Na+ gained in excess of
H2O OR Water is lost in excess of
Na+
Water shifts from cells to ECF

Management
IV Therapy ( 0.2 % or 0.45 % Nacl )
Diet
Diuretics

Management
IV THERAPY
FLUID
RESTRICTION
DIET

Potassium

3.5-5.0 mEq/L
Chief electrolyte of ICF
Major mineral in all cellular fluids
Aids in muscle contraction, nerve & electrical
impulse conduction, regulates enzyme activity,
regulates IC H20 content, assists in acid-base
balance
Regulated by kidneys/ hormones
Inversely proportional to Na

Hyperkalemia
Serum level > 5 mEq/L.

Management
Medication
IV Therapy
Possible Dialysis

Hypokalemia
Serum level < 3.5mEq/L

Management
Diet
Supplement
IV Therapy

Calcium Ca++
4.5-5.5mEq/L
Most abundant in body but:
99% in teeth and bones
Needed for nerve transmission, vitamin
B12 absorption, muscle contraction &
blood clotting
Inverse relationship with Phosphorus
Vitamin D needed for Ca absorption

Hypercalcemia
Serum Ca >
5.3mEq/L

Management
Medication
IV therapy

Hypocalcemia
Serum Ca < 4.3mEq/L

Positive Trousseaus Sign

CARPAL
SPASM
INDUCED
BY
INFLATING
BP CUFF
ABOVE
SYSTOLIC
PRESSURE

POSITIVE CHVOSTEKS SIGN

TAPPING
FACIAL
NERVE
CAUSES
SPASM OF LIP
AND CHEEK

MANAGEMENT

Diet
IV therapy

MAGNESIUM
1.5-2.5mEq/L
Most located within ICF
Needed for activating enzymes,
electrical activity, metabolism of
carbs/proteins, DNA synthesis
Regulated by intestinal absorption
and kidney

HYPOMAGNESEMIA
Serum < 1.5mEq/L
Results from decreased intake, prolonged
NPO status, chronic alcoholism &
nasogastric suctioning
S/S: muscle weakness, cardiac changes,
mental changes, hyperactive reflexes &
other hypocalcaemia S/S.
Tx: replacement IV therapy
restore normal Ca levels
( Mg mimics Ca) seizure precautions

Hyper magnesemia
Serum>2.5mEq/L
Results from renal failure, increased
intake
S/S: flushing, lethargy, cardiac
changes (decreased HR),decreased
resp, loss of deep tendon reflexes
Tx: restrict intake
diuretic Rx.

Chloride

Cl-

95-105mEq/L
Most abundant anion in ECF
Combines with Na to form salts
Maintains water balance, acid-base
balance, aids in digestion (hydrochloricacid) & osmotic pressure
Regulated by kidneys
Follows Sodium (Na)

Hypochloremia
Serum level 96mEq/L
Results from prolonged vomiting &
suctioning
S/S metabolic alkalosis, nerve
excitability, muscle cramps, twitching,
hypoventilation, decreased BP if severe
Tx: diet/IV therapy

Hyperchloremia
Serum level > 106mEq/L
Results from excessive intake or retention
by kidneys metabolic acidosis
S/S Arrhythmias, decreased cardiac
output, muscle weakness, LOC changes,
Kussmaulss respirations
Tx: restore fluid & electrolyte balance

Phosphate PO4 2.5-4.5mg/dl

Needed for acid-base balance,neurological &
muscle function, energy transfer ATP & affects
metabolism of carbs/proteins/lipids, B vitamin
synthesis
Found in the bones
Regulated by intake and kidneys
Inversely proportional to Calcium.

Hypophosphatemia
Serum level < 1.8mEq/L
Results from decreased intestinal
absorption and increased excretion
S/S bone & muscle pain, mental
changes, chest pain, resp. failure
Tx: Diet/ IV therapy

Hyperphosphatemia
Serum level> 2.6mEq/L
Results from renal failure, low intake of
calcium
S/S: neuromuscular changes (tetany), EKG
changes, paresthesia fingertips/mouth
Tx: Diet; hypocalcemic interventions
Medications: phosphate binding
The body can tolerate hyperphosphatemia
fairly well BUT the accompanying
hypocalcemia is a larger problem!

Electrolyte homeostasis
This means to maintain balance to
control by balancing the dietary intake of
electrolytes with the renal excretion and
reabsorption of electrolytes

Interventions for F/E balance

Assess patient carefully- note changes

Monitor I & O (Intake & Output)
Monitor weight changes
Monitor urine
Monitor lab results and dx test
Maintain proper IV therapy

Management
Treat the
underlying
causes

Summary
Fluid compartments in the body must
balance
Body systems regulate F&E balance
Assessment of body fluid is
important to determine causes of
imbalance
Interventions for imbalances are
based on the causes.