KESEIMBANGAN CAIRAN DAN

ELEKTROLIT
 Massa Tubuh Total

ICF = Intra cellular fluid = CIS = cairan

intra selular
45% 40% ECF = extra cellular fluid = CES = cairan
Solids Solids ekstra selular

2/3 ICF
55% 60%
Fluids Fluids
Cairan
80% interstisial
1/3 ECF
20% Plasma

Perempuan Laki-laki
CES dibagi:

Cairan interstitial : cairan disekitar sel tubuh dan limfe

(cairan dlm pembuluh limfe) gabungan kedua cairan ini
mancapai ¾ CES

Plasma darah : bgn cair dari darah mencapai ¼ CES

Cairan transseluler : seluruh cairan tubuh yg dipisahkan

dari CES oleh lapisan sel epitel. Sekitar 1%-3% berat badan
Komposisi kompartemen cairan
1. CES
- Ion natrium dan klorida serta bikarbonat dlm jumlah
besar tapi sedikit ion kalium, kalsium, magnesium, fosfat,
sulfat, dan asam organik
- Pd plasma konsentrasi protein lebih banyak
- Pd cairan interstitial mengandung sedikit protein
2. CIS
- Ion kalium intraseluler berkonsentrasi tinggi dan ion
natrium intraseluler berkonsentrasi rendah
- konsentrasi protein dlm sel tinggi yi sekitar 4x
konsentrasi dlm plasma
 Perpindahan cairan dan elektrolit

1. Difusi
perpindahan molekul dari tekanan/konsentrasi tinggi
ketekanan/konsentrasi rendah
2. Osmosis
perpindahan air dari konsentrasi zat terlarut rendah
ke konsentrasi zat terlarut tinggi
3. Transport aktif
perpindahan molekul dari tekanan/konsentrasi
rendah ke konsentrasi tinggi dgn menggunakan energi
metabolik yg diperoleh dari reaksi kimia seluler
4. Transport pasif
proses fisik yg tdk perlu mengeluarkan energi seluler
ataupun metabolik tapi memakai sumber energi
eksternal, misalnya panas
Sumber-sumber cairan (input & output)
2500 GIT 100 ml
Metabolik 300 ml
Paru 300 ml
2000 Makanan
700 ml Kulit 600 ml

1500

1000
Minum Ginjal
1600 ml 1500 ml
500 Input

Output
0

• Metabolik  respirasi seluler aerobik (produksi ATP)

 sintesis dehidrasi
(glukosa + fruktosa  sukrosa + H2O)
 Dehidrasi

Saliva Osmolaritas darah Volume darah

Mulut & pharynx Stimulasi osmoreseptor

kering Tekanan darah
hypothalamus
Produksi renin oleh
Sel2 juxtaglomeral
ginjal

Stimulasi pusat
Angiotensin II
Haus hypothalamus

Rasa haus Minum Cairan tubuh

Regulasi Pemasukan Cairan

 KESEIMBANGAN ELEKTROLIT

1. Natrium
- sumber utama natrium adlh makanan
- asupan bervariasi mulai dari 4 grm-20 grm NaCl
- Natrium dikeluarkan mll kulit, ginjal, dan sluran
gastrointestinal
- keseimbangan Na positif tjd jika asupan melebihi
keluaran, krn air terikat dgn natrium maka volume
CES dan plasma akan meningkat maka akan tjd
edema
- keseimbangan Na negatif tjd jika keluaran melebihi
asupan akan menyebabkan penurunan CES dan
plasma shg tekanan darah turun
Pengaturan Natrium

-GFR (glumerular filtration rate) mengatur jumlah

natrium yg difiltrasi
~ Penurunan tekanan darah mengakibatkan
vasokontriksi arteriol aferen yg mengurangi aliran
darah kedlm glomerulus, shg GFR menurun,
jumlah natrium yg difiltrasi berkurang dan shg
jumlah natrium dan air yg diekskresi berkurang
- Aldosteron menstimulasi reabsorpsi ion natrium
~ sistem renin-angiotensin-aldosteron
Renin dilepas dari aparatus juktaglomerular ginjal
kemudian renin akan bergabung dgn angiotensinogen
angiotensin I angiotensin II menstimulasi pelepasan
aldosteron
menstimulus sekresi ADH
dan ACTH
adalah vasokonstriktor kuat
yg menyebabkan tekanan
darah meningkat
2. Kalium
- kalium penting utk aktivitas listrik saraf dan jaringan
otot
- pengaturan kadar kalium darah dikendalikan oleh
aldosteron dan hormon lain yg menstimulasi asupan
kalium adlh hormon insulin dan epinefrin
3. Kalsium dan fosfat
- kalsium adlh elektrolit ekstraseluler
- kalsium berada dlm rangka, tempat berikatan dgn
fosfat dlm btk kristal
- fosfat dlm CIS tinggi sedangkan dlm CES rendah
- fungsi kalsium selain berperan dlm pembentukan tulang
juga dlm motilitas sel, pembekuan darah, kontraksi otot,
dan fungsi saraf
- fosfat ditemukan pd ATP
- fosfat dlm jumlah normal sekitar 3mg/kgBB/hari
- fosfat diplasma difiltrasi diglomerulus kemudian
dikemudian direabsorpsi dan diserap diduedenum
- pengaturan adlh oleh hormon paratiroid, kalsitonin,
vitamin D
 Konsentrasi Elektrolit & Anion Protein di Plasma, Cairan
Interstisial, dan Cairan Intrasel
mEq/L

Plasma

175 Cairan interstisial

Cairan intra sel
150 142 145 140

125 100 117 3

2 2 100
100

75
20 2 50
50 2 2 35 24 27 15

1 1 20
25 10
5 3 0.2
44

0
Na+ K+ Ca+2 Mg+2 Cl- HCO3- HPO42- SO42- Anion
Protein
FLUIDS and ELECTROLYTES

ELECTROLYTES
Hyponatremia [Na+ < 135 mEq/L; Normal = 135-145 mEq/L]

 Causes
  Na+ intake
  Na+ excretion [diaphoresis, GI suctioning]
 Adrenal insufficiency

 Assessment
 N & V, abdominal cramps, weight loss
 Cold, clammy skin,  skin turgor
 Apprehension, HA, convulsions, focal
neurologic deficit, coma [cerebral edema]
 Fatigue, postural hypotension
 Rapid thready pulse
FLUIDS and ELECTROLYTES

ELECTROLYTES

Hyponatremia [Na+ < 135 mEq/L; Normal = 135-145 mEq/L]

 Management
 Provide foods high in sodium
 Administer NSS IV
 Assess blood pressure frequently
[measure lying down, sitting & standing]
FLUIDS and ELECTROLYTES

ELECTROLYTES

Hypernatremia [Na+ >145 mEq/L; Normal = 135-145 mEq/L]

 Causes
 Excessive, rapid IV adm’n of NSS
 Inadequate water intake/dehydration-most
common cause
 Kidney disease

 Assessment
 Dry, sticky mucus membranes
 Flushed skin
 Rough dry tongue, firm skin turgor
 Intense thirst
 Edema, oliguria to anuria
 Restlessness, irritability [cerebral DHN]
FLUIDS and ELECTROLYTES

ELECTROLYTES

Hypernatremia [Na+ >145 mEq/L; Normal = 135-145 mEq/L]

 Nursing Intervention
 Weigh daily
 Assess degree of edema frequently
 Measure I & O
 Assess skin frequently & institute nursing
measures to prevent breakdown
 Encourage sodium-restricted diet
FLUIDS and ELECTROLYTES

ELECTROLYTES

Hyperkalemia [K+ > 5.5 mEq/L; Normal = 3.5-5.5 mEq/L]

 Causes
 Renal insufficiency
 Adrenocortical insufficiency
 Cellulose damage [burns]
 Infection
 Acidotic states
 Rapid infusion of IV sol’n w/ potassium-
conserving diuretics
FLUIDS and ELECTROLYTES

ELECTROLYTES

Hyperkalemia [K+ > 5.5 mEq/L; Normal = 3.5-5.5 mEq/L]

 Assessment
 Thready, slow pulse
 Shallow breathing
 N & V, diarrhea, intestinal colic
 Irritability
 Muscle weakness, flaccid paralysis
 Numbness, tingling
 Difficulty w/ respiration
FLUIDS and ELECTROLYTES

ELECTROLYTES

Hyperkalemia [K+ > 5.5 mEq/L; Normal = 3.5-5.5 mEq/L]

 Nursing Interventions
 Administer kayexalate as ordered
 Administer/monitor IV infusion of glucose
& insulin
 Control infection
 Provide adequate calories & carbohydrates
 Discontinue IV or oral sources of K+
FLUIDS and ELECTROLYTES

ELECTROLYTES

Hypokalemia [K+ < 3.5 mEq/L; Normal = 3.5-5.5 mEq/L]

 Causes
 Renal insufficiency
 Adrenocortical insufficiency
 Cellulose damage [burns]
 Infection
 Acidotic states
 Rapid infusion of IV sol’n w/ potassium-
conserving diuretics
FLUIDS and ELECTROLYTES

ELECTROLYTES

Hypokalemia [K+ < 3.5 mEq/L; Normal = 3.5-5.5 mEq/L]

 Assessment
 Thready, rapid, weak pulse
 Faint heart sounds
  BP
 Skeletal muscle weakness
  or absent reflexes
 Shallow respirations
 Malaise, apathy, lethargy
 Loss of orientation
 Anorexia, vomiting, weight loss
 Gaseous intestinal distention
FLUIDS and ELECTROLYTES

ELECTROLYTES

Hypokalemia [K+ < 3.5 mEq/L; Normal = 3.5-5.5 mEq/L]

 Nursing Interventions
 Administer K+ supplements to replace
losses
 Be cautious in administering drugs that
are not potassium-sparing
 Monitor acid-base balance
 Monitor pulse, BP and ECG
FLUIDS and ELECTROLYTES

ELECTROLYTES

Hypercalcemia [Ca > 5.8 mEq/L; Normal = 4.5-5.8 mEq/L]

 Causes
 Hyperparathyroidism
 Immobility
 Increased vitamin D intake
 Osteoporosis & osteomalacia [early stages]

 Assessment
 N & V, anorexia, constipation
 Headache, confusion
 Lethargy, stupor
 Decreased muscle tone
 Deep bone/flank pain
FLUIDS and ELECTROLYTES

ELECTROLYTES

Hypercalcemia [Ca > 5.8 mEq/L; Normal = 4.5-5.8 mEq/L]

 Nursing Interventions
 Encourage mobilization
 Limit vitamin D intake
 Limit calcium intake
 Normal saline
 Administer diuretics
 Calcitonin
FLUIDS and ELECTROLYTES

ELECTROLYTES

Hypocalcemia [Ca < 4.5 mEq/L; Normal = 4.5-5.8 mEq/L]

 Causes
 Acute pancreatitis
 Diarrhea
 Hypoparathyroidism
 Lack of vitamin D I the diet
 Long-term steroid therapy

 Assessment
 Painful tonic muscle & facial spasms
 Fatigue, dyspnea
 Laryngospasm, convulsions
 (+) Trousseau’s and Chvostek’s signs
FLUIDS and ELECTROLYTES

ELECTROLYTES

Hypocalcemia [Ca < 4.5 mEq/L; Normal = 4.5-5.8 mEq/L]

 Nursing Interventions
 Administer oral Ca lactate or IV CaCl2 or
gluconate
 Providing safety by padding side rails
 Administer dietary sources of calcium
 Vitamin D
 Provide quiet environment
FLUIDS and ELECTROLYTES

ELECTROLYTES

Hypermagnesemia [Mg > 3.0 mEq/L; Normal = 1.5-3.0

mEq/L]

 Causes
 Renal insufficiency, dehydration
 Excessive use of Mg-containing antacids or
laxatives
 Assessment
 Lethargy, somnolence, confusion
 N&V
 Muscle weakness, depressed reflexes
  pulse and respirations
 Nursing Intervention
 Withhold Mg-cont’ drugs/foods;
  fluid intake, unless CI
FLUIDS and ELECTROLYTES

ELECTROLYTES

Hypomagnesemia [Mg < 1.50 mEq/L; Normal = 1.5-3.0 mEq/L]

 Causes
 Low intake of Mg in the diet
 Prolonged diarrhea
 Massive diuresis
 Hypoparathyroidism
 Assessment
 Paresthesias, muscle spasm
 Confusion, hallucination, convulsions
 Ataxia, tremors, hyperactive deep reflexes
 Flushing of the face, diaphoresis
 Nursing Intervention
 Provide good dietary sources of Mg
Nursing Knowledge Base

 Fluid and electrolyte imbalances can severely affect

infants, as well as the severely ill, disoriented, or
immobile.
 Prolonged or severe compromises may lead to
irreversible chronic health problems.
Nursing Process
Assessment
 Age
 Past medical history
 Environment
 Diet
 Lifestyle
 Medication
Physical Assessment

 Daily weights
 Intake and output
 Laboratory studies
Planning

 Goals and outcomes

 Setting priorities
 Collaborative care
Interventions

 Enteral replacement of fluids

 Restriction of fluids
 Parenteral replacement of fluids
 Total parenteral nutrition
IV Therapy

 Vascular access devices

 Types of solutions