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FLUIDS AND ELECTROLYTESIntroduction
To maintain good health, a balance of fluids and electrolytes, acids and bases must be normallyregulated for metabolic processes to be in working state.
A cell, together with its environment in any part of the body, is primarily composed of FLUID.
Thus fluid and electrolyte balance must be maintained to promote normal function. Potential andactual problems of fluid and electrolytes happen in all health care settings, in every disorder and witha variety of changes that affect homeostasis.
The nurse therefore needs to FULLY understand the physiology and pathophysiology of fluid andelectrolyte alterations so as to identify or anticipate and intervene appropriately.
Fluids -
a solution of solvent and solute
Solvent -
a liquid substance where particles can be dissolved
Solute -
a substance, either dissolved or suspended in a solution
Solution
a homogeneous mixture of 2 or more substances of dissimilar molecular structure
usually applied to solids in liquids but applies equally to gasses in liquids
Body FluidsA.Function
1.Transporter of nutrients , wastes, hormones, proteins and etc2.Medium or milieu for metabolic processes3.Body temperature regulation4.Lubricant of musculoskeletal joints5.Insulator and shock absorber 
B.Body Fluid CompartmentsC.Body Compartment Volumes
neonates reach adult values by 2 yrs and are about half-way by 3 months
average values ~ 70 ml/100g of lean body mass
 percentage of water varies with tissue type,A.lean tissues ~ 60-80%B.bone ~ 20-25%C.fat ~ 10-15%
D.Tonicity of Body Fluids
Tonicity refers to the concentration of particles in a solution
The normal tonicity or osmolarity of body fluids is 250-300 mOsm/L1.Isotonic
Same as plasma2.Hypotonic
have a lesser or lowers solute concentration than plasma3.Hypertonic
higher or greater concentration of solutes
Osmole
the weight in grams of a substance producing an osmotic pressure of 22.4 atm. when dissolved in 1.0litre of solution
(gram molecular weight) / (no. of freely moving particles per molecule)
Osmolality
the number of osmoles of solute per kilogram of solvent
Osmolarity
the number of osmoles of solute per litre of solution
Mole
that number of molecules contained in 0.012 kg of C12, or,
the molecular weight of a substance in grams =
 Avogadro's number 
= 6.023 x 1023
Molality
the number of moles of solute per kilogram of solvent
Molarity
is the number of moles of solute per litre of solution
THE
 Normal 
DYNAMICS OF BODY FLUIDS
The methods by which electrolytes and other solutes move across biologic membranes are Osmosis,Diffusion, Filtration and Active Transport. Osmosis, diffusion and filtration are passive processes, whileActive transport is an active process.
1.OSMOSIS
This is the movement of water/liquid/solvent across a semi-permeable membrane from a lesser concentration to a higher concentration
Osmotic pressure is the power of a solution to draw water across a semi-permeable membrane
 
Colloid osmotic pressure (also called oncotic pressure) is the osmotic pull exerted by plasma proteins
2.DIFFUSION
“Brownian movement” or “downhill movement”
The movement of particles/solutes/molecules from an area of higher concentration to an area of alower concentration
This process is affected by:a. The size of the molecules- larger size moves slower than smaller size b. The concentration of solution- wide difference in concentration has a faster rate of diffusionc. The temperature- increase in temperature causes increase rate of diffusion
Facilitated Diffusion is a type of diffusion, which uses a carrier, but no energy is expended. Oneexample is fructose and amino acid transport process in the intestinal cells. This type of diffusionis saturable.
3.FILTRATION
This is the movement of 
BOTH 
solute and solvent together across a membrane from an area of higher pressure to an area of lower pressure
Hydrostatic pressure is the pressure exerted by the fluids within the closed system in the walls of the container 
4.ACTIVE TRANSPORT
Process where substances/solutes move from an area of lower concentration to an area of higher concentration with utilization of ENERGY
It is called an “uphill movement”
Usually, a carrier is required. An enzyme is utilized also.
Types of Active Transport:
a.Primarily Active Transport
Energy is obtained directly from the breakdown of ATP
One example is the Sodium-Potassium pump b.Secondary Active Transport
Energy is derived secondarily from stored energy in the form of ionic concentration difference between two sides of the membrane.
One example is the Glucose-Sodium co-transport; also the Sodium-Calcium counter-transport
THE REGULATION OF BODY FLUID BALANCE
To maintain homeostasis, many body systems interact to ensure a balance of fluid intake and output.A balance of body fluids normally occurs when the fluid output is balanced by the fluid input
Overview of Fluid Regulation by the Body SystemsA.Systemic Regulators of Body Fluids
1.
Renal Regulation (RAS)
This system regulates sodium and water balance in the ECF
The formation of urine is the main mechanism
Substance released to regulate water balance is RENIN. Renin activates Angiotensinogen toAngiotensin-I, A-I is enzymatically converted to Angiotensin-II ( a powerful vasoconstrictor)
 
2.
Endocrine Regulation
The primary regulator of water intake is the thirst mechanism
, controlled by the thirst center in thehypothalamus (anterolateral wall of the third ventricle)
Anti-diuretic hormone (ADH) is synthesized by the hypothalamus and acts on the collecting ducts of the nephron
ADH increases rate of water reabsorption
The adrenal gland helps control F&E through the secretion of ALOSTERONE- a hormone that promotes sodium retention and water retention in the distal nephron
ATRIAL NATRIURETIC factor (ANF) is released by the atrial cells of the heart in response toexcess blood volume and increased wall stretching. ANF promotes sodium excretion and inhibitsthirst mechanism
3.
Gastro-intestinal regulation
The GIT digests food and absorbs water 
The hormonal and enzymatic activities involved in digestion, combined with the passive and activetransport of electrolyte, water and solutions, maintain the fluid balance in the body.
B.Fluid Intake
Healthy adult ingests fluid as part of the dietary intake.
90% of intake is from the ingested food and water 
10% of intake results from the products of cellular metabolism
Usual intake of adult is about 2, 500 ml per day
The other sources of fluid intake are: IVF, TPN, Blood products, and colloids
C.Fluid Output
The average fluid losses amounts to 2, 500 ml per day, counterbalancing the input.
The routes of fluid output are the following:
SENSIBLE LOSS- Urine, feces or GI losses, sweat
INSENSIBLE LOSS- though the skin and lungs as water vapor 
URINE- is an ultra-filtrate of blood. The normal output is 1,500 ml/day or 30-50 ml per hour or 0.5-1 ml per kilogram per hour. Urine is formed from the filtration process in the nephron
FECAL loss- usually amounts to about 200 ml in the stool
Insensible loss- occurs in the skin and lungs, which are not noticeable and cannot be accuratelymeasured. Water vapor goes out of the lungs and skin.
Water Metabolism
Daily Balance: turnover ~ 2500 mla. Intake
•
drink ~ 1500 ml
•
food ~ 700 ml
•
metabolism ~ 300 ml b. Losses
•
urine ~ 1500 ml
•
skin ~ 500 ml
•
insensible losses ~ 400 ml
•
sweat ~ 100 ml
•
lungs ~ 400 ml
•
faeces ~ 100 mlMinimum daily intake ~ 500 ml with a "normal" dietMinimum losses ~ 1500 ml/dLosses are increased with;a. increased ambient T b. hyperthermia ~ 13% per °Cc. decreased relative humidityd. increased minute ventilatione. increased MRO2
FLUID IMBALANCESFluid Volume Deficit or Hypovolemia
Definition: This is the loss of extra cellular fluid volume that exceeds the intake of fluid. The loss of water and electrolyte is in equal proportion. It can be called in various terms- vascular, cellular or intracellular dehydration. But the preferred term is
hypovolemia.
Dehydration refers to loss of WATER alone, with increased solutes concentration and sodiumconcentrationPathophysiology of Fluid Volume Deficit
Etiologic conditions include:1.Vomiting2.Diarrhea
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