FLUID AND ELECTROLYTE IMBALANCES
Body fluid is composed primarily of water and electrolytes. The body is equipped with homeostatic mechanisms tokeep the composition and volume of body fluids within narrow limits. Organs involved in this mechanism includethe kidneys, lungs, heart, blood vessels, adrenal glands, parathyroid glands, and pituitary gland. Body fluid isdivided into two types: intracellular (within the cells) and extracellular (interstitial or tissue fluid, intravascular or plasma, and transcellular, such as cerebrospinal or synovial fluids).
All plans of care specific to underlying health condition causing imbalance, e.g., DM, HF, upper GI bleeding, renalfailure/dialysis.Metabolic acidosisMetabolic alkalosisRespiratory acidosisRespiratory alkalosis
1. Restore homeostasis.2. Prevent/minimize complications.3. Provide information about condition/prognosis and treatment needs as appropriate.
1. Homeostasis restored.2. Free of complications.3. Condition/prognosis and treatment needs understood.4. Plan in place to meet needs after discharge.
Because fluid and electrolyte imbalances usually occur in conjunction with other medical conditions, thefollowing information is offered as a reference. The interventions are presented in a general format for inclusion inthe primary plan of care.
Total body water, essential for metabolism, declines with age and also varies with body fat content and gender. Itconstitutes about 80% of an infant’s body weight, 60% of an adult’s, and as little as 40% of an older person’sweight.
Hypervolemia (Extracellular Fluid Volume Excess)
Excess sodium intake including sodium-containing foods, medications, or fluids (PO/IV)Excessive, rapid administration of hypertonic (or possibly isotonic) parenteral fluidsIncreased release of antidiuretic hormone (ADH); excessive adrenocorticotropichormone (ACTH) production, hyperaldosteronismDecreased plasma proteins as may occur with chronic liver disease with ascites, major abdominal surgery, malnutrition/protein depletionChronic kidney disease/acute renal failure (ARF)Heart failure (HF)