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Fluids and ElectrolytesINTRODUCTION
To maintain good health, a balance of fluids and electrolytes, acids and basesmust be normally regulated for metabolic processes to be in working state.
A cell, together with its environment in any part of the body, is primarilycomposed of FLUID.
Thus fluid and electrolyte balance must be maintained to promote normalfunction. Potential and actual problems of fluid and electrolytes happen in allhealth care settings, in every disorder and with a variety of changes thataffect homeostasis.
The nurse therefore needs to FULLY understand the physiology andpathophysiology of fluid and electrolyte alterations so as to identify oranticipate 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 molecularstructure
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 CompartmentsIntracellularExtracellularTranscellular
Within CellsOutside cellsContained in bodycavities55% or 2/3 TBW42.5% or 1/3 TBW2.5% Transport system of our bodyNot readily utilizedby the bodyPotassium*PhosphatesMagnesiumSodium*BicarbonatesChlorideCSF, Pleural fluid,Synovial Fluid andperitoneal fluidSecreted byepithelial cells
InterstitialIntravascularBound
Fluidsurroundingthe cellsWithin theblood vessels20%TBW or2/3 of ECF1/3 of ECFPlasma 7.5%Higher proteincontentBone andCartilage7.5%DenseConnectivetissues 7.5%
C.Body Compartment Volumes
Normal valuesPrematureTerm25 yrs45 yrs65 yrs TBW Male:Female:80%75%60%50%55%47%50%45%ECF45%40%20%
ICF35%35%40%Blood Volume90-100 ml/kg85 ml/kg70 ml/kg
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 solutesCommon Intravenous Solutions
SolutionNaCl-K+CaGluOsm.pHLactkJ/l
D5W
000027825350840
NaCl 0.9%
1501500003005.700
NaCl 3.0%
5135130008555.700
D4W/NaCL0.18%
3030002222823.5 –5-50672
Hartmans
1291095002746.72837.8
Plasmalyte
1409852945.52784
Haemaccel
1451455.16.2502937.300
Mannitol20%
000001086.200
Dextran 70
1541540003004-700Osmole
the weight in grams of a substance producing an osmotic pressure of 22.4atm. when dissolved in 1.0 litre 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 biologicmembranes are Osmosis, Diffusion, Filtration and Active Transport. Osmosis,diffusion and filtration are passive processes, while Active transport is an activeprocess.
1.OSMOSIS
This is the movement of water/liquid/solvent across a semi-permeablemembrane 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 pullexerted by plasma proteins
2.DIFFUSION
“Brownian movement” or “downhill movement”
The movement of particles/solutes/molecules from an area of higherconcentration to an area of a lower concentration
This process is affected by:a. The size of the molecules- larger size moves slower than smaller sizeb. The concentration of solution- wide difference in concentration has a fasterrate of diffusionc. The temperature- increase in temperature causes increase rate of diffusion
Facilitated Diffusion is a type of diffusion, which uses a carrier, but noenergy is expended. One example is fructose and amino acid transportprocess in the intestinal cells. This type of diffusion is saturable.
3.FILTRATION
This is the movement of
BOTH
solute and solvent together across amembrane from an area of higher pressure to an area of lowerpressure
Hydrostatic pressure is the pressure exerted by the fluids within theclosed system in the walls of the container
4.ACTIVE TRANSPORT
Process where substances/solutes move from an area of lowerconcentration 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 pumpb.Secondary Active Transport
Energy is derived secondarily from stored energy in the form of ionic concentration difference between two sides of themembrane.
One example is the Glucose-Sodium co-transport; also theSodium-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 fluidoutput is balanced by the fluid input
Overview of Fluid Regulation by the Body Systems
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