Fluid, Electrolyte, and Acid-Base Balance

Tony Suharsono Foundation of Nursing Nursing program, Medicine Faculty Brawijaya University, 2012

Tony fluid, alectrolyte,acid base, FN IV

 Body fluid
 Body

water and its dissolves substances of substances dissolves in

 Solution
 Mixture

a liquid
 Solvent
 The

liquid portion of a solution dissolved in a liquid

 Solute
 Substance
Tony fluid, alectrolyte,acid base, FN IV

Functions of Water in the Body
 Transporting nutrients to cells and wastes from cells  Transporting hormones, enzymes, blood platelets,  


 

and red and white blood cells Facilitating cellular metabolism and proper cellular chemical functioning Acting as a solvent for electrolytes and nonelectrolytes Helping maintain normal body temperature Facilitating digestion and promoting elimination Acting as a tissue lubricant
Tony fluid, alectrolyte,acid base, FN IV

Tony fluid, alectrolyte,acid base, FN IV

FN IV . alectrolyte.Tony fluid.acid base.

FN IV . alectrolyte.acid base. intraocular fluids. and in GI.Body Fluid Compartments  2/3 (65%) of TBW is intracellular (ICF)  1/3 extracellular water  25 % interstitial fluid (ISF)  8 % in plasma (IVF intravascular fluid)  2 % in transcellular fluids – CSF. serous membranes. respiratory and urinary tracts Tony fluid.

acid base.Tony fluid. FN IV . alectrolyte.

FN IV . alectrolyte.Tony fluid.acid base.

Faktor yang mempengaruhi air dalam tubuh :  Sel sel lemak  Usia  Jenis kelamin Tony fluid. alectrolyte.acid base. FN IV .

alectrolyte.acid base.Body water distribution Tony fluid. FN IV .

alectrolyte. FN IV .Intracellular Fluid Compartment (ICF)  Includes all water and electrolytes within cell membranes  2/3 of TBW or approximately 25 liters (70 Kg) Tony fluid.acid base.

alectrolyte.Extracellular Fluid Compartment (ECF)  Cairan yang ada di luar sel  1/3 dari total cairan tubuh atau 15 liter (70 Kg)  Relatif menurun dengan meningkatnya usia  Dibagi menjadi tiga kompartemen    Interstitial fluid Intravascular fluid Transcellular fluid Tony fluid. FN IV .acid base.

FN IV .Interstisial fluid (ISF)  Cairan yang ada di sekitar sel  25% dari TBW atau kira-kira 8 liter pd orang dewasa (70 Kg)  Termasuk di dalamnya cairan limfe Tony fluid. alectrolyte.acid base.

FN IV . 3 liter terdapat di dalam plasma dan sisanya di sel darah merah Tony fluid.Intravascular Fluid (IVF)  Cairan yang terkandung dalam pembuluh darah  8% dari TBW atau rata-rata 5-6 liter pada dewasa (70 Kg). alectrolyte.acid base.

pleural. dan ekskresi lambung  Jumlahnya kurang lebih 2% TBW Tony fluid. alectrolyte. pericardial. cairan intraokular. FN IV .Trascellular fluid  Cairan yang terkandung dalam rongga khusus dari tubuh  Terdapat dalam cairan cerebrospinal. sinovial.acid base.

alectrolyte.acid base. distribute body fluids between the fluid compartment  Positive ions .Electrolytes  Substance that ionizes (dissociate) in solution into their component ions (atoms or groups of ions with an electrical charge)  Electrolyte have special physiological functions in the body that maintain body fluid osmolarity. FN IV .cations  Negative ions .anions Tony fluid. regulate acid-base balance.

FN IV .Tony fluid.acid base. alectrolyte.

FN IV . in intracellular 15-20mEq/L Tony fluid. alectrolyte.Sodium (Na+)  Regulates fluid volume within extracellular fluid (ECF)  Regulates vascular osmotic pressure  Most abundant cation in ECF  Stimulates conduction of the nerve impulses  Maintain neuromuscular irritability  Normal value in Extracellular : 135-154 mEq/L.acid base.

acid base. FN IV . alectrolyte.5-5mEq/L.Potassium (K+)  Regulates osmolalyty of ICF  most abundant cation in ICF  Promotes transmission of nerve impulses  Promote contraction of skeletal and smooth muscle  Regulates acid-base balance by cellular exchange of hydrogen ion  Normal value in extra cellular 3. in intracelular 150-155mEq/L Tony fluid.

acid base.5-5.Calcium (Ca2+)  Provides strength and durability to bones and teeth  Promotes transmission of nerve impulses  Most abundant cation in body  Essential for blood clotting  Promotes absorption and utilization of vitamin B12  Normal value in extracellular 4.5mEq/L. in intracellular 1-2mEq/L Tony fluid. alectrolyte. FN IV .

5-5. and protein.5mEq/L. mainly those associated with vit B metabolism and the utilization of potassium. in intracellular 27-29mEq/L Tony fluid.acid base.  Promotes neuromuscular activity  More abundant in ICF than in ECF (second cation in ICF)  Normal value in extracellular 4.Magnesium (Mg2+)  Found in bone  Activates enzyme systems. FN IV . alectrolyte. calcium.

Cloride (Cl-)  Most abundant anion in ECF  Easily diffused into and out of cells  Helps regulate osmotic pressure  Part of HCl in gastric juice  Normal value in extracellular 98-106mEq/L. FN IV . alectrolyte. in intracellular 1-4mEq/L Tony fluid.acid base.

alectrolyte.Movement of Fluid Between Compartments  Fluids are constantly moving from one compartment to another by the processes of filtration and osmosis  Volume of each compartment remains stable  Fluid movements are regulated by hydrostatic pressure and osmotic pressure  Osmotic pressure gradients are determined by solute concentrations (electrolytes) Tony fluid.acid base. FN IV .

based on the number of solute particles on the concentrated side and the presence of a semipermeable membrane. Movement of the fluid through the semipermeable membrane from an area with higher hidrostatic pressure to an area with lower hidrostatic pressure.Movement of Fluid Between Compartments  Diffussion   Particle move across a permeable membrane and disperse all direction Rate of diffusion influenced by size of molecule. Solvent molecule move across a membrane to an area where there is a higher concentration of solute that cannot pass through the membran Occur when a cell membrane moves molecules or ions against an electrochemical gradient from an area of lesser concentration to an area of greater concentration Mevement the fluid between the intravascular and interstitial compartment.acid base. alectrolyte. and temperature. concentration. Tony fluid. FN IV  Filtration   Osmosis   Active transport   Colloid osmotic pressure  .

acid base.Tony fluid. FN IV . alectrolyte.

alectrolyte.Tony fluid. FN IV .acid base.

Konsentrasi cairan tubuh  Osmolaritas   Pengukuran kemampuan larutan untuk menciptakan tekanan osmotik dan dengan demikian mempengaruhi gerakan air Menggambarkan konsentrasi larutan  Tonisitas  Osmolaritas efektif.acid base. osmolaritas yang mampu menyebabkan air bergerak dari satu kompartemen ke kompartemen lain Tony fluid. alectrolyte. FN IV .

acid base. alectrolyte. FN IV .Tony fluid.

alectrolyte.Regulation of body water Tony fluid. FN IV .acid base.

FN IV .Regulation of body water  ADH – antidiuretic hormone + thirst (RAAS)     Decreased amount of water in body Increased amount of Na+ in the body Increased blood osmolality Decreased circulating blood volume  Stimulate osmoreceptors in hypothalamus ADH released from posterior pituitary Increased thirst Tony fluid.acid base. alectrolyte.

alectrolyte.Tony fluid. FN IV .acid base.

FN IV .acid base. alectrolyte.Tony fluid.

FN IV .acid base.Renin-angiotensin-aldosteron system Tony fluid. alectrolyte.

acid base.ADH release and effect Tony fluid. alectrolyte. FN IV .

acid base. FN IV . alectrolyte.Tony fluid.

alectrolyte. FN IV . sweating.Electrolyte Balance  Sodium Balance   aldosterone (from adrenal cortex) increases plasma sodium (Na +) concentrations by increasing rate of Na + reabsorption in the distal convoluted tubules and collecting ducts low plasma Na + due to: dietary intake. vomiting.acid base. diarrhea Tony fluid.

alectrolyte.increases K + Tony fluid.acid base.Potassium Balance  aldosterone decreases the plasma potassium (K +) concentrations by increasing the rate of K + secretion in the distal convoluted tubules and collecting ducts  increased dietary intake . FN IV .

acid base.stimulating the release of Ca 2+ (calcium) from bones .stimulating the reabsorption of Ca 2+ in renal tubules . FN IV . alectrolyte.increasing absorption of Ca 2+ from GI tract Tony fluid.Calcium Balance  Parathyroid hormone (PHT) increases plasma calcium concentrations by: .

increasing the excretion of Ca 2+ in the urine Tony fluid.Calcium Balance  Calcitonin (CT) decreases plasma calcium concentration by: . FN IV .stimulating the uptake of Ca 2+ by bones .acid base. alectrolyte.

alectrolyte.Acid base balance  Maintained by controlling the hydrogen (H+) concentrations of body fluids  Concentrations within a narrow pH range of 7.35-7. respiratory mechanisms and renal function Tony fluid. FN IV .acid base.45 are essential for survival  Hydrogen ion homeostasis is dependant on: .buffer systems.

FN IV . forming a weak acid When there is a shortage of hydrogen ions. which functions as a weak base. the weak base combines with the hydrogen ion. the weak acid dissociates releasing more hydrogen ions Tony fluid. that resists changes in pH When there is an excess of hydrogen ions. one a weak acid and one the salt of the weak acid. drastic changes in the pH of body     fluids Help to maintain constancy Consists of a pair of chemicals.acid base. alectrolyte.Buffer Systems  Prevent rapid.

acid base. usually within 1-3 minutes  Increase in exhalation of carbon dioxide increases the pH  Decrease in exhalation of carbon dioxide decreases pH Tony fluid.Respiratory Mechanisms  Rate and depth of breathing can adjust pH of body fluids. alectrolyte. FN IV .

synthesis and absorption of newly formed bicarbonate ions Tony fluid.secretion and excretion of hydrogen ions . FN IV . alectrolyte.acid base.Renal Mechanisms  Renal tubules raise blood pH by: .reabsorption of filtered bicarbonate ions (HCO 3-) .

45 Tony fluid.35 to 7. alectrolyte.Acid-Base Balance Imbalances (normal blood pH .condition in which blood pH is higher than 7.35  Alkalosis .condition in which blood pH is below 7.45)  Acidosis .7. FN IV .acid base.

acid base.Acid-Base Balance Imbalances  Stewart method  SID=Na+ .Cl SID normal = 140-102 = 38  SID < 38 asidosis  SID > 38 alkalosis Tony fluid. alectrolyte. FN IV .

acid base.Nursing Process  Assessment   Health history Physical exam          Daily weight Vital sign Intake output Edema Skin turgor Buccal (oral) cavity Eyes Jugular and hand veins Neuromuscular system Hemoglobin and hematocrit Osmolality pH urine Serum albumin Tony fluid. alectrolyte. FN IV  Diagnostic and laboratory data     .

alectrolyte.acid base.Nursing Diagnosis  Excess fluid volume  Deficient fluid volume  Risk for deficient fluid volume  Other nursing diagnose      Impaired gas exchange Decrease cardiac output Risk for infection Impaired oral mucus membrane Deficient knowledge Tony fluid. FN IV .

alectrolyte. FN IV .Tony fluid.acid base.

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