I.

Fluid and Electrolytes

Electrolytes:

a substance that is dissolved in a solution and

some of its molecules split or dissociate into
electrically charged atoms or ions
measured in liters (L) or milliliters (mL)

Body Fluid Compartments:

Fluid in each of the body compartments contains

electrolytes
To function normally, body cells must have fluids
and electrolytes move in to take its place
Whenever an electrolyte moves out of a cell
another electrolyte moves in to takes it place
The number of cations and anions must be the
same for homeostasis to exist

excess accumulation of fluid in the interstitial

spaces
*Localized edema occurs as a result of
traumatic injury from accident or surgery, local
inflammatory processes or burns
*Generalized edema aka ANASARCA
An excessive accumulation of fluid in the
interstitial space throughout the body as a
result of a condition such as cardiac, renal or
liver failure
Body Fluid:

1. Intracellular compartment
Refers to all the fluid inside the cells
2. Extracellular compartment
Fluid outside the cells
3. Intravascular compartment
Fluid within the blood vessels
4. Interstitial fluids
Fluids between cells and blood vessels
Third Spacing:

Edema

The accumulation and sequestration of

trapped extracellular fluid in an actual or
potential body space as a result of disease
or injury
The trapped fluid represents a volume loss
and is unavailable for normal physiologic
processes

Provides transportation of nutrients to the

cells and carries waste products from the cells
Total body fluid amounts to about 60% of
body weight
A loss of 10% of body fluid in an adult is
SERIOUS, while 20% loss is FATAL
Consists of fluid and dissolved substances

Body Fluid Transport:

1. DIFFUSION
- Movement of particles in all directions through
a solution
- A process by which a solute may spread
through a solution or solvent
- Diffusion of a solute will spread the molecules
from an area of HIGH concentration to an
area of LOWER concentration
2. OSMOSIS
- Diffusion of solvent molecules across a
membrane in response to concentration
gradient, usually from a solution of
LESSER to one of GREATER solute
concentration
- OSMOTIC PRESSURE: force that draws the
water from a less concentrated solution

through a selectively permeable membrane

into a more concentrated solution
3. FILTRATION
- Movement of solutes and solvents by
HYDROSTATIC PRESSURE
- The movement is from an area of GREATER
PRESSURE to an area of LOWER
PRESSURE
*HYDROSTATIC PRESSURE- a force exerted by
a weight of a solution
- When a difference exists in the hydrostatic
pressure on two sides of a membrane, water and
diffusible solutes move out of the solution that
has the higher hydrostatic pressure by the
process of filtration
! REMEMBER:
At the ARTERIAL END of the capillary, the HP >
OP, therefore fluids and diffusible solutes move
out of the capillary
At the VENOUS END of the capillary, the OP > HP,
and fluids and some solutes move into the
capillary
Osmolality: refers to the number of osmotically
active particles per kilogram of water
Normal OSMOLALITY of Plasma: 280-294
mOsm/kg
HYPOTONIC
0.45% Saline

ISOTONIC
0.9% Saline
D5W
D5NSS

HYPERTONIC
D5LR
5% Dextrose in
0.45 Saline
5% Dextrose in 0.9
Saline

Lactated Ringers

10% Dextrose
Water

in

a. ISOTONIC SOLUTIONS when solutions on both

sides of a selectively permeable membrane have
established
equilibrium
or are
equal
in
concentration
b. HYPOTONIC SOLUTIONS when a solution
contains a lower concentration of salt or solute
than other solutions
c. HYPERTONIC SOLUTIONS a solution that has a
higher concentration of solutes than another
solution is hypertonic
Active Transport:
If an ion is to move from an area of low
concentration to an area of high concentration,
an ACTIVE TRANSPORT SYSTEM is necessary
Body Fluid Excretion

The kidneys excrete the largest quantity of fluids

DAILY BODY FLUID EXCRETION
Skin (diffusion)
400mL
Skin (Perspiration)
100mL
Lungs
350mL
Feces
150mL
Kidneys
1500mL

Average total amt of water taken into the body by

all 3 sources is 2500mL per day

HOMEOSTASIS: indicates the relative stability of the

internal
environment
where
concentration
and
composition of body fluids must be nearly constant

Who maintains fluid and electrolyte balance?

a. KIDNEYS play a major role in controlling al
types of balance in Fluids and electrolytes
b. ADRENAL GLANDS via aldosterone secretion
aids in controlling ECF volume by regulating the
amt of sodium reabsorption in the kidneys
c. ADH regulates osmotic pressure of ECF by
regulating the amt of water reabsorption in
kidneys

Dehydration occurs when the fluid intake of the

body is not sufficient to meet the fluid needs of the
body
TYPES OF FLUID VOLUME DEFICITS
Water
and
Isotonic
dissolved
Dehydration
electrolytes
aka
are lost in
HYPOVOLEM
equal
IA

INSENSIBLE LOSS: how water is lost via the skin

Water enters the body through 3 sources:

1. Orally ingested liquids
2. Water in food
3. Water formed by oxidation of food

Hypotonic
Dehydration

Hypertonic
Dehydration

proportions
Results
in
decreased
circulating
blood
volume and
inadequate
tissue
perfusion
Water
loss
exceeds

Inadequate
intake
of
fluids
and
solutes
Fluid
shifts
bet
compartment
s
Excessive loss
of
isotonic
body fluids

Conditions
causing

increase fluid
loss:
Excessive
perspiration,
hyperventilation,
ketoacidosis,
prolonged
fevers,
diarrhea, early stage
renal
failure
and
Diabetes insipidus

Chronic
illness
Excessive
fluid
replacement
Renal failure
Chronic
malnutrition

ASSESSMENT:
Cardiovascular

CAUSES

FLUID VOLUME DEFICIT

Body Fluid Replacement:

electrolyte
loss
Fluid moves
from
IC
compartmen
t into the
plasma and
ISF
spaces
causing
CELLULAR
DEHYDRATIO
N
and
SHRINKAGE
Electrolyte
loss exceeds
water loss
Decrease in
plasma
volume
Fluid moves
from plasma
and
ISF
spaces into
cells causing
the cells to
SWELL

Respiratory
Neuromuscula
r
Renal
Integumentary
Gastrointestin
al

a. Thready, inc pulse rate

b. Dec
BP
and
orthostatic
hypotension
c. Flat neck and hand veins in
dependent position
d. Diminished peripheral pulses
a. Inc
rate
and
depth
of
respirations
a. Dec CNS activity from lethargy
to coma
b. Fever
a. Dec urinary output
b. Inc specific gravity
a. Dry skin
b. Poor turgor, tenting present
c. Dry mouth
a. Dec motility and diminished
bowel sounds

b. Constipation
c. thirst
HYPOTONIC DEHYDRATION
HYPERTONIC
DEHYDRATION

May
cause
circulator
overload
and
interstitial
edema
Occurs rarely
Fluid is drawn
from the ICF
compartment
and the ECF
volume expands

Skeletal muscle weakness

a. Hyperactive DTR
b. Pitting edema

Hypertonic
Overhydration

Interventions:
*Monitor CV, respi, neuromuscular, renal, integ and GI
status.
* Prevent further fluid loss and inc fluid compartment
volumes to normal ranges

Hypotonic
Overhydration

Known
as
WATER
INTOXICATION
The
excessive
fluid moves into
the ECF space
and all the body
fluid
compartments
expand

*provide oral rehydration therapy if possible and IV fluid

replacement if severe
*administer meds as prescribed
*administer O2 as prescribed

FLUID VOLUME EXCESS

Aka fluid overload or overhydration

Fluid intake or fluid retention exceeds fluid needs
of the body

TYPES OF FLUID VOLUME EXCESS

CAUSES

Results
from a. Inadequately
Isotonic
controlled IV
excessive fluid
Overhydration
therapy
in
the
ECF
aka
b.
Renal failure
compartment
HYPERVOLE
term
where only the c. Long
MIA
corticosteroid
ECF
compartment is
expanded
and
fluid does not
shift bet EC and
IC
compartments

therapy

Integumetary
a. Excessive
sodium
ingestion
b. Rapid
infusion
of
hypertonic
saline
c. Excessive
NaCo3
therapy
a. Early
renal
failure
b. CHF
c. SIADH
d. Inadequately
controlled IV
therapy
e. Replacement
of
isotonic
fluid loss with
hypotonic
fluids
f. Irrigation
of
wounds and
body cavities
with
hypotonic
fluids

ASSESSMENT:
Cardiovascula
r
Respiratory
Neuromuscul
ar

a.
b.
c.
d.
a.
b.
c.
a.
b.

Bounding. Inc pulse rate

Elevated BP
Distended neck and hand veins
Elevated CVP
Inc RR (shallow respirations)
Dyspnea
Moist crackles on auscultation
Altered LOC
Headache

Gastrointestin
al

c.
d.
e.
a.
b.
a.

Visual disturbances
Skeletal muscle weakness
Paresthesias
Pitting edema in dependent areas
Skin pale and cool to touch
Inc motility in GIT

Isotonic Overhydration
Hypotonic
Overhydration

a.
b.
a.
b.
c.
d.
e.

Liver enlargement
Ascites
Polyuria
Diarrhea
Nonpitting edema
Dysrhthmias
Projectile vomiting

INTERVENTIONS:

Monitor CV, Respi, Neuromuscular, Renal, Integ

and GI status.
Prevent further fluid overload and restore normal
fluid balance
Admin diuretics, OSMOTIC DIURETICS typically
are prescribed first to prevent severe electrolyte
imbalances.
Restrict fluid and sodium intake
Monitor I&O and weight.
Monitor electrolyte values and prep to admin med
to treat imbalance if present

Sodium (Na)
Normal levels: 135-145 mEq/L
Common food sources:
Bacon
Butter
Canned food
Cheese

Frankfurters
Ketchup
Lunch meat
Milk
Mustard
Processed food
Snack Food
Soy sauce
Table Salt
White and Whole wheat bread

[See Table 1 for HYPO and HYPER NATREMIA]

Potassium
Normal level: 3.5 to 5.1 mEq/L
Common food sources:
Avocado
Bananas
Cantaloupe
Carrots
Fish
Mushrooms
Oranges
Potatoes
Pork, Beef, Veal
Raisins
Spinach
Strawberries
Tomatoes
[See table 2 for HYPO and HYPER KALEMIA]

CALCIUM
Normal value: 8.6- 10.0 mg/dL
Common Food sources:
Cheese
Collard greens
Milk and soymilk

Rhubarb
Sardines
Spinach
Tofu
Yogurt, low fat