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Fluids and Electrolytes Outline
3 concepts
Fluids
Electrolytes
Acids and Bases
Important Concepts
Interstitial
Intracellular 15%
fluid
40%
Intravascula
r
5%
Transcellular
1-2%
The Intracellular Fluid
This
is compartment with the highest percentage
of water in adults.
The Extracellular Fluid
1. INTERSTITIAL FLUID
Found in between the cells
2. INTRAVASCULAR FLUID
Found inside the blood vessels and lymphatic
vessels
3. TRANSCELLULAR FLUID
Found inside body cavities like pleura,
peritoneum, CSF
Sample question
A. Blood pressure
B. Mental status
C. Urine output
D. Peripheral pulses
Sample question
A. Monitor urinary pH
B. Check the temperature periodically
C. Weight the patient daily
D. Obtain a serial serum Sodium level
Regulation of Body fluid
balance
1. The Kidney
Regulates primarily fluid output by urine
formation
Releases RENIN
Regulates sodium and water balance
Regulation of Body fluid
balance
2. Endocrine regulation
Regulates primarily fluid intake by thirst
mechanism
ADH increase water reabsorption on collecting
duct
Aldosterone increases Sodium retention in the
distal nephron
ANF Promotes Sodium excretion and inhibits
thirst mechanism
Regulation of Body fluid
balance
3. Gastro-intestinal regulation
The GIT digests food and absorbs water
Only about 200 ml of water is excreted in the
fecal material per day
The ELECTROLYTES
PI-SO
Potassium is inside
Phosphate is inside
Sodium is outside
Chloride is outside
Regulation of Electrolyte
Balance
1. Renal regulation
Occurs by the process of glomerular filtration,
tubular reabsorption and tubular secretion.
Urine formation
◦ If there is little water in the body, it is
conserved.
◦ If there is water excess, it will be eliminated.
Regulation of Electrolyte
Balance
2. Endocrinal regulation
Hormones play a role in electrolyte regulation
Aldosterone promotes Sodium retention and
Potassium excretion
ANF promotes Sodium excretion
Parathormone promotes Calcium retention
and Phosphate excretion
Calcitonin promotes Calcium excretion and
Phosphate excretion
THE CATIONS
SODIUM
POTASSIUM
CALCIUM
MAGNESIUM
SODIUM
The MOST ABUNDANT cation in the ECF
Normal range is 135-145 mEq/L
Major contributor of plasma osmolarity
FUNCTIONS
1. participates in the Na-K pump
2. assists in maintaining blood volume
3. assists in nerve transmission and muscle
contraction
Aldosterone increases sodium retention
ANF increases sodium excretion
POTASSIUM
MOST ABUNDANT cation in the ICF
Normal range is 3.5-5.0 mEq/L
Major electrolyte maintaining ICVF balance
FUNCTIONS
1. maintains ICF Osmolality
2. nerve conduction and muscle contraction
3. metabolism of carbohydrates, fats and protein
Aldosterone promotes renal excretion of K+
Acidosis promotes exchange of K+ for H+
in the cell
CALCIUM
Majority of calcium is in the bones and teeth
Normal serum range 8.5-10 mg/dL
FUNCTIONS
1. formation and mineralization of bones/teeth
2. muscular contraction and relaxation
3. cardiac function
4. blood clotting
5. enzyme activation
CALCIUM
Regulation:
GIT absorbs Ca+ in the intestine with the help
of Vit. D
Kidney Ca+ is filtered in the glomerulus and
reabsorbed
in the tubules
PTH increases Ca+ by bone resorption, Ca+
retention
and activation of Vitamin D
Calcitonin released when Ca+ is high, it
decreases Ca+
by excretion in the kidney
MAGNESIUM
Second to K+ in the ICF
Normal range is 1.3-2.1 mEq/L
FUNCTIONS
1. intracellular production and utilization of ATP
2. protein and DNA synthesis
3. neuromuscular irritability
THE ANIONS
CHLORIDE
PHOSPHATES
BICARBONATES
CHLORIDE
The MAJOR Anion in the ECF
Normal range is 95-108 mEq/L
FUNCTIONS
1. major component of gastric juice aside from
H+
2. together with Na+, regulates plasma
osmolality
3. participates in the chloride shift
4. acts as chemical buffer
PHOSPHATES
The MAJOR Anion in the ICF
Normal range is 2.5-4.5 mg/L
FUNCTIONS
1. component of bones
2. needed to generate ATP
3. components of DNA and RNA
PTH decreases PO4 in blood by renal excretion
Calcitonin increases renal excretion of PO4
BICARBONATES
Present both in ICF and ECF
Normal range- 22-26 mEq/L
FUNCTION
1. regulates acid-base balance
2. component of the bicarbonate-carbonic acid
buffer system
IMBALANCE: EXCESS
1. HYPERNATREMIA
More than 145 mEq/L
Fluid moves out of cell crenation
Etiology:↑ sodium intake, IVF, water loss in excess
of water, diarrhea
S/SX: dry, sticky tongue, thirst
IMBALANCE: EXCESS
2. HYPERKALEMIA
K+ more than 5.0 mEq/L
Etiology: IVF with K+, acidosis, Hyper-
alimentation
and K+ replacement
ECG: peaked T waves and wide QRS
IMBALANCE: EXCESS
3. HYPERCALCEMIA
Serum calcium more than 10.5 mg/dL
Etiology: Overuse of calcium supplements,
excessive Vit. D, malignancy, prolonged
immobilization, thiazide diuretic
ECG: Shortened QT interval
IMBALANCE: EXCESS
4. HYPERMAGNESEMIA
Serum magnesium more than 2.1 mEq/L
Etiology: use of Mg antacids, Renal failure, Mg
medications
S/SX: depressed tendon reflexes, oliguria, ↓RR
IMBALANCE: EXCESS
5. HYPERCHLOREMIA
Serum chloride more than 108 mEq/L
Etiology: sodium chloride excess
IMBALANCE: EXCESS
HYPERPHOSPHATEMIA
Serum PO4 more than 4.5 mg/dL
Etiology: Tissue trauma, chemotherapy. PO4
containing medications, osteoporosis
IMBALANCE : DEFICIENCY
1. HYPONATREMIA
Na level is less than 135 mEq/L
Water is drawn into the cell cell swelling
Etiology: prolonged diuretic therapy, excessive
burns, excessive sweating, SIADH, plain water
consumption
S/SX: nausea, vomiting, seizures
IMBALANCE : DEFICIENCY
2. HYPOKALEMIA
K+ level less than 3.5 mEq/L
Etiology: use of diuretic, vomiting and diarrhea
ECG: flattened , depressed T waves, presence of
“U” waves
IMBALANCE : DEFICIENCY
3. HYPOCALCEMIA
Calcium level of less than 8.5 mg/dL
Etiology: removal of parathyroid gland during
thyroid surgery, vit. D deficiency, Furosemide,
infusion of citrated blood
s/sx: Tetany, (+) Chovstek’s (+) Trousseaus’s
ECG: prolonged QT interval
ACID-BASE CONCEPTS
Acid-
substance that can donate or release
hydrogen ions
◦ Carbonic acid, Hydrochloric acid
ACID-BASE CONCEPTS
Buffer-
substance that can accept or donate
hydrogen
◦ Hemoglobin buffer
◦ Bicarbonate : carbonic acid buffer
◦ Phosphate buffer
ACID-BASE CONCEPTS
Excretion
Acid can be excreted, and Hydrogen can be
excreted in ACIDOTIC condition.
Bicarbonate can be excreted in ALKALOTIC
condition.
Ways to balance the acids and
bases
Production
Bicarbonate can be produced in ACIDOTIC
condition.
Hydrogen can be produced in ALKALOTIC
condition.
Ways to balance the acids and
bases