ARGUELLES, ANGELICA T.

BS NURSING 3A
NCM 112 LEC

Fluid and Electrolytes Assignment 

1.        What are the different processes of body fluid and solutes

movement? And give at least 2 examples each.

 Intracellular space (fluid in the cells) - is the place where most of the fluid
in the body is contained. This fluid is located within the cell membrane and
contains water, electrolytes and proteins.

Examples : Potassium, magnesium, and phosphate

 Extracellular space (fluid outside the cells).- It is divided into the

intravascular, interstitial, and transcellular fluid spaces:

Examples:

-intravascular space (the fluid within the blood vessels) contains plasma,
effective circulating volume. Approximately 3 liters of the average 6 liters of
blood volume in adults is made up of plasma. The remaining 3 L is made up
of erythrocytes, leukocytes, and thrombocytes.

-interstitial space contains the fluid that surrounds the cell and totals about 11
to 12 L in an adult. Lymph is an interstitial fluid.

-Transcellular space is the smallest division of the ECF compartment and

contains approximately 1 L. Includes cerebrospinal, pericardial, synovial,
intraocular, and pleural fluids, sweat, and digestive secretions.

The fluids are classified in to the following five types:

2. What are the different fluid mechanism?

Fluid mechanics is the study of fluid behavior (liquids, gases, blood, and
plasmas) at rest and in motion.

The fluids are classified in to the following five types:

 Ideal fluid: a fluid which is incompressible and is having no viscosity,
Ideal fluid is only an imaginary fluid as all the fluid, which exists, has some
viscosity.
 Real fluid: a fluid which possesses viscosity, is known as real fluid. All the
fluids in actual practice are real fluids.
 Newtonian fluid: a real fluid in which the shear stress is directly,
proportional to the rate of shear strain (or velocity gradient)
 Non-Newtonian fluid: a real fluid in which the shear stress is not
proportional to the rate of shear strain (or velocity gradient)
 Ideal plastic fluid: a real fluid in which the shear stress is more that the
yield value and the shear stress is proportional to the rate of shear strain
(or velocity

gradient)

TYPES OF FLOW:

Compressible and Incompressible flows -which the variation of the density

within the flow is considered constant.

Steady and Unsteady Flows- the velocity does not depend on time. When

the velocity varies with respect to time then the flow is called unsteady.

Laminar and Turbulent Flows - in which each fluid particle has a definite

path. In such flow, the paths of fluid particulars do not intersect each other. In

turbulent flow, the paths of fluid particles may intersect each other

3.       Research on the different laboratory tests for evaluating fluid

status. (meaning , normal values and its implication if it increase or
decrease )

3.1   Osmolality- the most accurate measurement of the kidney’s ability to

dilute and concentrate urine. It measures the number of solute particles in a
kilogram of water. Serum and urine osmolality are measured simultaneously
to assess the body’s fluid status..

NORMAL VALUES
Health adults serum osmolality: 280 to 300 mOsm/kg

normal urine osmolality: 200 to 800 mOsm/kg.

For a 24-hour urine sample, the normal value: 300 to 900 mOsm/kg

IMPLICATIONS :

DECREASING OSMOLALITY

 Fluid volume excess

 Syndrome of inappropriate Antidiuretic Hormone (SIADH)
 Acute kindney injury
 Diuretic use
 Adrenal insufficiency
 Hyponatremia
 Over hydration
 Paraneoplastic syndrome associated w/ lung cancer

INCREASING OSMOLALITY

 Severe dehydration
 Free water loss
 Diabetes insipidus
 Hypernatremia
 Hyperglycemia
 Stroke or head injury
 Renal tubular necrosis
 Consumption of methanol or ethylene glycol (antifreeze)
 High ion gap metabolic acidosis
 Mannitol therapy
 Advanced liver disease
 Alcoholism
 Burns

3.2   Osmolarity -another term that describes the concentration of solutions,

is measured in milliosmoles per liter (mOsm/L). The term osmolality is used

more often in clinical practice.
NV : usually within 10 mOsm

3.3   BUN - serve as index of renal function.Urea is a nitrogenous end product

of protein metabolism. Test values are affected by protein intake, tissue
breakdown and fluid volume changes

10 to 20 mg/dL (3.6 to 7.2

mmol/L)

NORMAL VALUES : 7-18 mg/dL; patients 60> years : 8-20 mg/dL

IMPLICATIONS:

INCREASE BUN

 Decreased renal function

 GI bleeding
 Dehydration
 increased protein intake
 fever and sepsis.

DECREASE BUN

 end-stage liver disease

 a low-protein diet
 Starvation
 any condition that results in expanded fluid volume (e.g., pregnancy).

3.4   Creatinine Clearance test -creatinine clearance test compares the

serum creatinine with the amount of creatinine excreted in a volume of urine
for a specified time. A 24-hour time frame is most common. At the beginning
of the test, the patient empties his bladder and the urine is discarded.

NORMAL VALUES : Normal creatinine clearance is 88–128 mL/min for

healthy women and 97–137 mL/min for healthy men

IMPLICATIONS:

Low/ decreased creatinine clearance:

 may suggest kidney disease or other conditions that can affect kidney
function

 Damage to or swelling of blood vessels in the kidneys (glomerulonephritis)

caused by, for example, infection or autoimmune diseases
 Bacterial infection of the kidneys (pyelonephritis)
 Death of cells in the kidneys' small tubes (acute tubular necrosis) caused
by, for example, drugs or toxins
 Prostate disease, kidney stone, or other causes of urinary tract
obstruction
 Reduced blood flow to the kidney due to shock, dehydration, congestive
heart failure, atherosclerosis, or complications of diabetes

High/Increased creatinine clearance rates may occasionally be seen

during pregnancy, exercise, and with diets high in meat, although this test is
not typically used to monitor these conditions.

3.5   Hematocrit - To determine the proportion of your blood that is made up

of red blood cells (RBCs) in order to screen for, help diagnose, or monitor
conditions that affect RBCs; as part of a routine health examination or if your
healthcare practitioner suspects that you have anemia or polycythemia

NORMAL VALUES:

MEN : 41%-50%.

WOMEN : 36%-44%

IMPLICATIONS :

LOW HEMATOCRIT

 A low hematocrit with low RBC count and low hemoglobin indicates
anemia.
 Excessive loss of blood from, for example, severe trauma, or chronic
bleeding from sites such as the digestive tract (e.g., ulcers, polyps, colon
cancer), the bladder or uterus (in women, heavy menstrual bleeding, for
example)
 Nutritional deficiencies such as iron, folate or B12 deficiency
 Damage to the bone marrow from, for example, a toxin, radiation or
chemotherapy, infection or drugs
 Bone marrow disorders such as aplastic anemia, myelodysplastic
syndrome, or cancers such as leukemia, lymphoma, multiple myeloma, or
other cancers that spread to the marrow
 Kidney failure—severe and chronic kidney diseases lead to decreased
production of erythropoietin, a hormone produced by the kidneys that
stimulates RBC production by the bone marrow.
 Chronic inflammatory diseases or conditions
 Decreased production of hemoglobin (e.g., thalassemia)
 Excessive destruction of red blood cells, for example, hemolytic anemia
caused by autoimmunity or defects in the red blood cell itself; the defects
could be hemoglobinopathy (e.g., sickle cell anemia), abnormalities in the
RBC membrane (e.g., hereditary spherocytosis) or RBC enzyme (e.g.,
G6PD deficiency)

HIGH HEMATOCRIT

 A high hematocrit with a high RBC count and high hemoglobin indicates
polycythemia.
 Dehydration—this is the most common cause of a high hematocrit. As the
volume of fluid in the blood drops, the RBCs per volume of fluid artificially
rises; with adequate fluid intake, the hematocrit returns to normal.
 Lung (pulmonary) disease—if you are unable to breathe in and absorb
sufficient oxygen, the body tries to compensate by producing more red
blood cells.
 Congenital heart disease—in some forms, there is an abnormal
connection between the two sides of the heart, leading to reduced oxygen
levels in the blood. The body tries to compensate by producing more red
blood cells.
 Kidney tumor that produces excess erythropoietin
 Smoking
 Living at high altitudes (a compensation for decreased oxygen in the air)
 Genetic causes (altered oxygen sensing, abnormality in hemoglobin
oxygen release)
 Polycythemia vera—a rare disease in which the body produces excess
RBCs inappropriately

3.6   Urine Sodium - determine whether your sodium level is within normal

limits; as part of an electrolyte panel or metabolic panel to help diagnose and
determine the cause of an electrolyte imbalance; to help monitor treatment for
illnesses that can cause abnormal sodium levels in the body

NORMAL VALUES: normal urine sodium values are generally 20 mEq/L in a

random urine sample and 40 to 220 mEq per day.

IMPLICATIONS

Low blood sodium (hyponatremia)

 Losing too much sodium, most commonly from conditions such

as diarrhea, vomiting, excessive sweating, use of diuretics, kidney
disease or low levels of cortisol, aldosterone and sex hormones (Addison
disease)
 Drinking too much water as might occur during exercise
 Excess fluid buildup in the body (edema) caused by heart
failure, cirrhosis, and kidney diseases that cause protein loss (nephrotic
syndrome)
 Conditions that lead to too much anti-diuretic hormone (ADH), causing a
person to keep too much water in the body; this can happen with several
diseases, particularly those involving the brain and the lungs, many kinds
of cancer, and with use of some drugs.

High blood sodium level (hypernatremia) include:

 Dehydration, losing too much water without drinking enough water, is a

common cause.
 Cushing syndrome 
 Diabetes insipidus, a condition caused by too little ADH
 Rarely, too much salt in the diet
4.        What is fluid challenge test?

The fluid challenge is used in the fluid management of many sick patients.
The principle behind the fluid challenge technique is that by giving a small
amount of fluid in a short period of time, the clinician can assess whether the
patient has a preload reserve that can be used to increase the stroke volume
with further fluids

REFERENCES:
https://study.com/academy/lesson/intracellular-fluid-definition-
composition.html#:~:text=Intracellular%20fluid%20is%20the
%20place,common%20electrolytes%20in%20the%20ICF.
https://shodhganga.inflibnet.ac.in/bitstream/10603/37515/6/06_chapter
%201.pdf
https://labtestsonline.org/tests/blood-urea-nitrogen-bun
https://labtestsonline.org/tests/creatinine-clearance
https://www.redcrossblood.org/donate-blood/dlp/hematocrit.html
https://pubmed.ncbi.nlm.nih.gov/21508838/#:~:text=The%20principle
%20behind%20the%20fluid,a%20fluid%20challenge%20are%20described.
Brunner & Suddarth's Medical-Surgical Nursing, 14th Edition