Week 2: fluid & electrolytes

● Body fluid compartments

○ Intravascular: fluid inside a blood vessel
○ intracellular : fluid inside cells
○ Extracellular: fluid outside of the cells
● Third space
○ Accumulation of and sequestration of trapped extracellular fluid in an actual or
potential body space as a result of disease or injury
○ Fluid may be trapped in body spaces such as the pericardial, pleural, peritoneal, or
joint cavities, the bowel, or abdomen or within soft tissues
● Edema
○ Excess of accumulation of fluid in the interstitial spaces
○ Localized: in one local area of the body as a result of traumatic injury from
accident or surgery
○ Generalized: excessive accumulation of fluid throughout the body
● Body fluid
○ Infants and older adults are at a higher risk for fluid-related problems
● Intake and Output
○ Insensible water loss: immeasurable water loss through sweating or breathing
○ Average adult intake and output is around 2500-3000mL
○ Minimum output for adults should be around 30mL/hour
● Balance
○ Kidneys work to balance fluid levels
○ Antidiuretic hormone - produced by pituitary gland to prevent more fluid loss;
holds onto fluids instead of voiding
● Fluid Volume Deficit Signs
○ Thready, tachy pulse, decreased BP, dysrhythmias,
○ Increased respiration rate and depth of breaths, dyspnea
○ Decreased CNS activity, feverm skeletal muscle weakness
○ Decreased urinary output
○ Dry skin, dry mouth, poor turgor
○ Decreased motility and diminished bowel sounds, constipation, thirst, decreased
body weight
○ Increased serum osmolality, hematocrit, BUN, serum sodium, urinary specific
gravity
● Fluid Volume Excess Signs
○ Bounding, increased pulse rate, elevated BP, distended neck & hand veins,
elevated CVP, dysrhythmias
○ Increased respiratory rate (shallow), dyspnea, crackles
○ Altered LOC, headache, visual disturbances, skeletal muscle weakness,
paresthesia
○ Increase urinary output
○ Pitting edema, pale, cool skin
○ Increased gastric motility, diarrhea, increased body weight, liver enlargement,
ascites
 ○ Decreased serum osmolality, hematocrit, BUN, serum sodium, urinary specific
gravity

Imbalance Level Contributing Factors Clinical Manifestations

Hypokalemia Potassium Inadequate potassium Fatigue, muscle

<3.5 mEq/L intake, diarrhea, weakness, Vfibb,
vomiting, chronic renal paresthesia, leg cramps,
disease, gastric suction, constipation, decreased
polyuria, corticosteroid, BP
digoxin

Hyperkalemia Potassium Excessive potassium Vague muscle weakness,

>5 mEq/L intake, renal failure, nausea, initial tachycardia
Addison’s disease, burns, followed by bradycardia,
use of dysrhythmia, flaccid
potassium-conserving paralysis, paresthesia,
diuretics, ACE inhibitors, irritability, anxiety
NSAIDS, chronic heparin
therapy

Hyponatremia Sodium SIADH, Diuretic therapy, Lethargy, nausea, apathy,

<135 mEq/L renal disease, excessive muscle cramps, muscular
sweating, hyperglycemia, twitching confusion
NPO, congestive heart
failure

Hypernatremia Sodium Water deficit, diabetes Elevated temp, lethargy

>145 mEq/L insipidus, diarrhea, or restlessness, thirst, dry,
hyperventilation, flushed skin, weakness,
excessive administration irritability, hyperreflexia,
of corticosteroids, ataxia, remors,
sodium bicarbonate, or tachycardia. Hyper or
sodium chloride hypotension, oliguria,
pulmonary edema

Hypocalcemia Calcium Inadequate intake or Confusion, paresthesia,

<8.5 mg/dl absorption, bone or muscle spasm,
soft-tissue deposition, hyperreflexia
blood transfusions,
decreased PTH &
vitamin D

Hypercalcemia Calcium Hyperparathyroidism, Fatigue, weakness,

>12 mg/dl bone metastasis, lethargy. Anorexia,
sarcoidosis. Excess nausea, constipation
vitamin D
Hypophosphatemia Phosphate Intestinal malabsorption, Thrombocytopenia,
<2 mg/dl increased renal excretion muscle weakness,
irritability, confusion,
numbness

Hyperphosphatemia Phosphate Chemotherapy, laxatives, Confusion, paresthesia,

>4.5 mg/dl hypoparathyroidism muscle spasm,
hyperreflexia

Hypomagnesemia Magnesium Malnutrition, intestinal Depression, confusion,

<1.5 mEq/L malabsorption, irritability, hyperreflexia,
alcoholism, renal muscle weakness, ataxia,
dysfunction, use of loop nystagmus, tetanus,
and thiazide diuretic convulsions
agents

Hypermagnesemia Magnesium Renal failure, excessive Nausea, vomiting, muscle

>2.5 mEq/L antacid intake weakness