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Fluid electrolyte & acid base imbalance

Pathophysiology ( Chamberlain University)

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Adaptation- Cellular level- hypertrophy, -Fluid excess occurs in the extracellular

hyperplasia, metaplasia. Fluid and compartment and may be referred to as
Electrolyte impact on adaption involves isotonic/iso-osmolar, hypotonic/ hypo-
maintain acid-base balance (renal, vascular osmolar, or hypertonic/hyper-osmolar,
and respiratory systems) Pressure gradients depending on the cause.
are maintained through fluid shifts and
component shifts. Example- If a condition ELECTROLYTES
exists and the solution is concentrated, water
moves to dilute the solution, or components SODIUM (135-145)
move to change the concentration.
-Primary cation (positively charged ion) in
Fluid Compartments the extracellular fluid
- Fluid is distributed between the
intracellular compartments(ICF) -Sodium is important for the maintenance of
fluid inside the cells, extracellular extracellular fluid volume through its effect
compartments (ECF) on osmotic pressure because it makes up
Extracellular compartments : approximately 90% of the solute in
-Intravascular fluid (IVF) or blood extracellular fluid.
- interstitial fluid (ISF) or intracellular
fluid (ICF) HYPONATREMIA
- cerebrospinal fluid
sodium deficit can result from direct loss of
sodium from the body or from an excess of
Hydrostatic and Osmotic Pressure water in the extracellular compartment,
resulting in dilution of sodium.
In the capillaries, hydrostatic pressure
increases filtration by pushing fluid and CAUSES:
solute OUT of the capillaries, while oncotic
pressure ( also known as colloid osmotic - sodium deficit - excess water in the
pressure) pulls the fluid into the capillaries extra cellular compartment.
and/or prevents fluid from leaving.
- Common causes for low sodium
Movement of Water
- Excessive sweating, vomiting, and
-Fluid constantly circulates throughout the diarrhea
body and moves relatively freely, depending
on the permeability of the membranes - Use of certain diuretics drugs with
between compartments by the processes of low salt diets
filtration or osmosis.
- Hormonal imbalances (insufficient
-depending on the relatively hydrostatic and ADH secretion)
osmotic pressure within the compartments.
Proteins and electrolytes contribute to the - Early chronc renal failure
osmotic pressure of a fluid and therefore are
important in maintaining fluid volumes. - Excessive water intake

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EFFECTS: -manifestations include fatigue, muscle

cramps, and abdominal discomfort or
Low levels impair nerve conduction, cramps with nausea and vomiting

HYPERNATREMIA Hyponatremia
Anorexia, nausea, cramps Fatigue, lethargy,
Excessive sodium level in the blood and muscle weakness
extracellular fluid > 145
Headache, confusion, seizures Decreased
CAUSES: blood pressure

Specific causes include the following: Hypernatremia

1. Insufficient ADH, which results in a  Weakness, lethargy, agitation

large volume of
 Fatigue, lethargy, muscle weakness
dilute urine (diabetes insipidus)
 Edema, elevated BP
2. Loss of the thirst mechanism
 Thirst; tongue and mucosa are dry
3. Watery diarrhea and

4. Prolonged periods of rapid POTASSIUM (3.5-5)

respiration
**Most important, abnormal potassium
EFFECTS: levels, both high and low, have a significant
and serious effect on the contractions of
The major effect of hypernatremia is a fluid cardiac muscle causing changes in the
shift out of the cells owing to the increased electrocardiogram (ECG) and ultimately
osmotic pressure of interstitial or cardiac arrest or standstill. **
extracellular fluid; this effect is manifested
by the following: HYPOKALEMIA:

 Weakness, agitation Low potassium levels < 3.5 mEq/ L

 Firm subcutaneous tissues (see Table CAUSES:

2.5)
Low serum potassium levels may result
 Increased thirst, with dry, rough from the following:
mucous membranes 1. Excessive losses from the body due to
diarrhea
 Decreased urine output because 2. Diuresis associated with certain diuretic
ADH is secreted drugs ; patients with heart disease who are
being treated with certain diuretic drugs
S&S such as furosemide may have to increase
their intake of potassium in food or take a

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potassium supplement because hypokalemia 3. Use of "potassium-sparing" diuretic

may increase the toxicity of heart drugs, which prevent potassium from being
medications such as digitalis excreted in adequate amounts

3. The presence of excessive aldosterone or 4.Leakage of intracellular potassium in to

glucocorticoids in the body (in Cushing the extracellular fluids in patients with
syndrome, in which glucocorticoids have extensive tissue damage such as traumatic
some mineralocorticoid activity, retaining crush injuries or bums
sodium and excreting potassium)
5. Displacement of potassium from cells by
4. Decreased dietary intake, which may prolonged or severe acidosis
occur with alcoholism, eating disorders, or
starvation EFFECTS:
 ECG shows typical dysrhythmias;
5. Treatment of diabetic ketoacidosis with can progress to cardiac arrest
insulin
 Muscle weakness, progression to
EFFECTS: paralysis(possible)

 Cardiac dysrhythmias , ECG patter  Fatigue, nausea, paresthesias also

changes; lead to cardiac arrest. common

 Hypokalemia interferes with S&S

neuromuscular function. Muscles
less respondent to stimuli; shown in Hypokalemia
fatigue & muscle weakness
 Cardiac arrhythmias, cardiac arrest
 Parasthesias (pins and needles  Anorexia, nausea, constipation
develop)  Fatigue, muscle twitch, weakness,
leg cramps
 Decreased GI , decreased appetite  Shallow respirations, paresthesias
 Postural hypotension, polyuria, and
 In severe defieciency; muscle nocturia
become weak; followed by shallow  Serum pH elevated-7.45 (alkalosis)
respirations
Hyperkalemia
 In severe cases; renal function is
impaired ; increased urine output.  Arrhythmias, cardiac arrest
 Nausea, diarrhea
HYPERKALEMIA  Muscle weakness, paralysis
beginning in legs
Increased levels of potassium > 5 mEq/L  Paresthesias-fingers, toes, face,
tongue
CAUSES:  Oliguria
1. Renal failure  Serum pH decreased-7.35 (acidosis)
2. Deficit of aldosterone

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CALCIUM ( 4.5- 5)
Heart contractions (become weak),
Extracellular cation, calcium balance conduction is delayed ; arrythmias develop ,
controlled by PTH (parathyroid BP drops
hormone)
HYPERCALCEMIA:
Also influenced by Vitamin D and CALCIUM LEVELS > 5 mEq/L
phosphate levels
CAUSES:
HYPOCALCEMIA < 4 mEq/L
1. Uncontrolled release of calcium ions
CAUSES: from the bones
2. Hyperparathyroidism
1. Hypoparathyroidism-decreased 3. Immobility, which may decrease
parathyroid hormone results in stress on the bone leading to
decreased intestinal calcium demineralization.
absorption 4. Increased intake of calcium due
either to excessive
2. Malabsorption syndrome-resulting in 5. vitamin D or to excess dietary
decreased intestinal absorption of calcium
vitamin D or calcium 5. Milk-alkali syndrome, associated
with increased milk and antacid
3. Deficient serum albumin intake, which may also elevate serum
calcium levels
4. Increased serum pH-resulting in
alkalosis In renal failure, EFFECTS:
hypocalcemia results from retention  Depression of neuromuscular
of phosphate ion, which causes loss activity ; leads to muscle weakness ,
of calcium; also, vitamin D is not loss of muscle tone, lethargy and
activated, thereby decreasing the stupor (accompanied by personality
intestinal absorption of calcium. changes, anorexia, nausea)
 High levels interfere with function of
EFFECTS: ADH, if case is severe blood volume
drops, renal function decreases,
Increase permeability & excitability of nerve nitrogen waste accumulates ; lead to
membranes( muscle twitching cardiac arrest)
 Cardiac contractions increase ;
Contraction of the fingers & hyperactive dysrhythmias develop
reflexes  If excess PTH bone density will
decrease leads to spontaneous bone
Chvostek signs (spasms of the lip, face) fractures.
Trousseau sign (carpopedal spasms when a  Formation of kidney stones
blood pressure cuff blocks circulation)
S&S
Tetany (skeletal muscle spasms. Causing
contraction and or cramps) Hypocalcemia

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 Tetany-involuntary skeletal muscle  Personality changes

spasm, carpopedal spasm,
laryngospasm  Increased heart rate with arrhythmias
 Tingling fingers
Mental confusion, irritability HYPERMAGNESEMIA
Arrhythmias, weak heart Cause of Hypermagnesemia
 contractions  Usually occurs with renal failure

Hypercalcemia Effects of Hypermagnesemia

 Apathy, lethargy Anorexia, nausea,  Depressed neuromuscular

 constipation function
Polyuria, thirst
Kidney stones Arrhythmias,  Decreased reflexes
prolonged
 strong cardiac contractions,  Lethargy
increased blood pressure
 Cardiac arrhythmias

MAGNESIUM (1.5- 2.5) PHOSPHATE (2.5- 4.5)

Intracellular FUNCTIONS:
Stored in bone
 In bone and tooth mineralization
HYPOMAGNESEMIA
Often linked with chronic alcoholism,  In many metabolic processes,
malabsorption. Malnutrition particularly those involving the
cellular energy source, adenosine
triphosphate (ATP)
Causes of Hypomagnesemia
 As the phosphate buffer system for
 Use of diuretics acid-base balance, and it has a role in
the removal of hydrogen ions from
 Diabetic ketoacidosis the body through the kidneys

 Hyperparathyroidism Causes of Hyperphosphatemia

 Hyperaldosteronism • Often results from renal failure.

Dialysis patients often take
Effects of Hypomagnesemia phosphate binders with meals to
control their serum phosphate levels.
 Neuromuscular hyperirritability
• Tissue damage or cancer
 Tremors or chorea (involuntary chemotherapy may cause the release
repetitive movements) of intracellular phosphate.

 Insomnia Effects of Hyperphosphatemia

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• The manifestations of  Nausea

hyperphosphatemia are the same as
those of hypocalcemia.  V omiting

CHLORIDE (95- 105)  Diarrhea

Chloride ions tend to follow sodium because  Muscle twitching

of the attraction between the electrical
charge on the ions, therefore high sodium  Confusion, sleepiness
levels usually lead to high chloride levels.
Causes of Hyperchloremia
Causes of Hypochloremia
 Excessive intake of sodium
• Associated with alkalosis in the early chloride, orally or
stages of vomiting when hydrochloric acid is intravenously
lost from the stomach.
 Hypernatremia due to other
Excessive perspiration associated with fever causes
or strenu- ous labor on a hot day can lead to
loss of sodium chloride, resulting in EFFECTS:
hyponatremia and hypochloremia, and
ultimately, dehydration. Edema, weight gain

Effects of Hypochloremia

ACID-BASE IMBALANCES

ACIDOSIS ALKALOSIS

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