Fluids and Electrolytes

CHLORIDE
 Cl – extracellular anion,
 Nornal serum levels = 96-106 mEq/L
 binds with Na, H (also K, Ca, etc)
 Most abundant anion in ECF
 exchanges with HCO3 in the kidneys & in RBC
 Cl- is roduces in the stomach as HCl acid

-
FUNCTIONS
 helps regulate BP, serum osmolarity
 Helps balance Na
 Acid/base balance (exchanges with HCO3)
 Major component of gastric secretions
 Na & Cl assist in determining osmotic pressure
 Works with Na+ to maintain serum osmolality.
 Maintains the balance of anions in the ICF and ECF

Sources
 salt, canned food, cheese, milk, eggs, crab, olives

IMBALANCES IN CHLORIDE

1. HYPOCHLOREMIA

CAUSES:
 Excessive losses through the GI system- vomiting, diarrhea
 nasogastric suctioning & irrigation
 Diuresis
 Metabolic alkalosis
 Hyponatremia, prolonged D5W IV
 Excessive water within the body
 over infusion of hypotonic solution
 excessive water intake

SIGNS & SYMPTOMS:

 hypoNa, hypoK, metabolic alkalosis
 Hyperactivity of muscles,tetany,weakness,dysrhythmias

Far Eastern University

Institute of Nursing
 Fluids and Electrolytes
NURSING DIAGNOSIS
 Fluid volume excess / deficit
 High risk for injury
 Impaired physical mobility

MANAGEMENT:
1. replace fluids as ordered
2. replace electrolytes
3. monitor serum electrolytes
4. increase patient's cl- intake
5. Assess for SZ
6. MIO
7. VS
8. ABG
9. Meds ( KCl or NaCl )

DIET: high chloride food

2. HYPERCHLOREMIA

CAUSES:
 Metabolic acidosis (terminal cancer, starvation)
 Usually noted in hyperNa, hyperK and loss of bicarbonate
 Dehydration

SIGNS & SYMPTOMS:

 Deep, rapid respirations, weakness, lethargy
 hyperK, hyperNa
 Diminished cognitive ability, hypertension

NURSING DIAGNOSIS
 Fluid volume excess / deficit
 High risk for injury
 Impaired physical mobility
 Self care deficit

NURSING MANAGEMENT:
 Identify patient at risk
 Treat acidosis
 Diuretics monitor V/S, M
 Measure I/O

Far Eastern University

Institute of Nursing
 Fluids and Electrolytes
 Hypotonic solutions, D5W to restore balance
 Monitor serum electrolytes
 Monitor ingestion of Cl- from sources
 MIO, VS, ABG
 Advise to avoid salt
 Meds : NaHCO3
 Correct DHN

Diet: low Cl (& usually Na)

Far Eastern University

Institute of Nursing