Fluid

A. Body fluids
I. Water
a. the most important nutrient of life
b. humans can only survive for a few days without water

II. Primary Function of Water in the body

a. provides a medium for transporting nutrients to cells and waste from cells and for
transporting substances such as hormones, enzymes, blood platelets, and red and white
blood cells
b. facilitates cellular metabolism and proper cellular chemical functioning
c. acts as a solvent for electrolytes and nonelectrolytes
d. helps maintain normal body temperature
e. facilitates digestion and promotes elimination
f. acts as a tissue lubricant

Body fluid compartments

1. intracellular fluid (ICF) compartment
a. contains fluid within the cells
b. constitutes about
1. 40% of an adult's body weight
2. 70% of an adult's total-body water
2. extracellular fluid (ECF) compartment
a. contains fluid outside the cells
b. constitutes about:
1. 20% of an adult's body weight
2. 30% of an adult's total-body water
includes:
1. intravascular fluid - a. fluid found within the vascular system e.g., plasma
2. interstitial fluid - fluid that surrounds tissue cells
B. Total-body water
a. refers to the total amount of water in the body expressed as a percentage of body weight
b. in the normal adult, total-body water - represents 50% - 60% of the body weight of a normal
adult
total-body water is divided as follows:
a. cell fluids = 35% - 45%
b. ECF = 15% - 20%
c. plasma = 5%
d. interstitial fluid = 10% - 15%
c. Variations in fluid content
1. total-body water varies according to:
a. a person's age
a. infants - total-body water = 77%
b. adults - total-body water = 50% - 60%
c. elderly - total-body water = 45%
2. risk factors:
a. since infants have considerably more body fluid and ECF than adults, they are
more at
risk for problems with fluid balance compared to adults
b. since fat cells contain little water, obese people are more at risk for problems with
fluid
balance compared to thin people
c. gender : females tend to have proportionally more body fat than males
 males - tend to have proportionally less body fat than females
d. since women have more body fat than males, women are more at risk for problems
with fluid balance compared to males

I. A person's fluid intake should normally be approximately balanced by fluid loss

a. fluid intake sources
i. ingested liquids
a. 1300 mL/24 hours
ii. water in ingested food
b. 100 mL/24 hours
iii. metabolic oxidation
c. 300 mL/24 hours
iv. total
d. 2600 mL/24 hours
b. fluid losses
v. kidneys
a. 1500 mL/24 hours
vi. skin
b. insensible loss
i. imperceptible losses
a. e.g., from evaporation and respiration
ii. 200 - 400 mL/24 hours
c. sensible loss
i. 300 - 500 mL/24 hours
vii. lungs
d. 400 mL/24 hours
viii. gastrointestinal
e. 100 mL/24 hours
ix. total
a. 2500 - 2900 mL/24 hours

FLUIDS IMBALANCES

A. Fluid volume deficit (FVD)

a. Deficiency in both the amount of water and electrolytes in the ECF where water and
electrolyte proportions remain near normal
i.. commonly known as hypovolemia
b. Occurs as a result of:
i. Abnormal losses through the skin, gastrointestinal tract, or kidney
ii. Decreased intake of fluid
iii. Bleeding
iv. A shift of fluid into a third space
b. The shift of fluid from the intravascular space into an area
where it is not readily accessible as ECF, e.g.:
i. sequestered in the bowel
ii. the interstitial spaces as edema
iii. in inflamed tissue
iv. in potential spaces such as the peritoneal or pleural
cavities
b. the patient with a shift of fluid into a third space may not manifest
signs/symptoms of fluid volume deficit
B. Fluid volume excess (FVE)
a. Excessive retention of water and sodium in similar proportions to normal ECF
i. commonly known as hypervolemia
ii. Occurs as a result of:
1. excessive intake of sodium chloride
2. administering sodium-containing infusions too rapidly, particularly to
patients with impaired regulatory mechanisms
3. disease processes that alter regulatory mechanisms, such as
congestive heart failure, renal failure, cirrhosis of the liver, and
Cushing's syndrome
iii. In FVE, both the intravascular and interstitial spaces have an increased water
and sodium chloride content
1. excess interstitial fluid is known as edema
2. edema can be found around the:
1. eyes
2. fingers
3. ankles
4. sacrum
3. edema may result in a weight gain in excess of 5%
iv. System for grading edema
1. 1+ pitting edema
1. slight indentation (2 mm)
2. normal contours
3. associated with interstitial fluid volume 30% above normal
2. 2+ pitting edema
1. deeper pit after pressing (4 mm)
2. lasts longer than 1+
3. fairly normal contour
3. 3+ pitting edema
1. deep pit (6 mm)
2. remains several seconds after pressing
3. skin swelling obvious by general inspection
4. 4+ pitting edema
1. deep pit (8 mm)
2. remains for a prolonged time after pressing, possibly minutes
3. frank swelling
5. brawny edema
1. fluid can no longer be displaced secondary to excessive
interstitial fluid accumulation
2. no pitting
3. tissue palpates as firm or hard
4. skin surface shiny, warm, moist
b. dehydration
i. deficiency in the amount of water in the ECF without a deficiency in electrolytes
ii. because water is lost while electrolytes, particularly sodium, are retained:
1. serum osmolality increases
2. serum sodium levels increase
- overhydration

INTRAVENOUS WATER AND THEIR INDICATIONS

INTRAVENOUS REHYDRATION
 - The type of solution used is based on the type of fluid lost from the body.
- Generally:
a. Isotonic ECFVD is treated with isotonic solutions.
b. Hypertonic ECFVD is treated with hypotonic solutions.
c. Hypotonic ECFVD is treated with hypertonic solutions.

- Interventions:
a. Administer cautiously to clients with ECFVD.
b. Ideally, a large IV needle gauge should be used (gauge 18-20), however most clients have
venous collapse, and it is difficult to find a vein
c. A small IV site may be used initially, and once fluids are re-established, a larger needle
may be inserted, a larger needle can be inserted if fluids or an IV access is still needed.
d. Rapid fluid replacement often results in overflow diuresis without cellular replacement.
e. Diuresis compounds dehydration and may result in hypernatremia (excess sodium level in
plasma volume)
f. In older adults or in those with renal or cardiac disease, rapid fluid replacement may result
to pulmonary edema.

FLUID IV FLUID CONTENTS USES COMMENTS

TRANSPORT
Hypotonic 5% dextrose in 50 g dextrose, no -replaces deficits of -supplies 170 kcal/L and
water (D5W) electrolytes total body water free water
-not used alone to -distilled water cannot
expand ECF volume be given IV because it
because dilution of would cause
electrolytes can occur hemodialysis of RBCs
Dextrose is metabolized
in the liver leaving a
solution of water but
without hemolytic
problems
Isotonic 0.9% NaCl 154 mEq/L of Na -ECF deficits in patients -not used for routine
(Normal saline and Cl with low serum levels of administration of IV
sol. or NSS, or Na or Cl and metabolic fluids because it
NS, or 0.9% alkalosis contains more sodium
NS) -before and after than ECF
infusion of blood -expands plasma and
products interstitial volume and
does not enter cells
Lactated 130 mEq/L Na, 4 -ECF deficits such as -solution is roughly
Ringer’s mEq/L K, 3 mEq/L fluid loss with burns isotonic but does not
solution (LR) Ca, 109 mEq/L Cl, -dehydration from loss contain magnesium and
20 mEq/L lactate of bile or diarrhea phosphate
-lactate is equivalent to
bicarbonate, and
solution can be used to
treat many forms of
acidosis
Cannot be used in
people with alkalosis;
solutions of acetate
Ringer’s are better for
these clients
Hypertonic Lactated 50g dextrose, 130 -ECF deficits such as -this solution is
Ringer’s mEq/L Na, 4 mEq/L fluid loss with burns and hypertonic because it is
solution with K, 3 mEq/L Ca, 109 bleeding a combination of 2
5% dextrose mEq/L Cl, 28 mEq/L -dehydration from bile solutions (D5W and LR)
(D5LR) lactate loss or diarrhea
-provides modest
calories (170 kcal)
5% Dextrose 50g dextrose, 154 -ECF deficits in patients -this solution is
and normal mEq/L Na and Cl with low serum levels of hypertonic because it is
saline (D5/0.9 Na & Cl and metabolic a combination of 2
NS) alkalosis solutions (D5W and NS)
-before and after the
infusion of blood
products
-provides modest
calories (170kcal)
5% Dextrose 50g dextrose -can be used as an -commonly used as
and 0.45% 77 mEq/L Na and Cl initial fluid for hydration maintenance fluid
normal saline because it provides
(D5/0.45 NS; more water than Na
D51/2 NS) -providers modest
calories (170 kcal)
5% dextrose 50g dextrose -can be used as an -commonly used as
and 0.225% 34 mEq/L Na and Cl initial fluid for hydration maintenance fluid
normal saline because it provides
(D5/0.2 NS; more water than Na
D5/1/4 NS) -provides modest
calories