FLUID

and
ELECTROLYTES
FLUID
- 60% of Adult’s body wt. consists of fluid
(water and electrolytes)

Factors affecting amount of body fluid: • Body

fat (thin > obese)
 • Gender (male > female)
• Age (young > older)

Highest volume of water – a) skin, b) muscle,

c) blood
2 Body fluid compartments
Intracellular – 2/3 of body fluid
Extracellular – 1/3 of body fluid
• Intravascular
- 6L
- FLUID: blood (3L plasma, 3L formed
elements)
• Interstitial
 - 12L
- FLUID: fluid surrounding cells
• Transcellular
- 1L
- FLUID: fluids in body cavities (e.g. CSF,
Pericardial, Intraocular, Pleural,
Sweat/Tears, Digestive Secretions)
• ICF and ECF normally shifts between each
other to maintain EQUILIBRIUM
• DISEQUILIBRIUM happens if there’s: ❖ a
LOSS OF FLUID from the body ❖ THIRD
SPACE FLUID SHIFT
- fluid shifts into a space that doesn’t
contribute to equilibrium
- Fluid shift from INTRAVASCULAR into
INTERSTITIAL (edema) and into
TRANSCELLULAR space
- Manifestations:
H.R.
Wt.
BP
CVP
I=O

Electrolytes
- active chemicals either positively (CATIONS) or
negatively (ANIONS) charged
- measured in mEq/L
- most accessible medium of measuring electrolyte
concentration: plasma

Major Electrolytes in the Body

and their Normal Values N.V.
(Serum)
Sodium 135 – 145 mEq/L
 Potassium 3.5 – 5 mEq/L
Calcium 4.5 – 5.5 mEq/L
Magnesium 1.5 – 2.5 mEq/L
Phosphorus 2.5 – 4.5 mg/dl
Chlorine 96 – 106 mEq/L
FLUID SHIFTING
• Hydrostatic pressure – pressure
exerted by fluid on blood vessel wall •
Osmotic pressure – pressure exerted
by plasma cells
REGULATION OF BODY FLUID COMPARTMENT
OSMOSIS – FLUID moves from LOWER to
HIGHER solute concentration

Related terms:
❖ Osmolality – Solute concentration
❖ Tonicity – ability of solute to cause osmosis
(Hypertonic/↑tonicity osmoles: Na, Mannitol and
Glucose)
❖ Osmotic pressure – concentration of solute that
is needed to stop osmosis
❖ Oncotic pressure – osmotic pressure exerted by
proteins
❖ Osmotic diuresis - ↑U.O. caused by excretion of
hypertonic osmoles
DIFFUSION – SOLUTE moves from area of
HIGHER CONCENTRATION to LOWER
CONCENTRATION

FILTRATION – Intravascular to Interstitial Shift

Hydrostatic Pressure to ↑Hydrostatic Pressure -
180L of plasma is being filtered by the kidney
every 24 hours

ACTIVE TRANSPORT
- energy must be expended to allow movement
against a concentration gradient
DIFFUSION
ROUTES of GAINS and LOSSES
• Input: Oral (eating and drinking), Parenteral
and Enteral administration of fluids
• Output
Kidneys – 1mL/kg/hr or 1 1/2 L of urine every
day Skin – Sensible perspiration (0-1L/hour) –
Insensible perspiration (600mL/day) through
evaporation
Lungs – Insensible (400mL/day) water vapor loss
– increased loss in DRY climate/ R.R. GIT –
100-200 mL/day
Average Daily I & O
Intake Output
Oral Liquids 1300 ml Urine 1500 ml H20 in Food
 1000 ml Stool 200 ml H20 produced Lungs 300
ml
by metabolism 300 ml Skin 600 ml Total 2600
ml 2600 ml
❖ (+) Penrose drain = 50mL
❖ (+) IFC = 1.2L
❖ (+) NGT, oral feeding = 800
mL ❖ BT = 250cc/bag x 2
❖ (+) IVF = @1000cc(start of shift)
and @100cc (end of shift)
❖ (+) Colostomy = 300mL
❖ Suctioned oral secretions = 50 mL
LAB TEST for Fluid Status
Serum OSMOLALITY (mOsm/kg) and
OSMOLARITY (mOsm/L)
- plasma sodium concentration
- Normal value: 275-300
Urine OSMOLALITY (mOsm/kg) and
OSMOLARITY (mOsm/L)
- Most reliable indicator of urine concentration -
Normal value: 250-900
Urine Specific Gravity
- Measures kidney’s ability to conserve and
excrete water
- Normal value: 1.010 – 1.025
- Inversely proportional to U.O.
Blood Urea Nitrogen (BUN)
- End product of of the metabolism of protein by
the liver
- Made up of urea
- Normal value: 10 – 20 mg/dL
- INCREASES with: Increased protein intake,
GI bleeding, dehydration and decreased renal
function
- DECREASES with: liver disease, decreased
protein intake/starvation, fluid overload
- Inversely proportional to renal function
Serum Creatinine
 - End product of muscle metabolism
- Better indicator of renal function because it is
not affected by protein intake/metabolic state
- Normal value: 0.7-1.4 mg/dL
Hematocrit
• Percentage of RBC vs. WHOLE BLOOD •
Normal value: Males: 42-52% Females:
35-47%
• HIGH in: dehydration/polycythemia •
LOW in: overhydration/anemia
HOMEOSTATIC MECHANISMS
• Kidney – regulates ECF, electrolytes (selective
retention and excretion) and pH (retaining H
 ions)
- excretion of metabolic wastes and toxins -
responds to ADH and aldosterone
- thus, renal failure causes multiple fluid and
electrolyte imbalances
• Heart and Blood Vessels- blood being pumped
by the heart circulates through the blood vessels
and being filtered in the kidney for excretion • Lung
- regulation of pH
- medium of insensible fluid loss
• Pituitary – stores ADH secreted by the
hypothalamus
• Adrenal Glands – secretion of
 ALDOSTERONE at the ADRENAL CORTEX
which promotes sodium and water retention,
and potassium excretion
- CORTISOL produced in ADRENAL
MEDULLA when secreted/administered in
large quantities can also cause sodium and
water retention
• Parathyroid Glands – Calcium and
phosphate balance
- Increases serum calcium by bone
resorption and absorption in the intestine
Other Mechanisms:
1. Baroreceptors
2. RAAS
3. Osmoreceptors
4. ADH + Thirst
5. Release of atial natriuretic peptide (ANP) and
atrial natriuretic factor (ANF)by atrial cardiac
cells