MANAGEMENT OF

PATIENTS WITH FLUIDS

AND ELECTROLYTES
IMBALANCES
BODY FLUIDS
BODY FLUID COMPARTMENTS
BODY FLUID COMPARTMENTS
BODY FLUID OSMOLARITY
 Isotonic sol. =
 Hypotonic sol =

 Hypertonic sol =
A solution of 1 Liter of water that contains 1
gram molecular weight of a substance that
doesn’t dissociate in solution ( such as glucose)
has an osmolarity of 1 Osm/L = Osmolarity

A solution of 1 L of water that contains 1 gram

molecular weight of an electrolyte that
dissociates into 2 ions ( such as sodium chloride)
has an osmolarity of 2 Osm/L
FLUID BALANCE
MECHANISMS OF FLUID BALANCE
NORMAL FLUID INTAKE AND LOSS IN ADULTS

Intake Output
Water in food - 1,000 ml Skin - 500 ml

Water from oxidation - 300ml Lungs - 300 ml

Water as liquid - 1200 ml Feces - 200 ml

Kidneys - 1500 ml

Total 2, 500 ml Total 2500 ml

 VOLUME DEFICIT VOLUME OVERLOAD
ASSESSMENT •↑ temp •no changes in temp
•Rapid & weak pulse •↑ pulse slightly
•↑ RR •↑ RR, SOB, dyspnea, rales
•Poor skin turgor- skin cool, (crackles)
moist •Periperal edema – bloated
•Hypotention •HPN
•Emaciation, wt. loss •Muffled heart sounds
•Dry eyes sockets, mouth & •Jugular vein distention
mucous •Urine spec gravity<1.010
•Anxiety, apprehension, •↑ venous pressure
exhaustion, seizures •↓ hct and BUN
•Urine specific gravity>1.030
•↓ urine output
•↑ hct
•↓ peripheral pulses
 VOLUME DEFICIT VOLUME OVERLOAD
PLAN/ • Force fluids •Administer diuretics
IMPLEMENTATION •Provide isotonic IV •Restrict fluids
fluids.eg LR or PNSS •Na-restricted diet (ave.
•I and O hourly daily diet- 6 to 15mg Na)
•Daily wt (1L. Fluid- 1kg or •Daily wt
2.2 lbs) •Assess breath sounds
•Monitor v/s •Check feet/ankle/sacral
•Check skin turgor region for edema
•Assess urine spec gravity •Semi-fowlers position if
dyspneic
•Elevate head of bed
 DIABETES INSIPIDUS SIADH
ASSESSMENT •Excessive urine output •Anorexia, nausea,
•Chronic severe vomiting
dehydration •Lethargy
•Excessive thirst •Headache
•Anorexia, wt loss •↓ deep tendon
•Weakness reflexes
•Constipation •Tachycardia
•↑ circulatory bld vol
•↓ urinary output
 DIABETES INSIPIDUS SIADH
ANALYSIS •Deficiency of ADH •ADH does fxn
•Dx test: properly, ADH is
-Low urine spec released even when
gravity plasma hypo-
-Urinary osmolality osmolalilty is present
below plasma level •Dx test:
-High serum Na -Serum Na ↓
- plasma osmolality ↓
-↑ specific gravity
ELECTROLYTE BALANCE

Na (+) Cl(-)
CATIONS (+) ANIONS (-)

Ca Bicarbonate
K Chloride
Na Phosphorus
Mg
FUNCTIONS OF ELECTROLYTES
1. Promote neuromuscular irritability

2. Maintain body fluid vol. & osmolality

3. Distribute body water between fluid

compartments

4. Regulate acid-base balance

ICF AND ECF ELECTROLYTE COMPOSITIONS
ELECTROLYTE COMPOSITION (mEq/L)

ICF ECF

Sodium 10 135-145

Potassium 140 3.5-5.0

Calcium 10 4.5-5.8

Magnesium 40 1.5-2.5

Chloride 4 98-108

Bicarbonate 10 24-28

Phosphate 100 1-1.5

MECHANISMS OF ELECTROLYTE BALANCE
MECHANISMS OF ELECTROLYTE BALANCE
MECHANISMS OF ELECTROLYTE BALANCE
MECHANISMS OF ELECTROLYTE BALANCE
MECHANISMS OF ELECTROLYTE BALANCE
MECHANISMS OF ELECTROLYTE BALANCE
MECHANISMS OF ELECTROLYTE BALANCE
FLUID ELECTROLYTES
DISORDERS
SODIUM IMBALANCES 135-145
SODIUM IMBALANCES 135-145
SODIUM IMBALANCES 135-145
SODIUM IMBALANCES 135-145
SODIUM IMBALANCES 135-145
SODIUM IMBALANCES 135-145
SODIUM IMBALANCES 135-145
SODIUM IMBALANCES 135-145
SODIUM IMBALANCES 135-145
SODIUM IMBALANCES 135-145
POTASSIUM IMBALANCES 3.5-5.0
POTASSIUM IMBALANCES 3.5-5.0
POTASSIUM IMBALANCES 3.5-5.0
POTASSIUM IMBALANCES 3.5-5.0
POTASSIUM IMBALANCES 3.5-5.0
POTASSIUM IMBALANCES 3.5-5.0
POTASSIUM IMBALANCES 3.5-5.0
POTASSIUM IMBALANCES 3.5-5.0
POTASSIUM IMBALANCES 3.5-5.0
POTASSIUM IMBALANCES 3.5-5.0
POTASSIUM IMBALANCES 3.5-5.0
POTASSIUM IMBALANCES 3.5-5.0
CALCIUM IMBALANCES 4.5-5.8
CALCIUM IMBALANCES 4.5-5.8
CALCIUM IMBALANCES 4.5-5.8
CALCIUM IMBALANCES 4.5-5.8
CALCIUM IMBALANCES 4.5-5.8
CALCIUM IMBALANCES 4.5-5.8
CALCIUM IMBALANCES 4.5-5.8
CALCIUM IMBALANCES 4.5-5.8
CALCIUM IMBALANCES 4.5-5.8
CALCIUM IMBALANCES 4.5-5.8
CALCIUM IMBALANCES 4.5-5.8
CALCIUM IMBALANCES 4.5-5.8
PHOSPHORUS IMBALANCES 1.0-1.5
PHOSPHORUS IMBALANCES 1.0-1.5
PHOSPHORUS IMBALANCES 1.0-1.5
PHOSPHORUS IMBALANCES 1.0-1.5
PHOSPHORUS IMBALANCES 1.0-1.5
PHOSPHORUS IMBALANCES 1.0-1.5
PHOSPHORUS IMBALANCES 1.0-1.5
PHOSPHORUS IMBALANCES 1.0-1.5
MAGNESIUM IMBALANCES 1.5-2.5
MAGNESIUM IMBALANCES 1.5-2.5
MAGNESIUM IMBALANCES 1.5-2.5
MAGNESIUM IMBALANCES 1.5-2.5
MAGNESIUM IMBALANCES 1.5-2.5
MAGNESIUM IMBALANCES 1.5-2.5
MAGNESIUM IMBALANCES 1.5-2.5
CHLORIDE IMBALANCES 98-108
CHLORIDE IMBALANCES 98-108
CHLORIDE IMBALANCES 98-108
CHLORIDE IMBALANCES 98-108
CHLORIDE IMBALANCES 98-108
CHLORIDE IMBALANCES 98-108
CHLORIDE IMBALANCES 98-108
CHLORIDE IMBALANCES 98-108
ACID- BASE BALANCE
ACID- BASE BALANCE
SOURCES OF HYDROGEN IONS
ARTERIAL BLOOD GAS (ABG)

NORMAL ARTERIAL BLOOD GAS VALUES

pH 7.35-7.45
Pco2 35-45 mmHg
HCO3 22-26 mEq/L
PO2 80-100 mmHg
ARTERIAL BLOOD GAS
ARTERIAL BLOOD GAS
ARTERIAL BLOOD GAS
ARTERIAL BLOOD GAS
RESPIRATORY ACIDOSIS
RESPIRATORY ACIDOSIS
RESPIRATORY ACIDOSIS
RESPIRATORY ALKALOSIS
RESPIRATORY ALKALOSIS
METABOLIC ACIDOSIS
METABOLIC ACIDOSIS
METABOLIC ALKALOSIS
METABOLIC ALKALOSIS
INTERPRETATION OF ABG RESULTS
INTERPRETATION OF ABG RESULTS
 pH = 7.15
Pa C02 = 68 mmHg
HC03 = 22 mEq/L
INTERPRETATION OF ABG RESULTS
 pH = 7.37
Pa C02 = 29 mmHg
HC03 = 17 mEq/L
INTERPRETATION OF ABG RESULTS
 pH = 7.57
Pa C02 = 26 mmHg
HC03 = 24 mEq/L
INTERPRETATION OF ABG RESULTS
 pH = 7.36
Pa C02 = 69 mmHg
HC03 = 36 mEq/L
INTERPRETATION OF ABG RESULTS

 A quick way to learn ABG interpretation is to

remember the mnemonic ROMS
 RespiOpposite Arrows
 Metabolic Same arrows
Normal (but technically
Acidic)
pH = 7.15 Acidic  pH = 7.37
Pa C02 = 68 mmHg Acidic Pa C02 = 29 mmHg Alkaline

HC03 = 22 mEq/L HC03 = 17 mEq/L

Normal Acidic