Fluids and electrolytes

Prepared By:
A. Lecturer Amjed A. Shraida

For First Stage

Fundamental of Nursing
 Fluids and electrolytes
• Fluids and electrolytes are vital to life and adequate balance is
imperative to maintain healthy functioning of the body.

• Fluids and electrolytes are involved in almost every cellular

reaction and function.

• Chemical reactions that occur in the body depend upon a

careful acid and base balance.
 Body Fluids

As the primary body fluid, water is the most important nutrient

of life. Although life can be sustained for many days without
food, humans can survive for only a few days without water.
 Functions of water in the body
1. Provide a medium for transporting nutrients to cells and wastes
from cells
2. Provide a medium for transporting substances such as
hormones, enzymes, blood platelets, and red and white blood
cells throughout the body
3. Facilitate cellular metabolism and proper cellular chemical
functioning
4. Act as a solvent for electrolytes and nonelectrolytes
5. Help maintain normal body temperature
6. Facilitate digestion and promote elimination
7. Act as a tissue lubricant
 Total body water
The term total body water or fluid refers to the total amount of water,
which is approximately 50% to 60% of body weight in a healthy person.

Fluid is located in two fluid compartments— intracellular fluid (ICF) &

extracellular fluid (ECF), based on its location in the body.

Total body water (TBW) = Extracellular space (20%) + Intracellular fluid

space (40%) .
 Fluid compartment

1- Intracellular fluid : (fluid that is within the cell):

represent 2/3 of the body’s fluid

2- Extracellular fluid : (fluid that is outside the cell):

represent 1/3 of the body’s fluid.
• The extracellular fluid (ECF) compartment is further divided
into the intravascular, interstitial, and transcellular fluid
spaces.
• Intravascular fluid : (fluid within the blood vessels) is
composed of blood products, water, and electrolytes.
• Interstitial fluid : fluid between the cells , tissue or organs
• Transcellular fluids: is the smallest division of the ECF
compartment include cerebrospinal, pericardial, synovial,
intraocular, and pleural fluids, as well as sweat and digestive
secretions.
 Factors that influence the amount
of body fluid

1. Age, in general, older people have a lower percentage of

body fluid than younger people due to increase in the fat
cells and lose muscle mass as a part of aging.

2. Gender, men have proportionately more body fluid than

women

3. Body fat composition, obese people have less fluid than

thin people do because fat cells contain little water.
 Fluid Balance

Normally, the amount of fluid intake and fluid loss is balanced in

adults and ranges from 1,500 to 3,500 mL each 24 hours, with

most people averaging 2,500 to 2,600 mL per day.

 Fluid Source (Fluid intake)
The human body obtains water from several sources, including
1,300 mL coming from ingested water, 1,000 mL coming from
ingested food, and 300 mL from metabolic oxidation, with total
averages 2,600 mL per day.

Route Amount (mL)

ingested water 1,300

ingested food 1,000

metabolic oxidation 300

Total 2600
 Fluid output (Fluid losses)

- Fluid is lost from the body through sensible and insensible

losses.

• Sensible losses can be measured and include fluid lost

during urination, defecation, and wounds.

• Insensible losses can’t be measured or seen and include

fluid lost from evaporation through the skin and as water
vapor from the lungs during respiration.
Fluid output ranges from 2,500 to 2,900 mL per day
(average 2,600 mL), as shown in the following table:

Route Amount (mL)

Urine 1,500
Insensible losses
Lungs 300
Skin 600
Gastrointestinal 200
Total 2600
 Movement of Body Fluids and Electrolytes
• Maintaining homeostasis of fluid volume and electrolytes is
essential to healthy body functioning.

• The body produces this balance by shifting fluids between the

ECF and the ICF.
• The mechanisms responsible for regulating this shift of fluids
and transporting materials to and from intracellular
compartments are :

1. Diffusion
2. Osmosis
3. Filtration
4. Active transport
1. Diffusion – the movement of molecules/solutes through a
semipermeable membrane from a high concentration to a
low concentration
2. Osmosis : the passage of water through a semipermeable
membrane from a low concentration of particles to a high
concentration of particles (The concentration of particles in a
solution, is referred to as the Osmolarity of a solution.)
3. Filtration is a moving of fluid and solutes together across a
membrane under pressure from an area of higher pressure to
an area of lower pressure.

4. Active transport: electrolytes move from a low concentration

to a high concentration by moving against the concentration
gradient. ATP provides the energy needed to do this.
Electrolytes
 Electrolytes
Electrolytes are substances that are capable of breaking into
particles called ions. An ion is an atom or molecule carrying an
electrical charge.

Some ions develop a positive charge and are called cations. The
major cations in body fluid are sodium, potassium, calcium,
hydrogen, and magnesium ions.

Other ions develop a negative charge and are called anions. The
major anions in body fluid are chloride, bicarbonate, and
phosphate.
The major intracellular electrolytes are
potassium and magnesium.

The major extracellular electrolytes are sodium

and chloride.
 Functions of the electrolytes

Electrolytes are important for:

• Maintaining fluid balance

• Contributing to acid–base regulation
• Facilitating enzyme reactions
• Transmitting neuromuscular reactions.
 Sources of Electrolytes
• Most electrolytes enter the body through dietary intake and
are excreted in the urine.

• Some electrolytes, such as sodium chloride and potassium, are

not stored by the body and must be consumed daily to
maintain normal levels.

• Other electrolytes, such as calcium, are stored in the body;

when serum levels drop, ions can shift out of storage into the
blood to maintain adequate serum levels for normal
functioning, at least in the short term.
Daily Electrolyte Requirements
Disturbances in fluid
and electrolyte
 Disturbances in fluid and electrolyte
• A number of factors such as illness, trauma, surgery, and
medications can affect the body’s ability to maintain fluid,
electrolyte.

• Renal disease is a significant cause of imbalances, in addition

to cardiovascular disease.

• Vomiting, diarrhea, or nasogastric suction can cause significant

fluid losses.

• Tissue trauma, such as burns, causes fluid and electrolytes to

be lost from damaged cells.

• Medications such as diuretics or corticosteroids can result in

abnormal losses of electrolytes and fluid loss or retention.
 Fluid Volume Deficit
hypovolemia
1- hypovolemia or isotonic fluid loss can be caused by a loss of
both water and solutes in the same proportion from the ECF
space.

FVD generally occurs as a result of:

A. abnormal losses through the skin, gastrointestinal tract, or
kidney
B. decreased intake of fluid
C. Bleeding
D. movement of fluid into a third space.
 Fluid Volume Deficit
Third space syndrome

̵ In third space syndrome, fluid shifts from the vascular space

into an area where it is not readily accessible as extracellular
fluid.

̵ This fluid remains in the body but is essentially unavailable for

use, causing an isotonic fluid volume deficit.

̵ Fluid may be isolated in the bowel, in injured tissue (e.g., severe

burns), or in potential spaces such as the peritoneal (ascites) or
pleural cavities.
 Maintenance Therapy

̵ When planning the correction of fluid loss for the patient with
FVD, the primary health care provider considers the
maintenance requirements of the patient and other factors
(eg, fever) that can influence fluid needs.

̵ If the deficit is not severe, the oral route is preferred,

provided the patient can drink.

̵ If fluid losses are acute or severe, the IV route is required.

 Maintenance Therapy

̵ In general, patients who are afebrile, not eating, not

physically active require less that 1 L of free water daily

̵ Patient’s with End-stage renal disease (ESRD) or

edematous states (ex. cirrhosis, heart failure) require less
maintenance due to decreased output and/or altered fluid
distribution
 Steps of maintenance
Step 1: Calculate Preoperative Fluid Losses

Estimated maintenance requirements follow the 4/2/1 rule:

4 cc/kg/hr for the first 10 kg,

2 cc/kg/hr for the second 10 kg,

1 cc/kg/hr for every kg above 20.

Or 35cc/kg/day

Or Weight in kg + 40 per hr
Example : Pt weight 85kg.
– 40 + 20 + 65 = 125cc/hr

– 85kg x 35cc/kg/24hr= 3L/24 hr= 125cc/hr

– 85 + 40 = 125cc/hr
Step 2: Calculate Ongoing Maintenance Requirements

Used when the patient is not expected to eat or drink normally

for prolonged period of time

Based on patient’s weight, using the same 4/2/1 rule as used to

calculate preoperative maintenance requirements

Step 3: Calculate Anticipated Surgical Fluid Losses

Based on patient’s weight and anticipated tissue trauma. A rough

guide can be found in Stoelting:

Minimal tissue trauma (ex. herniorrhaphy): 2-4 cc/kg/hr

Moderate tissue trauma (ex. cholecystectomy): 4-6 cc/kg/hr

Severe tissue trauma (ex. bowel resection): 6-8 cc/kg/hr

What type of fluid for maintenance?

Types of intravenous fluid

1.Crystalloids

2.Colloids

3.Blood and blood products

 Crystalloids
(Water + electrolyte)

1. The salts that dissolve readily into true solutions

2. Moving freely between the intravascular compartment and
interstitial spaces.
3. They are lost rapidly from the intravascular space into the
interstitial space
4. They can remain in the extracellular compartment for about
45 minutes
5. Because of this, larger volumes than colloids are required
for fluid resuscitation
 Types of Crystalloids solutions
Hypertonic crystalloid— has a higher concentration of electrolytes than the
body plasma (>295 mOsm/L).
Fluid shift from cells and interstitial spaces to intravascular .

Hypotonic crystalloid— has a lower concentration of electrolytes than the

body plasma (<275 mOsm/L).
Fluid shift from intravascular compartment to the cells and interstitial spaces .

Isotonic crystalloid— has the same concentration of electrolytes as the body

plasma (between 275 and 295 mOsm/L).
Fluid stays in the intravascular space .
Common Crystalloids
 Colloids

1. Colloids are (substances such as large protein molecules that do not

readily dissolve into true solutions).

2. They cannot pass through the walls of capillaries and into cells

3. They remain in blood vessels longer and increase intravascular volume

4. They attract water from the cells into the blood vessels

5. this movement may be beneficial in the short term because the

prolonged movement can cause the cells to lose too much water and

become dehydrated
Common colloids
 Blood and blood products
used to add volume to the blood system after a large loss
Plasma of blood.
Red Blood Cells carry oxygen from the lungs to other parts
of the body and then carry carbon dioxide back to the
lungs.
Red blood cells
A transfusion of whole blood or packed red blood cells
may be needed to treat acute blood loss or anaemia.

White Blood Cells help fight infection, bacteria and other

substances that enter the body. When the white blood cell
White blood cells
count becomes too low, transfusion of white blood cells
become important
Platelet transfusions are given when the platelet count is
Platelets
below normal.
 Fluid Volume Excess
Hypervolemia
Hypervolemia occurs when the body retains both water and
sodium in similar proportions to normal ECF.

Common causes include:

1. Malfunction of the kidneys, causing an inability to excrete
the excesses
2. Failure of the heart to function as a pump, resulting in
accumulation of fluid in the lungs and dependent parts of
the body.
 Fluid Volume Excess
Edema
̵ Due to the increased extracellular osmotic pressure from the
retained sodium and water, fluid is pulled from the cells to
ECF in order to equalize the tonicity, whereas the cells
become nearly depleted as a result of fluid pulled from them.

̵ The excessive ECF may accumulate in either the intravascular

compartments or interstitial spaces.

̵ Accumulation of fluid in the interstitial space is known as

edema.

̵ Edema can be observed around the eyes, fingers, ankles, and

sacral space, and can also accumulate in or around body
organs.
 Disturbances in
electrolyte balances
 Disturbances in electrolyte
balances include:
̵ Hyponatremia refers to a serum sodium level that is less than
135 meq/L
̵ Hypernatremia is a serum sodium level higher than 145 meq/L.
̵ Hypokalemia is a serum potassium level less than 3.5 mEq/L.
̵ Hyperkalemia refers to a potassium level greater than 5.0
meq/L.
̵ Hypocalcemia are calcium serum levels below 8.6 mg/dl.
̵ Hypercalcemia is calcium level greater than 10.2 mg/dl.
Acid Based Balance
An acid is a substance containing H+ that can
be liberated or released, such as carbonic acid
(H2CO3).

An alkali, or base, is a substance that can

accept or trap H+ ions, such as the bicarbonate
ion (HCO3-).

Acid–base balance refers to the balance

between input (intake and production) and
output (elimination) of hydrogen ion.
The unit of measure used to describe acid–base
balance is pH, which is an expression of H+ ion
concentration and the resulting acidity or alkalinity of a
substance.
 Abnormalities in Acid–Base
Balance

Disturbances in acid–base balance are classified either as

‘acidosis’, or ‘alkalosis’ .

Acidosis is used to describe the condition when the pH falls

below 7.35,

Alkalosis describes a pH above 7.45.

The disturbances in acid–base Balance are known as
respiratory acidosis or alkalosis and metabolic acidosis
or alkalosis,

Acid–base Balance mnemonic (ROME)

PH acidosis < 7.35 alkalosis > 7.45

R Respiratory PH  PO2  Alkalosis

O Opposite PH  PO2  Acidosis

M Metabolic PH  HCO3  Alkalosis

E Equal PH  HCO3  Acidosis
Thank You For
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