I.

Concepts of Fluid and Electrolyte Balance

A. Electrolyte - - -

substance that dissolving

-

on in so / , ionizes 0
•
-

some of its molecules split

-
or dissociate

electrically charged atoms or ions

-
measurement :

• metric
system For fluids
liters a) or milliliters (mu)
•
unit of measure for combining activity of
an electrolyte → mtq
• 1- Mtg of cation
→
reacts chemically
WI 1 mig of an anion
B. Body fluid compartments
hid in each
f- of the body contains electrolyte
-

electrolyte moves out of a cell → another electrolyte

moves to take its place
=
-

# cations # anions → homeostasis

-

compartments separated by
semipermeable membranes
-

intravascular compartment
blood vessel
↳ fluid a
-
-
-
intracellular
up all fluid d the cell
-
extracellular -

fluid o
attn
↳

includes interstitial fluid ( 3rd spae) fluids bet cells

-

C. 3rd sparing → in an actual body

trapped extracellular fluid as result OF din or injury space
-

a
-

trapped in Fas pericardial , pleural , peritoneal or

joint
cavities
not apparent until malfunction own
-

organ
p Edema
.

excess fluid awvmllalim OF fluid in the interstitial space

-

result OF alterations in Omotic pressure i hydrostatic pressure ,

capillary permeability and lymphatic obstruction
-
-
-
localiud edema
↳ result of traumatic auidents local
injury From or
surgery ,

inflammatory processes or bums

-
Generalized edema
aka
anasarc.am
↳

excessive
the
annihilation
body
of fluid in the
iape throughout
is
fr cardiac , renal or liver failure
E.
Body mid
transport nutrients body the
↳ to

↳
carry waste productsHue cells

↳ infantsG older aow Pñ of fluid related prob

* Intracellular -
70%
Extracellular 30%
-

Interstitial -
2201 .

Intravascular -
6%
Transeellular 21
-
.

-
constituents of body fluids
in consists of water and dissolved
substance
water
↳ →
largest
F.
Body Fluid Transport

D Diffusion
whereby bowtel dissolved substance
may spread
a
process
-

thru a sot or solvent I sit in Hathi Sowle is dissolved

-

from an area of higher concentration to an area of lower

concentration -
 →
-

permeable membrane substance pass thru restriction

-

selectively permeable P allows solute about restriction prevents

but
other to Wte to pass mm
ratty
a) osmosis
movement of across membrane to
in
response a
concentration
-

gradient
Sol OF lower to of higher sot concentration
from one
- -

pressure
-

-
Osmotic
solvent from a concentrated
selectively
m draws the less WI to a

permeable membrane in a more concentrated sowte

b) Filtration

byhydnstaticpresgurf.fm
movements of Sowles and solvents
-

hick pressure to an area of lower pressure

4) Hydrostatic pressure
~

the
-

force exerted
by ut of a solution
At arterial osmotic
end hydrostatic pressure > pressure
- →

p fluids move out

of the all
venous end → osmotic 7
hypnogogic
At pressure pressure
-

↳
fluid are reabsorbed
-

Remaining fluids
are absorbed by the hsmpnaticsystem@
5) osmolality
-
A- of osmotically active particles per kg of Ado
-
milliosmoles Cmosm)
275 295
mosmlkgcmmo4kg)
:
-
normal valve -

c- Movement of body Fluid

a. Isotonic cool
-

equal conurbation on both sides of a relatively personable

membrane
-
little osmosis occurs

b. Hypotonic Sol
-
contains lower concentration OF salt ,
more water

osmolality than body fluids

-

lower
c) hypertonic sit
has higher
- concentration of solutes
 d. osmotic pressure
-

amount is determined by the concentration of solutes in a

solution
e. Active transport
-

necessary when ay im is to move tnw a membrane from lower

concentration to a
higher concentration
moves molecules and
or ions against concentration osmotic
pressure
-

supplied
-
by metabolic processes in the all
-

ions of sodium , potassium , calcium , iron , hydrogen , sugar a

amino acids
A. Body Fluid Intake 9 Output
1. Body Fluid Intake
-
then 3 sources : orally ingested liquids , water in foods , water formed
by oxidation
of foods
2.
Body fluid output
insensible loss
-

↳ water lost time the skin

-
Kidneys
↳
play a major role in regulating fluid and electrolyte balance
and excrete the largest quantity of fluid
diarrhea A risk for fluid and electrolyte
imbalance
=
* severe a

Maintaining fluid and Electrolyte Balance

-
homeostasis
↳ indicates the relative stability of the internal environment
-

imbalance of fluids or
electrolytes G) →
replaced my intake
OF food H2O /
or
by W 801 or meds
-

kidney control balance in fluid and electrolyte

adrenal glandI
WngtÑ Fluid
-

thru the selection of aldosterone , aid in v01

by regulating the amt otum reabsorbed by the

kidneys
-

Antidiuretic hormone
↳ from the pituitary gland
↳ requites the
o pressure of ECF by regulating the amtoFH20_
 absorbed by the kidneys .

Fluid Volume Deficit

Dehydration
-

↳ occurs when the fluid intake of the

body is not
sufficient to meet the

fluid needs of the body

fluid volume replace electrolytes , eliminate of the

w restore ,
the cause

fluid volume deficit

*
Types of Fluid volume Deputy :
1) Isotonic Dehydration
→ lost in equal proportions
water and dissolved electrolytes
-

-
Known as hypowtemia
-
most common type
-

result torn * circulating blood volume and inadequate tissue perfusion

2) Hypertonic dehydration
-
water loss electrolyte loss
ÑÉom alterations the concentrations
electrolytes
of specific plasma
-
in

from ICF into plasma a interstitial fluid spaces

-

↳ causing #hydration
shrinkage
cello 9

3) Hypotonic dehydration -

electrolyte loss
⑤ water loss
-

.se# fluid compartments , causing a tin plasma not

shifts bet

-
frm plasma and interstitial Fluid spaces the cell
↳
causingpume deficit and causing cento swell
* causes of Fluid Volume Deficit
D.Isotonic dehydration
a) inadequate intake of fluids and solutes
b) Fluid shifts bet compartments
c) excessive losses of isotonic body fluids
a) Hypertonic dehydration
-
conditions that $ Fluid loss
-
ex .
Diabetes insipidus , diarrheal excessive perspiration
?⃝
3) Hypotonic dehydration
a) chronic illness
b) excessive fluid replacement (hypotonic)

c) kidney 01st

d) chronic malnutrition

Interventions :

a) isotonic dehydration
-

fluid cool
tx i isotonic

D) Hypotonic dehydration
hypotonic fluid 801
-

c) Hypertonic dehydration
hypertonic Fluid 801
-

oral rehydration antiemetic

- -

-
IV fluids -

antipyretic
antidiarrheal meds
-

-
monitor 1hr0
-
monitor etutwwpe valves

Fluid Volume Excess

fluid intake fluid retention > Fluid
or needs of the body
-

-
aka Fluid ooerload or overhydration
:
-
Goal Of tx
o restore fluid balance
•
correct electrolyte imbalance
•
control the underlying cause of the overload

⑦
:
types
1) Isotonic orenhydration → -

Hypervotemia
t
-

result frm excessive Fluid in the

in the ECF
-

only compartment is expanded

- causes
aÉEd and interstitial edema
-

if pt has poor cardiac Fxn -17 HFnray edema can happen

2) Hypertonic ooenhydrdtilon
rare
the Ect spare ? Hyper
-

into
caused
by A sodium intake
-

from ICF , the ECF WI expands → w/ time

contracts

3) hydration hyp
-

Hypotonic over
"

-
water intoxication - space
into the let
.

excessive fluid moves into the Intracellular space → ④body Fluid

compartments expand
-

electrolyte inbalata occur as result

of dilution
causes :

1) Isotonic over hydration

inadequately controlled W
therapy
-

kidney dse
-

long
-
term corticosteroid therapy
2) Hypertonic over hydration
-

excessive na ingestion
-

rapid infusion of hypertonic saline

-

excessive na bicarb therapy

3) Hypotonic hydration
over

early kidney da
-

-
HF
-
SIADH
-

inadequate control of N therapy

-

replacement of isotonic fluid loss a- hypotonic fluids

-

irrigation OF wounds and body cavities c- hypotonic fluids

Intervention:S :

prevent further overload

-

administer diuretics
osmotic diuretics → initial tx to prevent severe
↳
electrolyte imbalance
-

restrict fluid and na intake

-

monitor 190
-

monitor electrolyte values

0 0
- -

* BP -
-
PBP

t v10 Pub
-

-
IHYPOKAIÉMAT d. w potassium
normal potassium level :
for muscle weak -

measures
* e.
safety
3.5 to 5.0 Mtg/ L ness

potassium level : If taking dlc

-

K
losing diuretic
→
f-
.

less than 3.5 MEALL K sparing may

be prescribed
* life threatening Foods $ in K
-

g.
-
cause :

i. actual total body Kt loss

* never administer K via IV push ,
1M
excessive use of meds Suba
•
or

( diuretics / corticosteroids )
•
④ secretion of aldosterone
/HyPERkAM1A-
* •
vomiting ,
diarrhea -

potassium level
:
more than 5 MEALL
•
wound rcturainage -
pseudohyperkalemia
o
prolonged nasogastric suction in our due to methods of blood Spe
-

• excessive diaphoresis a. men collection and all lysis

nabs
kidney dse impairing Causes
-
• :

option of potassium 1) Excessive K intake

2) & potassium intake inpo a. overingestion of K rich foods

3) movement of K fr ECF to ICF or meds
alkalosis - b. rapid infusion K
containing
•
of
•
Hyper insulinism w fluids
4) Dilution of serum K
a) h k excretion
• water intoxication a. K sparing diuretics
i K
w
therapy deficient kidney DR
•
b.
Sol c. adrenal insufficiency
Interventions : 3) movement leftover
tr
a) monitor electrolyte value a. tissue damage
b) k supplements orally or W b- acidosis
c) oral K supplements c.
hyperwiamia
at
may cause nausea d.
hyper catabolism
-

vomiting ,
should not be Interventions :

taken on
empty stomach i. Dlc W K and
w/ hold K supplement
-
liquid Kel has unpleasant 2 . Initiate K restricted diet
taste should be taken c- 3 .
K excreting diuretics if renal Fxn
juice is not impaired
0 0

-
-

• ÷Ymm8 =

0 0
T waves
-
tall peaked wave
p
-

*
*
* peat

=
-

-
 uware
tk inverted T

PK Tall Reatuclt
Flat Pware
i

:
^

4) renal Fxn impaired

'

3) dilution of sewmn①
prepare sodium polystyrene sul excessive ingestion of hypotonic Sol
-

↳
-

Fonate coral /rectal)

-

kidney da -
HF
↳
-

promotes GI sodium absorption

-

Freshwater drowning
and k excretion -
start -

Hyperglycemia
:
5) dialysis if K levels are ai - interventions
-

ti catty high D hyponatremia 1- hypoxemia

a) N ca if severe ↳ W had
↳ to avert myocardial oxoi -

2) hyponatremia t hyperthermia
osmotic diuretics (promote
+ ability in

7) N administration of hypertonic excretion of H2o than ha

glucose c- regular insulin 1
3) meds that antagonize
into more excess K into cells ADH
8) only fresh blood ! 4) P oral ha intake
stored blood may elevate the K * 5) IF takin lithium B
↳ monitor lithium level
of older
be the breakdown
blood releases K .
M can count lithium secretion

a) avoid foods rich in K LD

hyponatremia precipitates lithium
w ) avoid salt toxicity
'

t.EE?.::::.mJIHyp0NATREMlA--
* normal valve
: more than 145 MEA/ L
'

causes :
135 to 145 MEA / L
-

serum Na level :
p b na excretion
lower than 135
mtqll a. corticosteroids
causes :
b. cushing 's syndrome
a) P na excretion
e
c. kidney da
diuresis vomiting d- hyper aldostewnism
•
•

o excessive diuretics 2.) p na intake

• diarrhea
④ secretion
aldosterone
of 3) ④ HW-inta.lu
4) P H2O loss :
.

a) inadequate na intake C
•
p metabolism •
intxn
npo fasting
o
, •
Fever •
diabetes
0
low salt diet insipidus
K
-5mg 1dL
= 3

ha = 135
-145mg1dL
Cd -

9-losing 1dL
Interventions :
:
Interventions
1) For fluid loss D oral or w ca
↳ w infusion 2) For Nca :

2) for inadequate renal excretion -

warm the sot
of sodium -
administer slowly
↳
diuretics that promote na monitor ECG
changes
-

loss
observe
infiltrating
for
-

3) Restrict na and Fluid intake

hypercalcemia
g) meds that P ca absorption
¥tn%YnaYInEmm7_: *
a)
"
aluminum

↳ reduce
hydroxide
phosphorus level

-
9 -105
serum level
mg 1dL (2. 25102.75mmol /
:
ygypnospnontb b)
*
U Vit D
thereby
D
ca towels

less than 9 mg 1dL maids in the

absorption thru
causes :
-

the intestinal tract

1) Inhibition of Ca absorption from
4) Quiet environment

⑤
-

tract
5) give Pree
rat intake OF Ca a) be careful for pathological
•
lactose intolerance fracture
•
malabsorption syndromes 7) 1090 calcium qwc Frrtx of
o
inadequate intake of Vitt acute ca deficit
•
ESRD

2- P ca excretion .

/#YPERcALLEm#
polyuric phase
-
•
Kidney da ,

diarrhea serum level :

wound drayage
-

• •

steatorrnea
o
more than no -5
mglldl
3- conditions that to ionized fraction causes :

of ca DA ca absorption
o
hyperpwtlinemia • P oral intake of ca ar Vit D
• alkaloid a) b ca excretion
or binders
o
ca chelation .

Kidney da
•
immobility otniande diuretics
•

hyperphosphaturia a.) P bone resorption of Ca

o destruction of parathyroid •
hyperparathyroidism .
immobility
gland PWD o
hyperthyroidism . use
glucocorticoids
of
 Interventions :
4) Hemoconutratim
adrenal Msu D restore ca tends
dehydration • -
•

a) oral cause diarrhea cy

•
use of lithium Ffioiency mg may
Interventions
: P my loss

1) Dlc IV infusion containing Ca and 3) Mgs04 by iv

oral meds E Vit b and calcium ↳ 1M can cause pain and muscle

2) Diuretics damage)
↳ ehohanu excretion of Ca ↳ seizure pree
DTR
3) meds that inhibit ca resorption us cheek

from the
bone such as (calcitonin)
4) dialysis if a- severe hypercalcemia IHYPERMA6NEC.FM#-
serum level :

b) cheek
-

portraiture
strain more than 2.6 Meall
of monitor flank or abdpain ,
the urine
for urinary stones
:
carbs

+7 Avoid foods rich in Ca is Pmg intake

omg containing antacids and laxa
-
-

htypomA6nESEMl# tires
*ToÉÑU : •
P mg per W
1- 8 -2-6 MEALL G.74
- I -07mmol
/c) 2) § renal excretion
serum level : ↳ result of renal insufficiency
-

lower than 1.8 meqk Interventions :

:
Causes 1) Diuretics
1) Insufficient Mg intake 2) W Cd Chloride orca blue

malnutrition
•
us revetments on carotid muscle

vomiting , diarrhea
•
3) Avid laxatives or diuretics rich

malabsorption syndrome in
•
ca
•
celiac du * ca Gluconate
2) Pmg excretion mame for Mg overdose
° diuretics
•
chronic alcoholism fHYP0PHosp7M#
:
5) 1C morement 0km9 * normal serum level
•

hyperglycemia ↳ 3.0 -4.5

mgldl 10.97 -
I-45mmol L/)
•
insulin administration - serum level
o

sepsis ↳ less than 3.0mg 1dL

 t
4
 Causes :

g. Assess renal system before administer

e) Insufficient phosphorus intake :
ration of phosphorus
2) P phosphorus excretion is .
monitor for fracture
•

Hyperparathyroidism r a. ⑨intake of
-
phosphorus rich food ,

Malignancy ④ oI=ca Foods

•
intake rich
•
Mg based or aluminum hydroxide
antacids *
Reciprocal relationship
3) Intracellular shift p serum ca
=
§ serum phosphorus
•
hyperglycemia a t.ca = 9 phosphors
•
respi alkalosis

assessment : IHyPERPH0SPHAM1#
1) Cardio : -
serum level :

•
↳ contractility and cardiac more 4.5mg1dL
than

output most
body systems tolerate A serum
-

•
slowed peripheral pulses a
phosphorus levels well
2.) Rsspi : shallow perspiration
-
P serum phosphorus , accompanied by
3) Neuro :
A serum calcium level
weakness Focused hypocalcemia
-
•
on
•
§ DTR Causes :

•
of bone density → cause
fracture , 1) In renal excretion

•
rhabdomyolysis 2) tumor lysis syndrome
4) CWS 3) hyperparathyroidism
•

irritability • seizure 4) p intake of phosphorus

oral laxatives or
•

confusion
↳
supp ,
8
enema
5) Hema
•
to platelet aggregation assessment : * refer to hypocalcemia
Interventions :
P bleeding
•
immunosuppression 1) molt OF hypocalcemia
interventions
:
a) phosphate binding meds
D Dlc meds that cause hiypopnospha
-

.
MP fecal excretion of phosphorus
tenia
w taken i meal
a) oral phosphorus t Vit D
supp 3) avoid laxatives / enema C.phosphate
3) scum level below 1mg1dL containing)
MN phosphorus 4) In intake of phosphorus rich

us administer
slowly foods
 -44.415 49.31
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