 electrolyte, serum osmolality, acid/base abnormalities:

1- Hypovolemia and hypervolemia

2- Hyponatremia and hypernatremia
3- hypo- & hyperkalemia
4- hypo- & hypercalcemia
5- hypo- & hypermagnesemia
6- hypo- & hyperphosphatemia
7- metabolic acidosis
8- metabolic alkalosis
9- respiratory acidosis
10- respiratory alkalosis
 electrolyte, serum osmolality, acid/base abnormalities causes:
1- vomiting/diarrhea
2- diuretic ingestion
3- CHF
4- SIADH
5- Chronic obstructive pulmonary disease
6- Diabetic ketoacidosis
7- Chronic renal failure

Insensible losses (unmeasurable) sensible losses (measurable)

 Respiration  Urine
 Sweat (skin)  Stool
 increased with elevations of  GI losses:
- body temp. - vomiting
- envir. temp. - nasogastric suction
- respiratory rate - diarrhea
- ileostomies, colostomies, or
enterocutaneous fistulae

ECF depletion TBW depletion

 occur acutely.  referred to as “dehydration”
 rapid and aggressive fluid replacement  All body compartments, more gradual, chronic
 Isotonic loss so no osmolality change  represents a loss of hypotonic fluid (proportionally more
 causes: water is lost than sodium) from all body compartments, a
A. external fluid losses (burns, hemorrhage, diuresis, GI losses, primary disturbance of osmolality is usually seen
and adrenal insufficiency)  hypotonic loss (higher loss of water than Na) so there is an
B. third-spacing of fluids (septic shock, anaphylactic osmolality changes
shock, or abdominal ascites).  causes:
1. insufficient oral intake
2. excessive insensible losses
3. diabetes insipidus
4. excessive osmotic diuresis
5. impaired renal concentrating mechanisms.
6. Long-term care residents are frequently admitted to
the acute care hospital with TBW depletion secondary to
lack of adequate oral intake, often with concurrent
excessive insensible losses.
 TBW Interstitial Intravascular intracellular
Dehydration 1. BW changes (lose) 1. Peripheral edema (sacral 1. Increased pulse rate 1. Serum osmolality &
Symptoms 2. CNS changes edema in supine 2. Decreased blood Na
3. Thirst position) pressure(orthostatic 2. Thirst
4. Decreased skin turgor 2. Pulmonary congestion hypotension) 3. Mental changes
5. High Na level (bld gasses, crackles, x- 3. S3 heart sound 4. Skin and mucous
6. High plasma ray) 4. Collapsed neck veins membranes
osmolality 3. Ascites, third spacing 5. Peripheral circulation 5. Decreased skin
7. Conc urine (color and temperature turgor
of extremities)
6. Renal perfusion
indicators:
- low Urine output
- Urine chemistry:
1. low urine Na (<10
Meq/L);
2. high specific gravity;
3. urine osmolality at
least 100 mOsm/L
7. (BUN)
Increased in blood Causes:
1. Dehydration
2. high protein intake and
catabolism
3. Kidney disease
4. Tissue necrosis
5. GI bleeding with
subsequent catabolism of
blood to nitrogen

decreased in blood causes:

1. End-stage liver failure
2. Overhydration

• BUN/Cr ratio >20

indicates dehydration
• BUN/Cr ratio <20
indicates intrinsic renal
damage

8. Hematocrit (Hct)
- Normal values Males
(40%-%50%) Females
(35%-45%)
- Hct: packed cell
volume
- increase in
dehydration,
erythrocytosis, or
polycythemia
 - decrease in anemia or
excess blood loss

Crystalloid solutions Colloidal solutions

Examples - normal saline - Albumin
- hypertonic saline - the dextrans,hetastarch
- lactated Ringer’s solution. - fresh frozen plasma
- D5W
- D5 + hypotonic saline
Composed Water + electrolytes do not dissolve into a true solution
of
movement Pass freely through semipermeable do not pass readily across semipermeable
membranes and remain in the membranes. Remain in the intravascular space and
intravascular space for shorter increase the oncotic pressure of the plasma. This
periods of time. effectively shifts fluid from
the interstitial compartment to the plasma
compartment.
uses correcting electrolyte imbalances
Therapeutic Fluids