NCMA113 LEC: FLUIDS AND ELECTROLYTES (SIR MIRADOR)

FLUIDS AND ELECTROLYTES Fluid Transport

Fluids - How does fluid is being transported from one compartment to
- 60% of an adult’s body weight another.
- Infants = more water (80%) - It can be from intracellular to extracellular or vice versa.
- Elderly = less water Diffusion
- More fat = less water - The movement of a substance from an area of high
- More muscle = high water concentration to an area of low concentration.
- Infants and elderly - prone to fluid imbalance - Diffusion happens in liquids and gases because their particles
- younger people have a higher percentage of body fluid than move randomly from place to place.
older and fat people. - ex. Perfume, coffee mix in water
Kinetics of Diffusion
1. The greater the concentration difference between the area
the greater the rate of diffusion.
2. The less the molecular weight the greater the rate of
diffusion.
3. The shorter the distance the greater the rate
4. The greater the cross section of diffusion pathway the
greater the rate of diffusion
5. The greater the temperature the greater is the molecular
motion the greater is the diffusion. (Means temp. increases
the rate of diffusion)
Diffusion through the cell membrane
a) Effect of lipid solubility in diffusion
- ex. O2, CO2, alcohol, fatty acids = very soluble in lipid
(passes easily in the cell membrane)
b) Carrier mediated facilitated diffusion = (insoluble, insulin
carries glucose across cell membrane)
Fluid compartment
Intracellular Fluid
- 25 liters of the total fluids in the body.
Extracellular Fluid
- 15 liters of the total fluids in the body.
a) Intravascular
- Plasma 3 liters
- Red cell 2 liters c) Diffusion through membrane pores = 8 A (Armstrong) (0.8
b) Interstitial nanometer)
- 12 liters - ex. Water molecule, urea molecule, chloride smaller than
Formula: the pore
d) Effect of electrical charge
ECF – Plasma volume = ITF - Electrical charges affects diffusion greatly.
- ex. Na cannot easily pass because of the positive charge.
Fluid Environment (Normal values) e) Effect of concentration difference on net diffusion rate.
Extracellular Fluid Intracellular Fluid
Na 142 mEq/L Na 15 mEq/L
K 5 mEq/L K 141 mEq/L
Ca 5 mEq/L Ca <1mEq/L
Mg 3 mEq/L Mg 58 mEq/L
Cl 103 mEq/L Cl 4 mEq/L
HCO3 28 mEq/L HCO3 10 mEq/L
P 4 mEq/L P 75 mEq/L
SO4 1 mEq/L SO4 2 mEq/L  GC in ECF and LC in ICF permits diffusion to become faster
Glucose 90 mg Glucose 0-20 mg and it increases rate of diffusion. The difference bet. The
Amino Acid 30 mg Amino Acid 200 mg concentration of substances in both sides affects the rate of
Cholesterole 0.5 gm Cholesterole 2- 95 gm diffusion.
Phospholipids 0.5 gm Phospholipids 2- 95 gm Osmotic Pressure
Neutral Fats 0.5 gm Neutral Fats 2- 95 gm - The minimum pressure, which needs to be applied to a
PO2 35 mm Hg PO2 20 mmHg solution to prevent the inward flow of its pure solvent across a
PCO2 46 mmHg PCO2 50 mmHg semipermeable. (When we look at ECF and ICF there are non-
pH 7.4 pH 7.0 diffusible solutes that can be found)

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 FUNDAMENTALS OF NURSING PRACTICE LEC: WEEK 3 – FLUIDS AND ELECTROLYTES (SIR MIRADOR)

- ECF side – cannot pass this semipermeable, there are the one
who attracts the water.

 In this illustration this vertical line signifies the semi-  Hypertonic- water or plasma gets out of the cell. It makes the
permeable membrane and on the ECF side there are non- cell shrink
diffusible solutes meaning these solutes cannot pass or cross  Isotonic- water coming out is being replaced by another vol. of
the semi-permeable membrane so what they do is to attract water. The cell becomes flaccid.
water because they have the capacity to hold the water  Hypotonic- fluid is going inside the cell making the cell swell
therefore water is being attracted from ICF to ECF. so the cell becomes turgid meaning the cell is swelling.
 Ex. Of these is hyponatremia in the ECF it attracts water from
inside the cell going to the ECF. Tonicity of IV Fluids
Active Transport  0.3%NaCl Hypotonic
- The movement of ions or molecules across a cell membrane  0.45% SALINE (1/2 NS) Hypotonic
into a region of higher concentration, assisted by enzymes and  0.9% NS Isotonic
requiring energy.  5% dextrose in water D5W Isotonic
- Substances from one side of the ECF going to the ICF. There  D5 ¼ NS Isotonic
is a substance form ECF which needs to be transported to the  Lactated Ringer’s solution Isotonic
ICF utilizing enzymes and energy. It can be adenosine  D5LR Hypertonic
triphosphate or ATP adenylate cyclase w/c utilizes adenosine  D5 ½ NS Hypertonic
monophosphate and when these subs. Is transported to ICF  D5 NSS Hypertonic
these adenosine recovers its phosphate compound restoring to
 D10W Hypertonic
its original form.
Formula for IV computation
Macro Drops
୴୭୪୳୫ୣ ୧୬ ୡୡ ୶ ୢ୰୭୮ ୤ୟୡ୲୭୰ ሺଵହ ୭୰ ଶ଴୫୪ሻ
Flow Rate =
୬୭.୭୤ ୦୭୳୰ୱ ୲୭ ୰୳୬ ୶ ଺଴ ୫୧୬.
 We can determine drop factor in drip chamber of fluid set
where in the spike when it is connected to the IV bottle. In the
drip chamber we can notice whether there is needle or it will
form a big drop or macro drop. When there is no needle in the
drip chamber the drop factor is considered to be 15 or 20 per
Problems that Cause Altered Fluid Volume
ml but regular is 15 drop per ml.
 Vomiting, diarrhea, fever, and infection.
 Used in computing drop per minute or per flow rate.
 Excessive sweating.
 No. of hours (sol. Is intended to be run or consume)
 Heat-related illness.
Micro Drops
 Excessive urination— known as polyuria, which can be caused ୴୭୪୳୫ୣ ୧୬ ୡୡ ୶ ଺଴ ୳୥୲୲ୱ/௠௟
by renal disease, renal failure, adrenal insufficiency, and Flow Rate =
୬୭.୭୤ ୦୭୳୰ୱ ୲୭ ୰୳୬ ୶ ଺଴ ୫୧୬.
overuse of diuretics.
 Blood loss from wounds, injuries, and bleeding disorders.  1 liter= 1,000 cc
 500 ml= 500 cc
Types of fluid for replacement  ml and cc is the same
Hypotonic  If flow rate is in micro drops or if we see needle in drip
- Solutions that have a lower osmolality than body fluids. chamber these tubings are intended to be used by pediatrics
- Use: cellular dehydration for fluid replacement patients so they have a larger no. but it is in a form of macro
- Fluid going inside the cell and it will swell. drops. So drop factor is 60 micro drops per ml while in macro
Hypertonic drop it has 15 to 2 drops per ml.
- Solutions that have a higher osmolality than body fluids.
- Use: (most commonly used in edema) to reabsorb fluids to ୚୭୪ ୧୬ ୡୡ
Cc per hour =
lessen edema ୦୭୳୰ୱ ୲୭ ୰୳୬
- > traumatic brain injury, intracranial hypertension, intracranial ୚୭୪ ୧୬ ୡୡ ୶ ୥୲୲ ୤ୟୡ୲୭୰
pressure reduction, hypovolemic shock, hyponatremia, Hours to run =
୤୪୭୵ ୰ୟ୲ୣ ୶ ଺଴ ୫୧୬
hypertonic saline for sepsis.
Isotonic
- Solutions that have the same osmolality as body fluids.  
- Use: balance the fluid in both ECF and ICF

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