St.

Paul University Philippines

Tuguegarao City, Cagayan 3503
SCHOOL OF NURSING AND HEALTH ALLIED SCIENCES
COLLEGE OF NURSING
2nd SEMESTER, A.Y 2022 – 2023
BACHELOR OF SCIENCE IN NURSING – LEVEL III

FLUID AND ELECTROLYTE IMBALANCES

DESCRIPTION:

Electrolytes are minerals in your body that have an electric charge. They are in your blood, urine,
tissues, and other body fluids. Electrolytes are important because they help:

 Balance the amount of water in your body

 Balance your body's acid/base (pH) level
 Move nutrients into your cells
 Move wastes out of your cells
 Make sure that your nerves, muscles, the heart, and the brain work the way they should

Sodium, calcium, potassium, chloride, phosphate, and magnesium are all electrolytes. You get
them from the foods you eat and the fluids you drink.

The levels of electrolytes in your body can become too low or too high. This can happen when
the amount of water in your body changes. The amount of water that you take in should equal the
amount you lose. If something upsets this balance, you may have too little water (dehydration) or
too much water (overhydration). Some medicines, vomiting, diarrhea, sweating, and liver or
kidney problems can all upset your water balance.

There are different fluid volume disturbances that may affect an individual.

 Fluid volume deficit or hypovolemia occurs when loss of ECF volume exceeds the
intake of fluid.
 Fluid volume excess or hypervolemia refers to an isotonic volume expansion of the ECF
caused by the abnormal retention of water and sodium in approximately the same
proportions in which they normally exist in the ECF.

Disturbances in electrolyte balances are common in clinical practice and must be corrected.
 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 usually indicates a deficit in total potassium stores.
 Hyperkalemia refers to a potassium level greater than 5.0 mEq/L.
 Hypocalcemia are serum levels below 8.6 mg/dl.

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 St. Paul University Philippines
Tuguegarao City, Cagayan 3503
SCHOOL OF NURSING AND HEALTH ALLIED SCIENCES
COLLEGE OF NURSING
2nd SEMESTER, A.Y 2022 – 2023
BACHELOR OF SCIENCE IN NURSING – LEVEL III

 Hypercalcemia is calcium level greater than 10.2 mg/dl.

 Hypomagnesemia refers to a below-normal serum magnesium concentration.
 Hypermagnesemia are serum levels over 2.3 mg/dl.
 Hypophosphatemia is indicated by a value below 2.5 mg/dl.
 Hyperphosphatemia is a serum phosphorus level that exceeds 4.5 mg/dl in adults.

ETIOLOGY:

Causes of fluid and electrolyte imbalances are discussed below in general.

 Fluid retention- retention of sodium is associated with fluid retention.

 Loss of sodium - Excessive loss of sodium is associated with decreased volume of body
fluid.
 Trauma - Trauma causes release of intracellular potassium which is extremely
dangerous.
 Loss of body fluids - FVD results from loss of body fluids and occurs more rapidly when
coupled with decreased fluid intake.
 Fluid overload - Fluid volume excess may be related to a simple fluid overload or
diminished function of the homeostatic mechanisms responsible for regulating fluid
balance.
 Low or high electrolyte intake - Diets low or excessive in electrolytes could also cause
electrolyte imbalances.
 Medications - There are certain medications that could lead to electrolyte imbalances
when taken against the physician’s orders.

PATHOPHYSIOLOGY

Nurses need an understanding of the pathophysiology of fluid and electrolyte balance to

anticipate, identify, and respond to possible imbalances.

 Concentrations - Electrolyte concentrations vary from those in the ICF to those in the
ECF.
 Sodium - Sodium ions outnumber any other cations in the ECF; therefore it is essential in
the fluid regulation of the body.
 Potassium - The ECF has a low concentration of potassium and can tolerate only small
changes in its concentrations.
 Maintenance - The body expends a great deal of energy in maintaining the sodium and
potassium concentrations through cell membrane pumps that exchange sodium and
potassium ions.

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 St. Paul University Philippines
Tuguegarao City, Cagayan 3503
SCHOOL OF NURSING AND HEALTH ALLIED SCIENCES
COLLEGE OF NURSING
2nd SEMESTER, A.Y 2022 – 2023
BACHELOR OF SCIENCE IN NURSING – LEVEL III

 Osmosis - When two different solutions are separated by a membrane that is

impermeable to the dissolved substances, fluid shifts from the region of low solute
concentration to the high solute concentration until the solutions are of equal
concentrations.
 Diffusion - Diffusion is the natural tendency of a substance to move in an area of higher
concentration to an area of lower concentration.

CLINICAL MANIFESTATIONS:

Signs and symptoms that occur in fluid and electrolyte imbalances are discussed below.

 Fluid volume deficit. 

- Clinical signs and symptoms include acute weight loss, decreased skin turgor,
oliguria, concentrated urine, orthostatic hypotension, a weak, rapid heart rate,
flattened neck veins, increased temperature, thirst, decreased or delayed capillary
refill, cool, clammy skin, muscle weakness, and cramps.
 Fluid volume excess
- Clinical manifestations for FVE include edema, distended neck veins, and
crackles.
 Hyponatremia
- Signs and symptoms include anorexia, nausea and vomiting, headache, lethargy,
dizziness, confusion, muscle cramps and weakness, muscular twitching, seizures,
dry skin, and edema.
 Hypernatremia
- The signs and symptoms are thirst, elevated body temperature, hallucinations,
lethargy, restlessness, pulmonary edema, twitching, increased BP and pulse.
 Hypokalemia
- Clinical manifestations are fatigue, anorexia, muscle weakness, polyuria,
decreased bowel motility, paresthesia, ileus, abdominal distention, and hypoactive
reflexes
 Hyperkalemia
- Signs and symptoms include muscle weakness, tachycardia, paresthesia,
dysrhythmias, intestinal colic, cramps, abdominal distention, and anxiety.
 Hypocalcemia
- The signs and symptoms are numbness, tingling of fingers, toes, and circumoral
region, positive Trousseau’s sign and Chvostek’s sign, seizures, hyperactive deep
tendon reflexes, irritability, and bronchospasm.
 Hypercalcemia

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 St. Paul University Philippines
Tuguegarao City, Cagayan 3503
SCHOOL OF NURSING AND HEALTH ALLIED SCIENCES
COLLEGE OF NURSING
2nd SEMESTER, A.Y 2022 – 2023
BACHELOR OF SCIENCE IN NURSING – LEVEL III

- The signs and symptoms include muscle weakness, constipation, anorexia, nausea

and vomiting, dehydration, hypoactive deep tendon reflexes lethargy, calcium
stones, flank pain, pathologic fractures, and deep bone pain.
 Hypomagnesemia
- Clinical manifestations include neuromuscular irritability, positive Trousseau’s
and Chvostek’s sign, insomnia, mood changes, anorexia, vomiting, and increased
deep tendon reflexes.
 Hypermagnesemia
- Signs and symptoms are flushing, hypotension, muscle weakness, drowsiness,
hypoactive reflexes, depressed respirations, and diaphoresis.
 Hypophosphatemia
- Signs and symptoms include paresthesias, muscle weakness, bone pain and
tenderness, chest pain, confusion, seizures, tissue hypoxia, and nystagmus.
 Hyperphosphatemia
- Clinical manifestations are tetany, tachycardia, anorexia, nausea and vomiting,
muscle weakness, and hyperactive reflexes.

DIAGNOSIS:

The following are laboratory studies useful in diagnosing fluid and electrolyte imbalances:

 BUN - BUN may be decreased in FVE due to plasma dilution.

 Hematocrit- Hematocrit levels in FVD are greater than normal because there is a
decreased plasma volume.
 Physical examination - Physical exam is necessary to observe the signs and symptoms
of the imbalances.
 Serum electrolyte levels - Measurement of electrolyte levels should be performed to
check for presence of an imbalance.
 ECG - ECG changes can also contribute to the diagnosis of fluid and electrolyte
imbalance.
 ABG analysis - ABG analysis may reveal acid-base imbalances.

RISK FACTORS:

Infants, young children and older adults are more prone to changes in electrolyte levels, but an
imbalance can happen to anyone.

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 St. Paul University Philippines
Tuguegarao City, Cagayan 3503
SCHOOL OF NURSING AND HEALTH ALLIED SCIENCES
COLLEGE OF NURSING
2nd SEMESTER, A.Y 2022 – 2023
BACHELOR OF SCIENCE IN NURSING – LEVEL III

Certain conditions can also throw off your body’s electrolyte levels. You may be more likely to
develop an electrolyte imbalance if you have:

 Burns.
 Cancer.
 Cardiovascular disease, heart failure or high blood pressure.
 Dehydration due to not drinking enough liquids or from excessive vomiting, diarrhea,
sweating (hyperhidrosis) or fever.
 Overhydration or water intoxication (drinking too much water).
 Eating disorders.
 Kidney disease.
 Liver disease like cirrhosis.
 Substance use disorder.

Certain medications can also affect electrolyte levels. These include:

 Antibiotics.
 Chemotherapy drugs.
 Corticosteroids.
 Diuretics and laxatives.

COMPLICATIONS:

Fluid and electrolyte imbalances could result in complications if not treated promptly.

 Dehydration - Fluid volume deficit could result in dehydration of the body tissues.
 Cardiac overload - Fluid volume excess could result in cardiac overload if left untreated.
 SIADH - Water is retained abnormally in SIADH.
 Cardiac arrest - Too much potassium administered could lead to cardiac arrest.

MEDICAL/SURGICAL MANAGEMENT:

Treatment of fluid and volume imbalances needs accuracy to avoid consequences that can result
in complications.

 Isotonic electrolyte solutions - These solutions are used to treat the hypotensive patient
with FVD because they expand plasma volume.

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 St. Paul University Philippines
Tuguegarao City, Cagayan 3503
SCHOOL OF NURSING AND HEALTH ALLIED SCIENCES
COLLEGE OF NURSING
2nd SEMESTER, A.Y 2022 – 2023
BACHELOR OF SCIENCE IN NURSING – LEVEL III

 Accurate I&O - Accurate and frequent assessments of I&O should be performed when
therapy should be slowed or increased to prevent volume deficit or overload.
 Dialysis - Hemodialysis or peritoneal dialysis is performed to remove nitrogenous wastes
and control potassium and acid-base balance, and to remove sodium and fluid.
 Nutritional therapy - Treatment of fluid and electrolyte imbalances should involve
restrictions or enforcement of the concerned electrolyte.

PHARMACOLOGICAL MANAGEMENT:

 AVP receptor agonists - These are new pharmacologic agents that treat hyponatremia by
stimulating free water excretion.
 Diuretics - To decrease fluid volume in FVE, diuretics are administered.
 IV calcium gluconate - If serum potassium levels are dangerously elevated, it may be
necessary to administer IV calcium gluconate.
 Calcitonin - Calcitonin can be used to lower the serum calcium level and is particularly
useful for patients with heart disease or heart failure who cannot tolerate large sodium
loads.

NURSING MANAGEMENT:

Close monitoring should be done for patients with fluid and electrolyte imbalances.

 I&O - the nurse should monitor for fluid I&O at least every 8 hours, or even hourly.
 Daily weight - Assess the patient’s weight daily to measure any gains or losses.
 Vital signs - Vital signs should be closely monitored.
 Physical exam - Physical exam is needed to reinforce other data about a fluid or
electrolyte imbalance.
 Monitor turgor - Skin and tongue turgor are indicators of the fluid status of the patient.
 Urine concentration - Obtain urine sample of the patient to check for urine
concentration.
 Oral and parenteral fluids - Administer oral or parenteral fluids as indicated to correct
the deficit.
 Oral rehydration solutions - These solutions provide fluid, glucose, and electrolytes in
concentrations that are easily absorbed.
 Central nervous system changes - The nurse must be alert for central nervous system
changes such as lethargy, seizures, confusion, and muscle twitching.
 Diet - The nurse must encourage intake of electrolytes that are deficient or restrict intake
if the electrolyte levels are excessive.

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 St. Paul University Philippines
Tuguegarao City, Cagayan 3503
SCHOOL OF NURSING AND HEALTH ALLIED SCIENCES
COLLEGE OF NURSING
2nd SEMESTER, A.Y 2022 – 2023
BACHELOR OF SCIENCE IN NURSING – LEVEL III

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