FLUIDS – ELECTROLYTES AND ACID- - Promotes cellular chemical

BASE BALANCE function

- Maintains normal body
BODY FLUID COMPARTMENTS temperature
- Eliminates waste products
 Intracellular fluid compartment
from the cells
(ICF)
- Fluid found inside the cells FUNCTIONS OF ELECTROLYTES
- It comprises 2/3 (70%) of the
body fluid  Promote neuromuscular irritability
 Extracellular fluid compartment  Maintain body fluid volume and
(ECF) osmolality
- Fluid found outside the cells.  Distribute body water between fluid
- It comprises 1/3 (30%) of the compartments
body fluid  Regulate acid-base balance
- May be interstitial fluid (in-
NORMAL VALUES
between the cells)
 Intravascular fluid ELECTROLYTES NORMAL VALUES
(plasma) SODIUM (Na) 135 – 145 mEg/L
 Transcellular fluid POTASSIUM (K) 3.5 – 5 mEg/L
(digestive juices, CALCIUM (Ca) 4.5 – 5.5 mEg/L
pleural fluid, water in PHOSPHATE 1.7 – 2.6 mEg/L
the renal tubules & (HPO4)
CSF CHLORIDE (Cl) 98 – 108 mEg/L
MAGNESIUM (Mg) 1.5 – 2.5 mEg/L
FACTORS OF BODY WATER
DISTRIBUTION
INTERNAL REGULATION OF BODY
 In infants, 80% of the body weight is WATER AND ELECTROLYTES
water.
 Sodium and water regulation
 In males, 60% of the body weight is
 Thirst – major control of
water. Males are more muscular
actual fluid intake
than females.
 Kidneys – major organs
 In females, 50% of the body weight
controlling output
is water. Females have more
 ADH – retains water in the
adipose tissue than males.
renal tubules
FUNCTIONS OF WATER  RAAS – aldosterone retain
sodium and water (sodium
 Extracellular fluid primarily determines
- Maintains blood volume osmolality (concentration) of
- Transports gases, nutrients the body fluids)
and other substances to the
cells RAAS (RENIN – ANGIOTENSIN –
 Intracellular fluid ALDOSTERONE SYSTEM)
  Potassium Regulation
 Aldosterone and hydrogen
ions regulate potassium
levels
 Aldosterone retains sodium
and excretes potassium
 Alkalosis increases k
excretion
(hypokalemia)
 Acidosis decreases k
excretion
(hyperkalemia)
 K is the major cation in the
ICF
 K is necessary in the
conduction of nerve impulses
and promotion of skeletal
and cardiac muscle activity
HYRDROGEN IN CONENTRATION
MOVEMENTS OF FLUIDS
 Calcium Regulation
 Parathormone,
thyrocalcitonin and Vitamin D
regulate calcium levels
 Vitamin D promotes calcium
absorption from GIT
 Calcium promotes
neuromuscular irritability;
bone and teeth development
and blood clotting
 Parathormone elevates s.
Ca levels by withdrawing
calcium from bones (bone
resorption)
 Thyrocalcitonin lowers s.
Ca levels by depositing Ca in
the bones (bone absorption)
 Calcium and phosphorus
have inverse relationship

PASSIVE TRANSPORT

 Diffusion – transport of solutes from

area of higher concentration to lower
concentration across semi-
permeable membrane
 Osmosis – transport of solvent from
area of lower concentration to higher
 concentration across semi- - Examples: D10W, D50W,
permeable membrane D5LR, D5NM

ACTIVE TRANSPORT

 Hydrostatic pressure – caused by

the blood pressing against walls of
blood vessels (pushing force)
 Colloid Osmotic pressure (oncotic
pressure) – pressure needed to
overcome the pull of CHON. Pull or
absorb fluid from the interstitial
space

TYPES OF SOLUTION

 POTASSIUM INSIDE, SODIUM

OUTSIDE

ELECTROLYTE IMBALANCES:

SODIUM IMBALANCES

 Hyponatremia (sodium deficit)

- Caused by sodium loss or
water excess
 Causes:
 Diuretics
 Low Na diet
 Decreased aldosterone
secretions
TYPES OF INTRAVENOUS FLUIDS  Edema
 Ascites
 ISOTONIC SOLUTION
 Burns
- Has the same concentration
 Diaphoresis
as the body fluids
- Examples: D5W, NaCl 0.9%
 Hypernatremia (Sodium excess,
& Plain ringer’s lactate
edema)
- Sodium and water excess
 HYPOTONIC SOLUTION
result to edema
- Has lower concentration than
 Causes:
the body fluids
 Hyperventilation and diarrhea
- Example: NaCl 0.3%
 High sodium intake
 Sodium tablets
 HYPERTONIC SOLUTION
 Water deprivation
- Has HIGHER concentration
than the body fluids
 increased neuromuscular
irritability
- Everything is high and fast
 Causes:
 Decreased ionized calcium
 Excess loss of calcium
 Inadequate dietary intake of
calcium-rich food
 Decreased calcium
absorption

 Hypercalcemia
- Decreased cell membrane
permeability which
POTASSIUM IMBALANCES decreases neuromuscular
 Hypokalemia (Potassium Deficit) irritability
- Everything is low and slow
- Characterized by decreased
 Causes:
neuromuscular irritability
 Calcium loss from bones
- Everything is low and slow
 Excessive intake of calcium
 Causes:
 Hyperparathyroidism
 Decreased food and fluid
 Hypervitaminosis D
intake (starvation)
 Steriod therapy
 Increased loss of potassium
 Shifting of K into the cells MAGNESIUM IMBALANCE

 Hyperkalemia (potassium excess)  Hypomagnesemia

- Characterized by increased - Magnesium inhibits
neuromuscular irritability acetylcholine release
- Everything is high and fast - In hypomagnesemia, there is
 Causes: increased acetylcholine
 Excess dietary intake of release which results to
potassium-rich food increased neuromuscular
 Excess parenteral irritability
administration of potassium - Everything is high and fast
 Decreased excretion of  Causes:
potassium  Prolonged malnutrition or
 Shifting of potassium out of starvation
cells  Malabsorption syndromes
 Hypercalcemia
CALCIUM IMBALANCES  Alcohol withdrawal
syndromes
 Hypocalcemia
 Draining fistulas
- Increased cell membrane
permeability which results to
 Hypermagnesemia
 -There is decreased
acetylcholine release which
result to decreased
neuromuscular irritability
- Everything is low and slow
 Causes:
 Excessive intake of
magnesium-containing
antacids
 Renal failure
 Diabetic ketoacidosis

 If pH is 7 and below or 7.8 and

above, death occurs.
 If pH and pCO2 are primarily
affected, respiratory acid-base
imbalances will result
 If pH and HCO3 are primarily
affected, metabolic acid – base
imbalances will be experienced.

RESPIRATORY ACIDOSIS (Carbonic

Acid Excess)

 Caused by failure of the respiratory

system to remove carbon dioxide
ACID-BASE IMBALANCES from the body fluid as it is produced
in the tissues
 Arterial Blood Gas Analysis (ABG)  Disorders that lead to
hypoventilation result to retention of
carbon dioxide

Respiratory Alkalosis (Carbonic Acid

Deficit)

 Caused by loss of carbon dioxide

from the lungs at a faster rate that it
is produced in the tissues
 Disorders that lead to
hyperventilation result to excess loss
of carbon dioxide.
METABOLIC ACIDOSIS (Bicarbonate ARTERIAL BLOOD GAS ANALYSIS
Deficit)
 Commonly ordered on the client with
 Results from abnormal of fixed acids COPD, pulmonary edema, ARD, MI
or loss of base or PNA.
 Assessment:  Also used for non-emergencies such
 Headache as weaning from ventilator
 Mental dullness  helpful in the assessment of children
 Kussmaul’s breathing who are acutely ill with either
 hyperkalemia pulmonary or non pulmonary
disorders who require an artificial
METABOLIC ALKALOSIS (Bicarbonate airway
Excess)
ALLEN’S TEST
 Results from loss of hydrogen ions
or addition of base to body fluids.  To assess adequacy of blood supply
 Assessment to the client’s non-dominant hand.
 Hypoventilation  STEPS:
 Mental confusion 1. Have client open and close
 Dizziness fist a few times.
 Numbness and tingling of 2. While fist is clenched,
fingers and toes, muscle simultaneously occlude both
twitching radial and ulnar arteries.
 Tetany and seizures 3. While arteries are occluded,
ask client to slowly unclench
fist and relax hand. (the palm
should be pale from lack of
arterial blood flow)
4. Then, release the pressure
over the ulnar artery. The
palm should turn pink within
7 to 15 seconds (+ Allen’s
 test), indicating that arterial
circulation has resumed. If
that does not happen, you
will need to select another
site.

ACCESSIBLE VESSELS FOR ARTERIAL

PUNCTURE

 Radial artery – superficial, easily

compressible and with good
collaterals with ulnar artery. Ideal
vessel for arterial puncture.
 Brachial artery
 Femoral artery
 Temporal artery
 Dorsalis pedis artery