Fluid and Electrolytes

Our body is made of 70% of water

 Brain consists of 90% water

 Bone consists of 22% water
 Water protects and moistures our joint
 Blood consists of 83% water
 Muscle consists of 73% water

Water helps with:

 Transporting nutrients and oxygen into cell

 Moisturizes the air in our lungs helps our metabolism

Systemic:

 Detoxifies the body

 Water helps regulate body
 Helps our organ to absorb nutrients better
 Protect our organs

Our body is not made out of plain water but ELECTROLYTES:

6 main electrolytes:

 Potassium
 Sodium
 Chloride
 Calcium
 Phosphate
 Magnesium

Electrolyte – is a substance that will conduct electricity when dissolved in water (blood in the body). It
produces electrical charge which becomes ions.

Fluid and Electrolytes help with:

 Contraction of Muscles
 Sending nerve impulses
 Creating bones
 Balancing fluids in our body via osmosis
 Maintaining the blood’s acid base balance

How does a human maintain levels of fluids and electrolytes?

 We get majority of our electrolytes from food and majority are absorbed by our gut

Note: If you have GI (Gastro Intestinal) problems, this would cause less effective absorption of
electrolytes
  After absorption from food, electrolytes then enter our blood stream and get filtered by the
kidneys.

Note: If you have Kidney (Renal System) problems, this would lead to problems with your electrolyte
levels.

 Patients who have high abnormal electrolyte levels will need to go for dialysis machine. The
machine is going to replace what the kidney nephrons should be doing.

Things that affect fluid and electrolytes:

Exit route:

 Trauma
 Blood loss
 Burns
 Diarrhea
 NG Suction

Disease process:

 Aldosterone
 High aldosterone levels cause elevated sodium levels (hypernatremia) and low potassium
levels (hypokalemia), often resulting in an electrolyte imbalance.
 Antidiuretic Hormone Problems such as SIADH (Syndrome of Inappropriate Antidiuretic
Hormone)
 SIADH causes your body to retain too much water. The main sign and consequence of ADH is
(hyponatremia), which is when you have low levels of sodium (salt) in your blood.

Sodium
Sodium is a major ELECTROLYTE found in ECF (Extra cellular fluid. Essential for acid-base, fluid balance,
active and passive transport mechanism, irritability and CONDUCTION of nerve-muscle tissue.

Sodium plays a huge role in regulating the water inside and outside of our cells along with muscle
contraction and nerve impulses.

Note: Sodium is OUTSIDE of the cell because of higher concentration of sodium in the extracellular fluid.

“Where SODIUM goes, WATER follows.”

 Water loves sodium, where there is higher concentration of sodium, it pulls water to where
it is ECF (extracellular fluid) or ICF (intracellular fluid).
 When you eat salty food, you usually crave for WATER. (Just a concept)

Normal levels of sodium: 135 – 145 mEq/L (milliequivalents per liter)

Hypernatremia: more than 145 mEq/L

Hyponatremia: less than 135 mEq/L

Hypertonic – water flows out of cell and cell shrinks.

Hypotonic – water flows into cell and cell grows/swells.

Note: If there are sodium problems, you will be seeing issues with muscle contractions and nerve
impulses.

HYPERNATREMIA

Signs and Symptoms of Hypernatremia:

 BIG AND BLOATED

F lushed Skin

R estless, anxious, confused, irritable

I ncreased BP and fluid retention

E dema (pitting)

D ecreased urine output

S kin flushed and dry

A gitation

L ow-grade fever

T hirst (dry mucous membranes)

Causes of Hypernatremia:

Increased Sodium Intake:

Excess oral sodium ingestion

 Excess administration of IV fluids w/ sodium

 Hypertonic IV fluids
 Corticosteroids

LOSS OF FLUIDS:

 Fever
 Watery diarrhea
 Diabetes insipidus (a rare condition where you pee a lot)
 Excessive diaphoresis (excessive sweating due to a secondary condition)
 Infection
HEMO CONCENTRATION = INCREASED SODIUM!

Note: The sodium level in the blood becomes abnormally high when water loss exceeds sodium loss.

Decreased Sodium Excretion:

 Kidney Problems

Cushing’s Syndrome:

 overproduction of cortisol (stress hormone)

 high cortisol = high sodium in blood and less potassium
 leads to hypernatremia and hypokalemia

Conn’s Syndrome:

 overproduction of aldosterone
 high aldosterone in body = high sodium in blood and less potassium
 leads to hypernatremia and hypokalemia

Management of Hypernatremia:

If due to fluid loss:

 Administer IV infusions

If the cause if inadequate renal excretion of sodium:

 Give diuretics that promote sodium loss

Note: Restrict sodium and Fluid Intake as prescribed.

HYPONATREMIA

Signs and Symptoms of Hyponatremia:

S eizures and Stupor

A bdominal cramping

L ethargy (weakness/fatigue)

T endon reflexes diminished, trouble concentrating

L oss of urine and appetite

O rthostatic hypotension, overactive/hyperactive bowel sounds

S hallow respirations (late)

S pasms of muscles

Causes of Hyponatremia:
Increased sodium excretion (5D’s)

 Diaphoresis (ex: high fever)

 Diuretics
 Diarrhea and vomiting
 Drains (NGT suction)
 Diuretics (Thiazides and loop diuretics)

SIADH (Syndrome of inappropriate antidiuretic hormone secretion)

 causes your body to retain too much water

Addison’s Disease

 Low aldosterone

Adrenal insufficient (adrenal crisis)

Inadequate sodium intake

 Fasting
 NPO (‘nil per os’/ nothing by mouth)
 Low-salt diet

Overload of Fluid:

 CHF (Congestive Heart Failure)

 Renal Failure
 Hypotonic fluids

Management of Hyponatremia:

A dminister IV sodium chloride infusions (Only if due to hypovolemia)

D iuretics (if due to hypervolemia)

Hyponatremia -> high fluids and low salt = hemodilution

D aily Weights (Where sodium goes, water FLOWS)

S afety (orthostatic hypotension AKA risk for falls)

A irway Protection (NPO)

Don’t give food to a lethargic, confused client

(INCREASED RISK FOR ASPIRATION)

L imit Water Intake

Hypervolemic hyponatremia (high fluid & low salt)

T each to avoid a diet high in salt

(Canned food, packaged/processed meats, etc.)