Fluids and Electrolyte Worksheet

Section 1: Water Content of the body/Fluids

The two major fluid compartments in the body are _intracellular_(inside the cells) and the extracellular spaces
extracellular (outside the cells)

Approximately two-thirds of body water is located within cells and is called _intracellular fluid (ICF); the ICF
constitutes approximately 42% of body weight.

Approximately ___one-third___ of the ECF is in the plasma space (3 L in a 70-kg man), and two-thirds is in the
interstitial space (8 L in a 70-kg man).

Other ECF components include lymph and transcellular fluids.

Transcellular fluids account for approximately 1 L and include:

1) Cerebrospinal fluid
2)fluid in GI tract and joint spaces
3) pleural
4) peritoneal
5)intraocular and pericardial fluid

There are two main compartments you want to be familiar with: intracellular and extracellular

Intracellular

Intra means inside and cellular means cell = inside the cell

This is the compartment inside of the cell and accounts for 2/3 of
our body water. Memory Tip: most of our fluid is inside the cell.

Extracellular

Extra means outside of and cellular means cell = outside of the

cell

This is the compartment outside of the cell, and it accounts for

1/3 of our body water.

It includes 3 fluid compartments:

Interstitial

This is the fluid that surrounds the outside of the cells or found in
between the cells.

It plays a vital role in helping be a medium for electrolytes and

other substances to move to and from the cell to the plasma with
the assistance of the capillaries.
Intravascular

Also known as the plasma This is the fluid found inside the blood vessels and contains so many important substances like electrolytes, blood cells,
and so forth.

Transcellular

Smallest compartment. This is the fluid found in certain body cavities like the spinal fluid, fluid around the heart/lungs, and joints etc

Fluid Gain and LOSS *Important Notes

 1 litre of water weighs 1 kg. Therefore, if a patient loses 2kg in 24 hours they have a fluid loss of 2L

Section 2: Mechanisms Controlling Fluid and Electrolyte Movement

Diffusion: movement of molecules from an area of __HIGH__ concentration to one of __LOW__ concentration

1)How does the movement of molecules stop?

The membrane separating the two areas must be permeable by
diffusing the substance for the process to occur. The net movement
of molecules stops when the concentrations are equal in both areas.

2) Simple diffusion requires no external energy. What moves via diffusion?

Gases (e.g. oxygen, nitrogen, carbon dioxide) and substances (e.g., urea) can permeate cell membranes anad
are distributed throughout the body.

Facilitated Diffusion: involves the use of a protein carrier in the cell membrane.
1) True or False: Facilitated diffusion is passive and requires no energy TRUE
2) Example of facilitated diffusion. Glucose transport into the cell
3) The protein carrier combines with a molecule and moves across the membrane
from an area of HIGH concentration to one of LOW concentration

Active Transport: is a process requiring ENERGY in which molecules move AGAINST the concentration
gradient.
1) What is an example of active transport? Sodium potassium pump
The intracellular and extracellular concentrations of sodium and potassium differ
greatly, to maintain this concentration difference, the cell uses active transport to move
sodium out of the cell and potassium into the cell.
2) Example of an energy source? Adenosine triphosphate (ATP).

Osmosis: is the movement of water between two compartments separated by a semipermeable membrane,
one that allows the movement of water but not solute

Osmosis. Water moves through the membrane from an area of ___LOW_ solute concentration to an area of
__HIGH_ solute concentration.
 1) True or False: Osmosis requires no outside energy sources TRUE
2) Osmosis stops when: The concentration differences disappear or when hydrostatic
pressure builds and is sufficient to oppose any further movement of water. Diffusion and
osmosis are important in maintaining the fluid volume of body cells and the
concentration of the solute.

Section 3: Osmotic Movement of Fluids

Cells are affected by the osmolality of the fluid that surrounds them.

Match the term with the definition

1)Hypertonic: Those with solutes more concentrated than they are in the cells are hypertonic (hyperosmolar).
2)Hypotonic: Solutions in which solutes are less concentrated than they are in cells are hypotonic (hypo-
osmolar).
3)Isotonic: Fluids with the same osmolarity as the cell interior are isotonic.

_3__Fluids with the same osmolality as the cell interior.

__2_Solutions in which the solutes are less concentrated than they are in cells.

_1__Those with solutes more concentrated than they are in cells.

Normally, the ECF and the ICF are __ISOTONIC____to one another, so no net movement of water occurs

Solution How it works Additional Information

Hypertonic If the cell is surrounded by
 hypertonic solution, water leaves
the cell to dilute the ECF; the cells
shrinks and may eventually die.
Hypotonic If a cell is surrounded by hypotonic
solution, water moves into the cell,
causing the cell to swell and burst.
Isotonic If a cell is surrounded by isotonic
solution (normal water balance) ,
results in no change.

Fluid type Solution Examples How does it work? Things to watch for
Isotonic Why would a patient get an Excessive
Iso means equal 0.9% saline order for isotonic solution? administration of
Tonic means conc of 5% dextrose in water these fluids can
solution (D5W) (after To increase extracellular cause elevation of
fluid volume. i.e. patient sodium and
administration of this
has lost the extracellular
Means equal body absorbs the chloride levels.
fluid. Which could be
concentration of the dextrose and in body because of blood loss,
solution water is left which in turn dehydration, diarrhea or
becomes hypotonic surgery.
solution)
5% dextrose in 0.225% Isotonic solutions will not
cause and shift between
saline
ICF and ECF. Just used as
Lactated ringers fluid replacement.

Hypertonic Colloids, dextran, Shifts of interstitial fluid Fluid leaking to

mannitol, or other
Hyper means excessive hypertonic solutions
Excessive concentrated Six of them:
solution 3% saline
5% saline
10% dextrose in water
5% dextrose in 0.9%
saline
5% dextrose in 0.45%
saline
5% dextrose in LR
(LACTATED RINGERS)
These solutions are given
in intensive care unit and
are very hard on the
veins. Usually given via
central lines.
to plasma: Fluid is drawn surrounding tissues,
into the plasma space from
the interstation whenever Cell shrinking
there is an increase in the
plasma osmotic or oncotic Cause fluid overload,
pressure. In turn water is causing pulmonary
drawn from the cells via edema.
osmosis, which causes
equilibrium of the
osmolarity between the ICF
Eg: wearing of elastic
and the ECF.
compression gradient
stockings or hose to
Why are they given? decrease peripheral
edema is a therapeutic
When cells are swollen, application of this effect.
for example: cerebral
edema, hyponatremia.
Hypotonic Shifts of plasma to Fluid overload, heart
Hypo means under or 0.45% saline (1/2 saline) interstitial fluid: failure, liver failure,
beneath 0.225% saline (1/4 NS) accumulation of fluid int the obstruction of venous
interstitum (edema) occurs return to the heart (by
0.33 % saline (1/3 saline)
if venous hydrostatic tourniquets,
Tonic is concentration pressure rises, plasma restrictive clothing,
of solution ** D5W can also be used oncotic pressure venous thrombosis
as dextrose is decreased, or interstitial and venous
So it means the metabolized in body** oncotic pressure rises. insufficiency
concentration of Edema may also develop if (varicose veins).
solution is lower than it the lymphatic outflow is
obstructed, which causes When to not give
should be
these solutions?
decreased removal of
interstitial fluid. Increased ICP.

Why do we use it? Patients with burns or

trauma. As these
When cell is dehydrated; patients are already
d/t Diabetic ketoacidosis or hypovolemic.
hyperglycemia.

Plasma Expanders Colloids, dextran, They stay in vascular space

hetastarch. and increase the osmotic
pressure.
Colloids are protein
5% albumin: it has
solutions such as
concentration similar to that of
plasma, albumin, and
plasma and expands the ICF
commercial plasmas. millilitre for milliliter.

Albumin is available in 25% albumin is hypertonic

5% and 25% and causes additional fluid to
move from the interstitium.

Dextran is a complex
synthetic sugar. Because it is
metabolized slowly, it remains
in the vascular system for
prolonged period but not as
long as a colloid solution. It
causes additional fluid to
move into intracellular space.
Packed Red Blood Cells Loop diuretics may be Packed RBCs have the
administered with blood advantage of giving the
patient primarily RBCs; the
to prevent symptoms of blood bank can use the
fluid volume excess in plasma for blood components.
anemic patients who are
not volume depleted. Packed RBCs have a
decreased plasma volume,
they will increase oncotic
pressure and pull fluid into the
intravascular space