Presentation

Topic

Body Fluids and Electrolytes
by

Rashid Hussain
Post R.N Bsc Nursing Khyber Medical University Post Graduate Nursing College Hayatabad Peshawar.
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Introduction
A cell, together with its environment in any part of the body, is primarily composed of FLUID. The cells of our bodies live in a pond, most of the weight of the human body is water. All of a cell’s operations rely on water as a diffusion medium for the distribution of electrolytes, gases, nutrients, and waste products. Thus fluid & electrolyte balance must be maintained to promote normal body functions. Any imbalance can affect homeostasis.
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AIM: To share the knowledge among the
OBJECTIVES:

participants about Fluid and Electrolytes balance
At the end of presentation the participants will be able to: Describe Explain the different of body body fluid fluids compartments between the

(ICF,ECF,IVF).

movement

compartments.
 

Enlist the normal electrolytes. Discuss the imbalance of electrolytes.
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Body fluid compartments
60% of adult total body weight is fluid
 

Intra-cellular 65% of all body fluid.

 

  

Special note 80% TBW infants. 50% TBW geriatrics.

 

Extra-cellular 35% of all body fluid Three extracellular compartments. 1. Intra-vascular 8% 2. Interstitial 25% 3. Third space (eyes, joints,plural space,etc.)2%

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Fluid compartments are separated by membranes that are freely permeable to water.

Movement of fluids due to: • Hydrostatic pressure • Osmotic pressure
Capillary filtration (hydrostatic pressure) Capillary colloid osmotic pressure Interstitial hydrostatic pressure Tissue colloid osmotic pressure
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   

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Regulation of Water Intake

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Tonicity
a solution

refers to the concentration of particles in

The normal tonicity or osmolarity of body fluids is 250-300 mOsm/L

•Isotonic Same as plasma •Hypertonic
solutes higher or greater concentration of or lowers solute

•Hypotonic

have a lesser concentration than plasma

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Cell in a hypertonic solution

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Cell in a hypotonic solution

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Movement of body fluids (a.)
Natural movement no energy required.

Osmosis

Diffusion

Movement of solvent, H2O across a semipermeable membrane, from an area of lesser solute (particle) concentration to an area of higher solute concentration.

Movement of solute (particles) from an area of higher concentration to an area of lower concentration.
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Movement of body fluids (b.)
Movement requiring energy (Biochemical Processes)
Active transport

Facilitated diffusion

Movement of a substance across a cell membrane, through special portals in the cell wall, from an area of less concentration to an area of high concentration. Na+/K+ pump

A Biochemical process in which a substance is selectively transported across a cell membrane using a carrier molecule and energy. Insulin/glucose

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Electrolytes
Ions = Charged particles

Cation: Positively
Charged particles.

Anion: Negatively
charged particles.

   

Sodium ( Na +) Potassium ( K+) Calcium (Ca++)
  

Chloride

(Cl-)

Bicarbonate (HCO3-) Phosphate (HPO4 -)

Magnesium (Mg++)

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Serum Values of Electrolytes
Cations
Concentration, mEq/L

Sodium 135 - 145 Potassium 3.5 - 4.5 Calcium 4.0 - 5.5 Magnesium 1.5 - 2.5

Anions

Chloride 95 - 105 Bicarbonate 23 - 30 Phosphate 2.5 - 4.5

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Sodium
    

Most abundant extracellular cation. Regulates body water distribution. Aids nerve impulse transmission. Aids transfer of POTASSIUM into cells. Sodium levels are controlled by the kidneys
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Electrolyte balance

Na

+

(Sodium)

• 90 % of total ECF cations • 136 -145 mEq / L • Pairs with Cl- , HCO3- to neutralize charge • Low in ICF • Most important ion in regulating water balance • Important in nerve and muscle function
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Regulation of Sodium

Renal tubule reabsorption affected by hormones: • Aldosterone • Renin/angiotensin • Atrial Natriuretic Peptide (ANP)

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Renin-Angiotensin-Aldosterone System

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summary
water Thirst center ADH RAAS ANP ↑Intake ↓Output ↓Output ↑output volume ↑ ↑ ↑ ↓ sodium ↑reabsorption osmolality ↓ ↓ normal

↓ reabsorption normal
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Electrolyte imbalances: Sodium

Hypernatremia (high levels of sodium)

• Plasma Na+ > 145 mEq / L • Due to ↑ Na + or ↓ water • Water moves from ICF → ECF • Cells dehydrate
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Hypernatremia Due to:
• Hypertonic IV soln. • Oversecretion of aldosterone • Loss of pure water
  

Long term sweating with chronic fever Respiratory infection → water vapor loss Diabetes – polyuria

• Insufficient intake of water (hypodipsia)
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Clinical manifestations of Hypernatremia
  

Thirst Lethargy Neurological dysfunction due to dehydration of brain cells

Decreased vascular volume

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Treatment of Hypernatremia

Lower serum Na+ • Isotonic salt-free IV fluid • Oral solutions preferable

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Hyponatremia
  

Overall decrease in Na+ in ECF Two types: depletional and dilutional Depletional Hyponatremia
Na+ loss: • diuretics, chronic vomiting • Chronic diarrhea • Decreased aldosterone • Decreased Na+ intake
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Clinical manifestations of Hyponatremia

Neurological symptoms
• Lethargy, headache, confusion, apprehension, depressed reflexes, seizures and coma

Muscle symptoms
• Cramps, weakness, fatigue

Gastrointestinal symptoms
• Nausea, vomiting, abdominal cramps, and diarrhea

Tx – limit water intake or discontinue meds 32

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Potassium
 

Most abundant intracellular cation. Necessary for transmission and conduction of nerve impulses.

 

Maintenance of normal cardiac rhythm. Necessary for smooth and skeletal muscle contraction.
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Hyperkalemia
      

Serum K+ > 5.5 mEq / L Check for renal disease Massive cellular trauma Insulin deficiency Potassium sparing diuretics Decreased blood pH Exercise causes K+ to move out of cells
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Clinical manifestations of Hyperkalemia
    

Early – hyperactive muscles , paresthesia Late - Muscle weakness, flaccid paralysis Change in ECG pattern Dysrhythmias Bradycardia , heart block, cardiac arrest

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Changes in ECG due to Hyperkalemia

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Treatment of Hyperkalemia

If time, decrease intake and increase renal excretion

  

Insulin + glucose Bicarbonate Dialysis

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Hypokalemia
 

Serum K+ < 3.5 mEq /L Beware if diabetic • Insulin gets K+ into cell • Ketoacidosis – H+ replaces K+, which is lost in urine
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Causes of Hypokalemia
 

Decreased intake of K+ Increased K+ loss • Chronic diuretics • Acid/base imbalance • Trauma and stress • Increased aldosterone
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Clinical manifestations of Hypokalemia

Neuromuscular disorders • Weakness, flaccid paralysis, respiratory arrest, constipation

   

Dysrhythmias, appearance of U wave Postural hypotension Cardiac arrest Treatment• Increase K+ intake, but slowly, preferably by foods
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Calcium
   

Extracellular cation Plays role in nerve impulse transmission. Increases force of muscle contractions. Functions as an enzyme co-factor in blood clotting.

Necessary for structure of bone and teeth.
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Calcium Imbalances
 

Most in ECF Regulated by: • Parathyroid hormone
 

↑Blood Ca++ by stimulating osteoclasts ↑GI absorption and renal retention

• Calcitonin from the thyroid gland
 

Promotes bone formation ↑ renal excretion
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Hypercalcemia

Results from:
• Hyperparathyroidism • Hypothyroid states • Renal disease • Excessive intake of vitamin D • Certain drugs • Malignant tumors – hypercalcemia of malignancy
 

Tumor products promote bone breakdown Tumor growth in bone causing Ca++ release
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Hypercalcemia
 

Usually also see hypophosphatemia Effects: • Many nonspecific – fatigue, weakness, lethargy • Increases formation of kidney stones and pancreatic stones • Muscle cramps • Bradycardia, cardiac arrest • GI activity also common
 

Nausea, abdominal cramps Diarrhea / constipation
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• Metastatic calcification

Hypocalcemia

 

Hyperactive neuromuscular reflexes and tetany differentiate it from hypercalcemia Convulsions in severe cases Caused by:
• Renal failure • Lack of vitamin D • Suppression of parathyroid function • Hypersecretion of calcitonin • Malabsorption states • Abnormal intestinal acidity and acid/ base bal. • Widespread infection or peritoneal inflammation45 45

Hypocalcemia

Diagnosis:
• Chvostek’s sign • Trousseau’s sign

Treatment:
• IV calcium for acute • Oral calcium and vitamin D for chronic

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Bicarbonate
   

Principle buffer of body pH. (extracellular) Neutralizes acids. Plays important role in acid / base balance. Acts as chemical sponge to soak up Hydrogen ions. (Acidic metabolic waste) For every one Hydrogen ion twenty bicarbonate ions are released to maintain balance.
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Phosphate

Plays an important role in ATP storage.

Chief intracellular buffer acts to maintain intracellular pH.

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References

Martini,H.Frederic; Fundamental of Anatomy and Physiology, Thrid edtion, 1995.

http://www.scribd.com/doc/5525384/Fluids-andElectrolytes

http://www.scribd.com/doc/13016483/phathophy siology2Water-and-Electrolytes-balance-andimbalance
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