FLUID, ELECTROLYTE,

AND ACID-BASE BALANCE

NUR 102 - Chapter 14

Body fluids

 Extracellular fluids (ECF)

• Interstitial fluid - fills the spaces between most
cells of the body
• Intravascular fluid - plasma (WBC, RBC and
platelets in this fluid)
Body fluids

 Intracellular fluids (ICF)

• Liquids within cell membranes
• 40% of body weight
Components in body fluids

 Electrolyte
• an element that when dissolved can carry an
electrical current
• Cations - (+) ; Anions - (-)
• neuromuscular function
• acid-base balance
Components of body fluids

 Minerals
• ingested compounds
• serve as catalysts in nerve response, muscle
contraction, and metabolism of nutrients in
foods, regulate electrolyte balance
Movement of body fluids

 Diffusion
• Area of higher concentration to an area of
lower concentration till even distribution
 Osmosis
• Movement of a pure solvent, e.g. water
through a semipermeable membrane from a
solution that has a lower solute concentration
to one that has a higher solute concentration
Osmotic pressure

 Drawing power of water (dependent on

the number or molecules in solution)
• Isotonic
• Hypotonic
• Hypertonic
Movement of body fluids

 Filtration
• Water and diffusible substances move
together in response to fluid pressure
 Active transport
• Requires energy
• Able to move larger molecules and go from
less to greater concentration
Fluid Intake

 Hypothalamus - thirst control center

 Oral fluid intake requires an alert state
 Osmoreceptors - monitor osmolality
Fluid Output

 Loss through the kidneys and GI tract

 Insensible
 Sensible
Cations

 Sodium (Na+)
• Most abundant in the extracellular fluid
• Maintains water balance, transmits nerve
impulses, contracts muscles
• Values - 135-145 mEq/L
Cation

 Potassium (K+)
• Major intracellular cation
• Regulates neuromuscular excitability,
muscular contraction, and acid-base
• Value - 3.5 -5.3 mEq/L
Cation

 Calcium (Ca2+)
• Cardiac conduction, blood coagulation, bone
growth and formation, & muscular relaxation
• Value - 4 - 5 mEq/L
Cation

 Magnesium (Mg2+)
• Second most important of intracellular fluids
• Enzyme activities, muscular excitability
• Value - 1.5 - 2.5 mEq/L
Electrolyte Imbalances

 Hyponatremia
• GI losses, sweating, & diuretics
• S/S: N/V/D, abd cramps, personality change
 Hypernatremia
• Ingestion of large amounts
• S/S: Dry tongue and mucous membranes,
restlessness, convulsions, thirst, dry skin
Electrolyte imbalances

 Hypokalemia
 Causes: K+ wasting diuretics
 N/V/D
 polyuria
 S/S: weak, irregular pulse
• hypotension
• weakness
Electrolyte imbalances

 Hyperkalemia
• Causes: Renal failure
• S/S: irregular slow pulse, weakness, irritability
Electrolyte Imbalances

 Hypocalcemia
• Causes: Vitamin D deficiency
• S/S: Numb and tingling fingers and circumoral
region, muscle cramps
 Hypercalcemia
• Causes: osteoporosis, prolonged
immobilization
• S/S: decreased muscle tone, weakness,
lethargy, kidney stones
Electrolyte imbalances

 Hypomagnesemia
• Causes: malnutrition and alcoholism polyuria
• S/S: muscular tremors, hyperactive deep
tendon reflexes
 Hypermagnesemia
• Causes: Renal failure
• S/S: hypoactive deep tendon reflexes, shallow
and slow respirations
 Acid - Base Balance

 Blood pH - 7.35 - 7.45

 paCO2 - 35 - 45
 Bicarbonate (HCO3) - 22-26 mEq/L
Respiratory Acidosis

 pH < 7.35
 paCO2 > 45 mm Hg
 Causes: Respiratory failure
 Hypoventilation
 Resp muscles paralysis
 Airway obstruction
Respiratory Alkalosis

 pH > 7.45
 paCO2 < 35 mm Hg
 Causes: excessive exhalation of CO2
(hyperventilation)
Metabolic Acidosis

 pH < 7.35
 bicarbonate - < 22 mEq/L
 Causes: Starvation, DKA, Diarrhea, drug
use
Metabolic Alkalosis

 pH > 7.45
 bicarbonate > 26 mEq/L
 Causes: excessive vomiting, prolonged
gastric suctioning
Fluid & Electrolyte Imbalances

 Burns - body fluid loss

 Renal D/O - abnormal retention of Na,
Cl, K
 GI Disturbances - Loss of fluid,
potassium, and chloride
 Exercise
S/S electrolyte imbalance

 Head: irritability
 Fontanels: depressed, bulging
 Eyes: sunken
periorbital edema
 Mouth: mucous membranes
 CV: neck veins, edema, blood pressure
 Resp: Crackles
Imbalances

 GI: abdomen, V/D

 Renal: Oliguria or anuria (FVD, FE)
 Diuresis (FVE)
 Increased urine spec. gravity (FVD)
 Skin (Temp)
• increased - met acidosis, hypernatremia
• decreased - FVD
Replacement of fluids and
electrolytes
 Types of IV fluids
 Isotonic
 Hypertonic
 Hypotonic
IV complications

 Infiltration
• IVF enter SQ space
 Phlebitis
• vein inflammation
• S/S: pain, redness, warmth
 Fluid overload
• Fluids given too rapidly
 Bleeding
Discontinuing an IV

 Stop infusion
 Remove tape
 1 - 2 minute pressure
Blood transfusions

 Large bore catheter (18 ga or larger)

 Give with normal saline
 Baseline vital signs
 Double check with two RNs
 Begin transfusion slowly
 Observe closely for first 15 min
Transfusion Reactions

 Caused by:
• blood incompatibility
• allergic sensitivity
• S/S: fever, chills, rash, hypotension, shock
 Treatment: stop transfusion, give NS,
save tubing, prepare for emergency
drugs