FLUIDS &

ELECTROLYTES

Caesar G. Balatero, RN, MN

 COURSE DESCRIPTION

This program is designed to enrich

knowledge and understanding of the
participants on concept of fluid volume
and electrolyte status.
 OBJECTIVES
1. To discuss problems and treatments
commonly associated with fluids and
electrolyte imbalances.

2. To explain the need for corrective and

replacement therapy in body fluids and
electrolytes disturbances.
 COURSE CONTENTS

01 Dynamics of fluid and electrolytes

Water, electrolytes

02 Fluid and electrolytes replacement therapy

Types of IVF solutions, nursing considerations

03 Electrolyte imbalances
Functions of electrolytes, symptoms,
dehydration
 01
DYNAMICS OF FLUIDS
& ELECTROLYTES
Water overview, electrolytes
 WATER

Comprises about 60% to 70% of

the total body weight

Varies with age, weight and

gender
 FUNCTIONS OF WATER IN THE BODY

Transport Facilitate Aid

nutrients to cells and wastes
from cells, hormones, enzymes,
blood
cellular metabolism and
digestion and promotes
proper cellular chemical
elimination
functioning
 FUNCTIONS OF WATER IN THE BODY

Act Act Help

as a solvent for electrolytes and as a tissue lubricant and maintain normal body
non-electrolytes cushion temperature
 FLUID COMPARTMENTS

Extracellular
Intracellular
fluid inside cells fluid outside cells

large amounts of large amounts of Na+, Ca2+,

K+, PO43-, Mg2+ Cl-, HCO3-

includes
intravascular and
interstitial fluids
 WATER LOSS

Sensible Insensible
● Urination ● Perspiration
● Defecation ● Respiration
● Wound drainage ● Changes in humidity levels,
● Gastric drainage respiratory rate and depth, and
● Vomiting fever
 WATER LOSS vs WATER GAIN

Causes of Increased Water Loss Causes of Increased Water

Gain
● Fever ● Increased sodium intake
● Diarrhea ● Increased sodium retention
● Diaphoresis ● Excessive intake of water
● Vomiting ● Excessive secretion of ADH
● Gastric suctioning
● Tachypnea
ELECTROLYTES
An electrolyte is a substance, that when
dissolved in water, gives a solution that
can conduct electricity

● Simple inorganic salts

● Dissociate when dissolved in water to
form positively and negatively
charged ions
● All inorganic acids, bases and salts
are electrolytes
● Also known as ionic solutes
IONS
IMPORTANCE OF ELECTROLYTES
Maintain voltages across cell membranes

Carry electrical impulses to other cells

Found in blood or the human body in the form

of acids, bases or salts (sodium, calcium,
potassium, chlorine, magnesium, bicarbonate)

Conduct an electric current that transports

energy thoughout the body
 EFFECTS OF ELECTROLYTES
The loss of electrolytes in the body can lead
to an unbalance of fluids in the body and
the pH, and a damage of the electric
potential between the nerve cells that
transmit the nerve signals.
 MAJOR ELECTROLYTES
Sodium Potassium Calcium
controls and regulates volume chief regulator of cellular nerve impulse, blood clotting,
of body fluids enzyme activity and water muscle contraction, B12
content absorption

Magnesium Chloride Bicarbonate

metabolism of carbohydrates maintains osmotic pressure in body’s primary buffer
and proteins, vital actions blood, produces hydrochloric system
involving enzymes acid

Phosphate
involved in important chemical
reactions in body, cell division
and hereditary traits
REGULATION OF BODY FLUID
COMPARTMENTS
Tonicity
the ability of solutes to
cause osmotic driving
forces
Filtration
the movement of water and solutes from an
area of high hydrostatic pressure to an area of
low hydrostatic pressure

Osmolality Osmotic Pressure

reflects the concentration of fluid that affects
the amount of hydrostatic
the movement of water between fluid
pressure needed to stop the
compartments by osmosis
flow of water by osmosis
 FLUID VOLUME DEFICIT
● a state or condition where the fluid output exceeds the
fluid intake
● occurs when the body loses both water and electrolytes
from the ECF in similar proportions
● may be an acute or chronic condition managed in the
hospital, outpatient center, or home setting

Hypovolemia
deficiency in amount of water and electrolytes in ECF with near
normal water/electrolyte proportions

Dehydration
decreased volume of water and electrolyte change

Third-space fluid shift

distributional shift of body fluids into potential
body spaces
FLUID VOLUME EXCESS
Hypervolemia
excessive retention of water and sodium in ECF

Overhydration
above normal amounts of water in extracellular spaces

Edema
above normal amounts of water in extracellular spaces

Interstitial-to-plasma shift
movement of fluid from space surrounding cells to blood
02
FLUID & ELECTROLYTES
REPLACEMENT THERAPY
Types of IVF solutions, nursing
considerations
CRYSTALLOIDS vs COLLOIDS
Crystalloids
contain small molecules that flow easily across semipermeable membranes, from the bloodstream
into the cells and body tissues. Crystalloid solutions are distinguished by the relative tonicity
(before infusion) in relation to plasma and are categorized as isotonic, hypotonic, or hypertonic.

Colloids
contain large molecules that do not pass through semipermeable membranes and therefore remain in
the blood vessels. Also known as volume/plasma expanders, colloids expand intravascular volume
by drawing fluid from the interstitial space into the vessels through higher oncotic pressure. Less
total volume is required compared to IV fluids. Colloids are indicated for patients in malnourished
states and patients who cannot tolerate large infusions of fluid.
TYPES OF IV SOLUTIONS
Isotonic
solutions have the same osmolality as the
extracellular fluid

Hypotonic
solutions have a lower concentration of solutes and are more
dilute than extracellular fluid
Net movement = extracellular  intracellular.

Hypertonic
solutions have a higher concentration of solute and are more
concentrated than extracellular fluids.
Net movement = intracellular  extracellular
 ISOTONIC
● 0.9% NaCl (Normal Saline Solution, NSS)
● Dextrose 5% in Water (D5W) (also hypo)
● Ringer’s Solution
● Lactated Ringer’s Solution (slightly hypo)
● Isotonic Electrolyte Solution (IES)
● Plasma-Lyte
● Normosol

Crystalloids
 HYPERTONIC
● Hypertonic Sodium Chloride IV Fluids
 3% sodium chloride (3% NaCl) containing 513 mEq/L of sodium and chloride with an osmolality of 1030 mOsm/L.
 5% sodium chloride (5% NaCl) containing 855 mEq/L of sodium and chloride with an osmolality of 1710 mOsm/L.
● Hypertonic Dextrose Solutions
 Isotonic solutions that contain 5% dextrose (e.g., D5NSS, D5LRS) are slightly hypertonic since they exceed the total osmolality of
the ECF. However, dextrose is quickly metabolized and only the isotonic solution remains. Therefore, any effect on the ICF is
temporary.
● Dextrose 10% in Water (D10W)
● Dextrose 20% in Water (D20W)
● Dextrose 50% in Water (D50W)
● Balanced Multiple Maintenance Solution

Crystalloids
 HYPOTONIC
● 0.45% Sodium Chloride (0.45% NaCl)
● 0.33% Sodium Chloride (0.33% NaCl)
● 0.225% Sodium Chloride (0.225% NaCl)
● 2.5% Dextrose in Water (D2.5W)
● Lactated Ringer’s Solution
● Dextrose 5% in Water (D5W)

Crystalloids
COLLOIDS
● Albumin 5%
● Albumin 20%, 25%
● Low-molecular weight dextran (LMWD);
High-molecular weight dextran (HMWD)
● Hetastarch (6%); Hespan
NURSING CONSIDERATIONS
Isotonic
NURSING CONSIDERATIONS
Hypertonic
NURSING CONSIDERATIONS
Hypotonic
 03
ELECTROLYTE
IMBALANCES
Functions, symptoms,
dehydration
ELECTROLYTE IMBALANCES

SODIUM (Na+) 135 - 145 mEq/L

Functions
● Maintains osmolality
● Participates in active transport
● Helps regulate body fluids
● Participates in the action potential
ELECTROLYTE IMBALANCES

SODIUM (Na+) 135 - 145 mEq/L

Hyponatremia
● Serum sodium level falls below 130 mEq/L
● Cells become swollen
● Neurological disturbances: cerebral edema,
headache, lethargy, depression, confusion,
convulsions, coma
● Cardiovascular disturbances: postural
hypotension, shock
ELECTROLYTE IMBALANCES

SODIUM (Na+) 135 - 145 mEq/L

Hypernatremia
● Serum sodium is more than 150 mEq/L
● Cells shrink
● Complications: Osmotic diuresis, cellular
dehydration, circulation decreases
ELECTROLYTE IMBALANCES

POTASSIUM (K+) 3.5 - 5 mEq/L

Functions
● Transmission of nerve impulses
● Resting membrane potential
● Acid-base balance
● Promotes myocardial, skeletal, and smooth
muscle contractility
ELECTROLYTE IMBALANCES

POTASSIUM (K+) 3.5 - 5 mEq/L

Hypokalemia
● Less than 3 mEq/L
● Cardiovascular: dysrhythmias, hypotension, digitalis toxicity, myocardial
damage, cardiac arrest
● Neurological: lethargy, confusion, depression
● Gastrointestinal : paralytic ileus
● Skeletal Muscle: weakness, flaccid paralysis, weakness of respiratory muscles,
respiratory arrest
● Renal System: decreased ability to concentrate urine, water loss, kidney damage
● Acid-Base Balance: metabolic alkalosis
ELECTROLYTE IMBALANCES

POTASSIUM (K+) 3.5 - 5 mEq/L

Hyperkalemia
● Greater than 5.5 mEq/L
● heart palpitations, shortness of breath, chest
pain, nausea, or vomiting, abdominal pain,
diarrhea, numbness in limbs
ELECTROLYTE IMBALANCES

8.5 - 10.5 mg/dl or 4.5

CALCIUM (Ca ) 2+
- 5.8 mEq/L
Functions
● Formation of bone and teeth
● Contraction of muscle
● Blood coagulation
● Blocks sodium transport into the cell
● Transmission of nervous impulses
ELECTROLYTE IMBALANCES

8.5 - 10.5 mg/dl or 4.5

CALCIUM (Ca ) 2+
- 5.8 mEq/L
Hypocalcemia
● <0.9 mmo/L ionized calcium
● Nervous system: paresthesia
● Muscular system: tetany, laryngeal spasms
● Cardiovascular system: congestive heart
failure, decreased cardiac output, cardiac
dysrhythmias
ELECTROLYTE IMBALANCES

8.5 - 10.5 mg/dl or 4.5

CALCIUM (Ca ) 2+
- 5.8 mEq/L
Hypercalcemia
● >12 mg/dL total calcium or >1.5 mmol/L
ionized calcium
● Neurologic: lethargy, confusion, coma
● Skeletal: deep bone pain, fractures
● Renal: stonen
● Gastrointestinal: constipation, anorexia,
nausea and vomiting
● Cardiovascular: shortened QT interval,
bradycardia, cardiac arrest
 DEHYDRATION
● the excessive loss of water and electrolytes
from the body
● Dehydration can be caused by losing too
much fluid, not drinking enough water or
fluids, or both.
● Infants and children are more susceptible to
dehydration than adults because of their
smaller body weights and higher turnover of
water and electrolytes, so are the elderly and
those with illnesses.
CAUSES OF DEHYDRATION
● Dehydration occurs when losses are not
replaced adequately and a deficit of water and
electrolytes develops.
● May occur in vomiting or diarrhea
● Presence of an acute illness where there is
loss of appetite and vomiting: e.g. pneumonia,
DHF, other acute illnesses
● Excessive urine output, such as with
uncontrolled diabetes or diuretic use
● Excessive sweating (sports)
● Burns
CAUSES OF DEHYDRATION
● Since diarrhea and vomiting are the most
common causes of dehydration in children,
the volume of fluid loss may vary from 5
ml/kg (normal) to 200 ml/kg
● Concentration of electrolytes lost also varies
● NaCl and K are the most common electrolytes
lost through stools
CHECKING THE MAIN SX
● In order to diagnose the type of dehydration,
you need to know the history and you must do
a thorough physical examination
● We classify the type of dehydration depending
on the amount of water and electrolytes lost
● These are reflected by the signs and
symptoms the patient will present
CLASSIFICATION
● Dehydration is classified as no
dehydration, some dehydration, or
severe dehydration based on how
much of the body's fluid is lost or
not replenished.
● When severe, dehydration is a life-
threatening emergency.
 ASSESSMENT
● Graded according to the signs and symptoms that reflect
the amount of fluid lost.
● There are usually no signs or symptoms in the early
stages.
● As dehydration increases, signs and symptoms develop.
Initially, thirst, restlessness, irritability, decreased skin
turgor, sunken eyes, and sunken fontanelles.
● As more losses occur, these effects become more
pronounced.
 CLINICAL SIGNS OF DHN
*Restless, irritable *Lethargic or unconscious,
Look at condition Well , alert
floppy*

Eyes Normal Sunken Very sunken and dry

Tears Present Absent Absent
Mouth and tongue Moist Dry Very dry
Thirst Drinks normally, not thirsty Thirsty, drinks eagerly *Drinks poorly or not able to
drink
Feel skin pinch Goes back quickly *Goes back slowly *Goes back very slowly
If the patient has 2 or more If the patient has 2 or more
The patient has no sign of signs, including at least 1 signs, including at least 1
Decide
dehydration *signs*, there is Some *sign* , there is Severe
Dehydration Dehydration
 HYPOVOLEMIC SHOCK
(sequelae)

● An emergency condition in which severe blood and fluid loss make

the heart unable to pump enough blood to the body due to
decreased preload
● The diminished preload decreases the CO and the SVR increases in
an effort to compensate for the diminished CO and maintain
perfusion to the vital organs.
● Leads to multiple organ failure.
HYPOVOLEMIC SHOCK
(sequelae)

Signs
● diminished sensorium (lethargy)
● Lack of urine output
● Cool moist extremities
● A rapid and feeble pulse
● Decreased BP
● Peripheral cyanosis
● Death
THANK YOU!