Fluid, Electrolyte and Acid-Base Balance negatively charged ions (anions), they are critical regulators in the distribution

ritical regulators in the distribution Hypernatremia (Serum Sodium < 146 mEq/L)
The body normally maintains a balance between the amount of fluid of body fluid. The main electrolytes in body fluid are: Causes:
taken in and the amount excreted. Health promotion requires maintenance of • Sodium (Na+), • High sodium intake
body fluid and acid-base balance. • Potassium (K+), Electrolyte Normal values
• Administration of IV fluids (hypertonic or isotonic saline)
• Calcium (Ca2+), and Sodium 135-148 mEq/L • Hypertonic saline abortions
Body Water Distribution • Magnesium (Mg2+) • Renal dysfunction
Water is the largest single Potassium 3.5-5.0 mEq/L • Uncompensated diabetes insipidus
constituent of the body, Acid-Base Balance • CHF, Nephrotic syndrome and cirrhosis
Calcium 8.4-10.5 mg/dl
representing 45% to 75% of Acid-base balance refers to Manifestations and Nursing Interventions
the body’s total weight. About the homeostasis of the hydrogen ion Magnesium 1.3-2.0 mEq/L Manifestations Nursing Interventions
two-thirds of the body fluid is concentration in extracellular fluid. The
Phosphate 2.7-4.5 mg/dl Restlessness, Agitation,  Monitor level of consciousness
intracellular and remaining slightest variation in the hydrogen ion
Delirium, Convulsions, Coma  Institute Safety measures for seizures
one-third is extracellular. concentration causes marked alterations
in the rate of cellular chemical reactions.
Chloride 96-109 mEq/L Increased muscle tone,  Maintain body alignment and assist
Bones are made up of nearly
The pH symbol is used to indicate the hydrogen ion concentration of body hyperreflexia with movement.
one-third water, while the
Flushed, dry skin, Red, dry
muscles and brain cells contain fluids; 7.35 to 7.45 is the normal pH range of extracellular fluid.  Administer oral hygiene hourly.
70% water. Body fat is When the number of free hydrogen ions increases to the point that tongue & sticky mucous
essentially free of water; the pH value becomes less than 7.35, the body is in a state of acidosis. The Tachycardia  Monitor vital signs hourly
therefore, the ratio of water to opposite occurs with alkalosis, in which a pH value higher than 7.45 results  Admn. oral fluid/parenteral hypotonic
Nausea, vomiting, anorexia
body weight is greater in from a low hydrogen ion concentration. soln.(0.3%NaCl) as ordered
leaner people than in obese The body has three main control systems that regulate acid-base Polyuria  Monitor I/O hourly
people. Water is present in all balance to counter acidosis or alkalosis:  Monitor laboratory findings
body tissues and cells, and • The buffer systems, Biochemical Changes  Teach about foods high in Na & about
serves two main functions: to • Respiration, and Na-retaining drugs
act as a solvent for the • Renal control of H+ concentration
essential nutrients, so that Potassium:
they can be used by the body; Electrolyte Imbalances Hypokalemia (Serum Potassium < 3.5 mEq/L)
and to transport nutrients and oxygen from the blood to the cells and to
Sodium: Causes:
remove waste material and other substance from the cells back to the blood • Abnormal loss of K+ (K+ depleting diuretics e.g. thiazide, furosemide)
so they can be excreted by the body. Water is also needed by the body to: Hyponatremia :( Serum Sodium < 135 mEq/L)
Causes: • Inadequate replacement(malnutrition, starvation, NPO & K+ free IV fluids)
• Give shape and form to the cells • Regulate body temperature • Loss of GI secretions (vomiting, diarrhoea, suctioning etc.) • Increased movement into cells (possible when insulin given)
• Loss of ECF sodium (peritonitis, burns etc.) • Adrenal tumor, Cirrhosis, CHF
• Act as a lubricant in joints • Cushion body organs
• ECF sodium dilution (CHF, cirrhosis, nephrosis) Manifestations and Nursing Interventions
• Maintain peak physical performance
• Advanced renal disorders Manifestations Nursing Interventions
• Diuretics, ADH, or SIADH(syndrome of inappropriate ADH) Abdominal Distention,  Admn. of K+ replacement therapy as
Water loss has a negative effect on the body’s ability to function,
Manifestations and Nursing Interventions: nausea & vomiting ordered.
because every 2% to 5% of water loss results in a 30% decrease in work
Manifestations Nsg. Interventions Malaise, disorientation,  Admn. of Oral potassium should be
performance (Kloss, 1995; Kleiner, 1999).
Headaches, Apprehension,  Admn. Comfort measures as needed coma, loss of tactile diluted in 4-8 oz of water or juice
discrimination  IV potassium 20-40mEq/ 1L of IV fluids
Electrolytes Lethargy, Confusion,  Monitor level of consciousness
 Muscle weakness &
An electrolyte is a compound that, when dissolved in water or Depression & convulsion Institute safety measures for seizure  Protect from injury
Muscular Weakness  Assist with range of motion hyporeflexia
another solvent, forms or dissociates into ions (electrically charged particles).
Dry, pale skin & mucous  Admn. IV isotonic solution (0.9%NaCl) Constipation & Polyuria  Monitor I/O hourly
The electrolytes provide inorganic chemicals for cellular reactions and control
 Diminished breath sounds,
mechanisms. Electrolytes have special physiological functions in the body, i.e.
Tachycardia & Hypotension
Monitor hourly vital signs & I/O  Monitor vital signs hourly
 tachycardia, Increased
• Promote neuromuscular irritability, Restrict fluids and Admn. diuretics  Monitor heart rate and rhythm
sensitivity to digitalis, ST
• Maintain body fluid osmolarity,  Monitor daily intake of Na & watch for  Monitor closely for signs of digitalis
Nausea, vomiting, diarrhoea, depression, T-wave inverted,
• Regulate acid-base balance, and abdominal cramps
water intoxication with SIADH
heart block, cardiac
toxicity(premature atrial & ventricular
• Distribute body fluids between the fluid compartments. (Headache & behavioural changes)
arrest(severe Hypokalemia)
beats)
 Monitor serum sodium levels
 Teach client about K+ rich foods and
Electrolytes are expressed as milliequivalents per liter (mEq/L). Biochemical changes  Teach about intake of Na, side effects
Biochemical changes how to prevent excessive loss( abuse of
Because electrolytes produce either positively charged ions (cations) or of diuretics, & other causes.
laxatives and diuretics)
Hyperkalemia (Serum Potassium > 5.0 mEq/L) Decreased muscle tone &
 Encourage client movement and exercise
Causes: deep tendon reflexes,
 Assist client with movement to decrease
• Acute and chronic renal failure osteoporosis, osteomalacia,
pain
• Cellular damage (K+ released into ECF when cells destroyed) deep bone pain
• Insulin deficiency Heart block,
 Monitor for ECG changes
• Adrenal deficiency Arrest(Hypercalcemia crisis)
• Rapid IV infusion of K+ Nausea, vomiting, anorexia,  Teach to decrease Ca2+ intake & increase
constipation fibre
Manifestations and Nursing Interventions
Flank pain from calculi,  Encourage oral intake of acid-ash fluids
Manifestations Nursing Interventions
Polyuria to decrease deposit of calcium salts.
 Restrict oral and parenteral potassium
Abdominal cramps, nausea,
intake as ordered
diarrhoea
 Admn. of ion exchange resins(Kayexalate) Magnesium:
Muscular weakness, Hypomagnesemia (Serum Magnesium < 1.3 mEq/L)
 Assess for pain and provide comfort Causes:
paresthesias, muscle cramps
measures as indicated • Impaired intake (impaired intestinal absorption)
& pain
Oliguria or anuria  Monitor I/O hourly • Excessive urinary excretion (diuretics and alcoholism)
Bradycardia, T-wave tented, • Severe renal disease
 Monitor vital signs & heart rhythm hourly
QRS complex widened, Life- Manifestations and Nursing Interventions
for ECG changes
threatening dysrhythmias Manifestations Nursing Interventions
 Teach client about K+ rich foods, K+ Disorientation, Confusion,  Monitor for seizure activity & laryngeal
Biochemical changes
conserving diuretics etc. Vertigo, Tremors, Irritability stridor
Increased tendon reflexes
Calcium: Increased BP, Tachycardia,
 Monitor for ECG changes
T-wave flat or inverted, ST
 Assess the client for digitalis toxicity
Hypocalcemia (Serum Calcium < 8.4 mg/dl) segment depressed
Causes: Biochemical changes  Teach to avoid excess use of laxatives
• Parathyroid deficiency
• Poor vitamin D intake and absorption Hypermagnesemia (Serum Magnesium > 2mEq/L)
• Some malignancies Causes:
• Inadequate dietary intake (e.g. during pregnancy and lactation) • Renal failure (diabetic ketoacidosis)
Manifestations and Nursing Interventions • Excessive treatment of magnesium deficit
Manifestations Nursing Interventions Manifestation and Nursing Interventions
Anxiety, irritability, tingling  Monitor client’s state of sensorium for Manifestations Nursing Interventions
and numbness of fingers, safety factors and breathing for laryngeal Lethargy, Drowsiness, Coma  Monitor level of consciousness
tetany, convulsions stridor Muscle weakness, decreased  Assess patellar reflexes, if absent notify
Laryngospasm, abdominal  Admn. of 10% calcium gluconate deep-tendon reflexes practitioner
and muscle cramps,  Admn. of calcium lactate orally Decreased Resp. & BP,
pathologic fractures  Diet high in Ca2+ with Vit.D supplement  Monitor vital signs q15-30mins & for
Bradycardia, QRS complex
Decreased stroke volume, ECG changes
widening, QT interval
ST segment lengthened,  Monitor ECG for changes  Encourage fluids unless contraindicated
prolonged
prolonged PR interval

Hypercalcemia (Serum Calcium > 10.5 mg/dl) References:

Causes: • Sue C. DeLaune, Patricia K. Ladner; FUNDAMENTALS OF NURSING:
STANDARDS & PRACTICE; 2nd Edition, Delmar, Thomson learning Inc.
Bone tumors, immobility
• Springhouse; FLUIDS AND ELECTROLYTES MADE INCREDIBLY EASY; 2nd
Overconsumption of milk or dietary salts Edition. Springhouse
Hyperparathyroidism • Urden L, Davie J, Thelan L; ESSENTIALS OF CRITICAL CARE NURSING;
Renal impairment Mosby year book
Manifestations & Nursing Interventions
Manifestations Nursing Interventions Prepared By,
Depression & Lethargy  Monitor State of sensorium Mr. Prasanth Kurien Mathew, Ist Yr M.Sc (N), SCON, Salem (2009)