I.

Fluid and Electrolytes

Electrolytes: a substance that is dissolved in a solution and some of its molecules split or dissociate into electrically charged atoms or ions measured in liters (L) or milliliters (mL)

Third Spacing: The accumulation and sequestration of trapped extracellular fluid in an actual or potential body space as a result of disease or injury The trapped fluid represents a volume loss and is unavailable for normal physiologic processes

1. DIFFUSION Movement of particles through a solution in all directions

A process by which a solute may spread through a solution or solvent Diffusion of a solute will spread the molecules from an area of HIGH concentration to an area of LOWER concentration

Body Fluid Compartments: Fluid in each of the body compartments contains electrolytes To function normally, body cells must have fluids and electrolytes move in to take its place Whenever an electrolyte moves out of a cell another electrolyte moves in to takes it place

Edema excess accumulation of fluid in the interstitial spaces *Localized edema occurs as a result of traumatic injury from accident or surgery, local inflammatory processes or burns *Generalized edema aka ANASARCA An excessive accumulation of fluid in the interstitial space throughout the body as a result of a condition such as cardiac, renal or liver failure

2. OSMOSIS

Diffusion of solvent molecules across a membrane in response to concentration gradient, usually from a solution of LESSER to one of GREATER solute concentration OSMOTIC PRESSURE: force that draws the water from a less concentrated solution through a selectively permeable membrane into a more concentrated solution

The number of cations and anions must be the

same for homeostasis to exist

1. Intracellular compartment Refers to all the fluid inside the cells

Body Fluid:

2. Extracellular compartment Fluid outside the cells

Provides transportation of nutrients to the

cells and carries waste products from the cells Total body fluid amounts to about 60% of body weight A loss of 10% of body fluid in an adult is SERIOUS, while 20% loss is FATAL Consists of fluid and dissolved substances

3. FILTRATION

Movement of solutes and HYDROSTATIC PRESSURE

solvents

by

3. Intravascular compartment Fluid within the blood vessels

The movement is from an area of GREATER PRESSURE to an area of LOWER PRESSURE

4. Interstitial fluids Fluids between cells and blood vessels

*HYDROSTATIC PRESSURE- a force exerted by a weight of a solution

Body Fluid Transport:

- When a difference exists in the hydrostatic pressure on two sides of a membrane, water and diffusible solutes move out of the solution that has the higher hydrostatic pressure by the process of filtration ! REMEMBER: At the ARTERIAL END of the capillary, the HP > OP, therefore fluids and diffusible solutes move out of the capillary At the VENOUS END of the capillary, the OP > HP, and fluids and some solutes move into the capillary Osmolality: refers to the number of osmotically active particles per kilogram of water Normal OSMOLALITY of Plasma: 280-294 mOsm/kg
HYPOTONIC 0.45% Saline ISOTONIC 0.9% Saline D5W D5NSS Lactated Ringers HYPERTONIC D5LR 5% Dextrose in 0.45 Saline 5% Dextrose in 0.9 Saline 10% Dextrose in Water

c. HYPERTONIC SOLUTIONS a solution that has a higher concentration of solutes than another solution is hypertonic

HOMEOSTASIS: indicates the relative stability of the internal environment where concentration and composition of body fluids must be nearly constant

Active Transport: If an ion is to move from an area of low concentration to an area of high concentration, an ACTIVE TRANSPORT SYSTEM is necessary

Who maintains fluid and electrolyte balance? a. KIDNEYS play a major role in controlling al types of balance in Fluids and electrolytes b. ADRENAL GLANDS via aldosterone secretion aids in controlling ECF volume by regulating the amt of sodium reabsorption in the kidneys

Body Fluid Excretion The kidneys excrete the largest quantity of fluids

c. ADH regulates osmotic pressure of ECF by

regulating the amt of water reabsorption in kidneys

DAILY BODY FLUID EXCRETION Skin (diffusion) 400mL Skin (Perspiration) 100mL Lungs 350mL Feces 150mL Kidneys 1500mL

FLUID VOLUME DEFICIT

Dehydration occurs when the fluid intake of the body is not sufficient to meet the fluid needs of the body TYPES OF FLUID VOLUME DEFICITS Isotonic Water and dissolved Dehydration electrolytes aka are lost in HYPOVOLEM equal IA

CAUSES
Inadequate intake of fluids and solutes Fluid shifts bet compartment s Excessive loss of isotonic body fluids

INSENSIBLE LOSS: how water is lost via the skin

Body Fluid Replacement: Water enters the body through 3 sources: 1. Orally ingested liquids 2. Water in food 3. Water formed by oxidation of food

a. ISOTONIC SOLUTIONS when solutions on both sides of a selectively permeable membrane have established equilibrium or are equal in concentration b. HYPOTONIC SOLUTIONS when a solution contains a lower concentration of salt or solute than other solutions

Average total amt of water taken into the body by

all 3 sources is 2500mL per day

Hypertonic Dehydration

proportions Results in decreased circulating blood volume and inadequate tissue perfusion Water loss exceeds electrolyte

Conditions causing increase fluid

Hypotonic Dehydration

loss Fluid moves from IC compartmen t into the plasma and ISF spaces causing CELLULAR DEHYDRATI ON and SHRINKAGE Electrolyte loss exceeds water loss Decrease in plasma volume Fluid moves from plasma and ISF spaces into cells causing the cells to SWELL

loss: Excessive perspiration, hyperventilation, ketoacidosis, prolonged fevers, diarrhea, early stage renal failure and Diabetes insipidus

b. Constipation c. thirst HYPOTONIC DEHYDRATION HYPERTONIC DEHYDRATION Interventions: Skeletal muscle weakness a. Hyperactive DTR b. Pitting edema

Hypertonic Overhydration

Chronic illness Excessive fluid replacement Renal failure Chronic malnutrition

compartments May cause circulator overload and interstitial edema Occurs rarely Fluid is drawn from the ICF compartment and the ECF volume expands

*Monitor CV, respi, neuromuscular, renal, integ and GI status. * Prevent further fluid loss and inc fluid compartment volumes to normal ranges *provide oral rehydration therapy if possible and IV fluid replacement if severe *administer meds as prescribed *administer O2 as prescribed Hypotonic Overhydration

ASSESSMENT: Cardiovascular a. Thready, inc pulse rate b. Dec BP and orthostatic hypotension c. Flat neck and hand veins in dependent position d. Diminished peripheral pulses a. Inc rate and depth of respirations a. Dec CNS activity from lethargy to coma b. Fever a. Dec urinary output b. Inc specific gravity a. Dry skin b. Poor turgor, tenting present c. Dry mouth a. Dec motility and diminished bowel sounds

Known as WATER INTOXICATION The excessive fluid moves into the ECF space and all the body fluid compartments expand

FLUID VOLUME EXCESS

Aka fluid overload or overhydration Fluid intake or fluid retention exceeds fluid needs of the body CAUSES
a. Inadequa tely controlled IV therapy b. Renal failure c. Long term corticosteroid therapy

Respiratory Neuromuscula r Renal Integumentary Gastrointestin al

TYPES OF FLUID VOLUME EXCESS Results from Isotonic excessive fluid Overhydration in the ECF aka compartment HYPERVOLE where only the MIA

a. Excessive sodium ingestion b. Rapid infusion of hypertonic saline c. Excessive NaCo3 therapy a. Early renal failure b. CHF c. SIADH d. Inadequa tely controlled IV therapy e. Replace ment of isotonic fluid loss with hypotonic fluids f. Irrigation of wounds and body cavities with hypotonic fluids

ASSESSMENT: Cardiovascula r Respiratory a. b. c. d. a. b. c. Bounding. Inc pulse rate Elevated BP Distended neck and hand veins Elevated CVP Inc RR (shallow respirations) Dyspnea Moist crackles on auscultation

ECF compartment is expanded and fluid does not shift bet EC and IC

Neuromuscul ar

Integumetary Gastrointestin al

a. b. c. d. e. a. b. a.

Altered LOC Headache Visual disturbances Skeletal muscle weakness Paresthesias Pitting edema in dependent areas Skin pale and cool to touch Inc motility in GIT

Sodium (Na) Potassium

Normal levels: 135-145 mEq/L Common food sources: Bacon Butter Canned food Cheese Frankfurters Ketchup Lunch meat Milk Mustard Processed food Snack Food Soy sauce Table Salt White and Whole wheat bread

Normal level: 3.5 to 5.1 mEq/L Common food sources: Avocado Bananas Cantaloupe Carrots Fish Mushrooms Oranges Potatoes Pork, Beef, Veal Raisins Spinach Strawberries Tomatoes

Isotonic Overhydration Hypotonic Overhydration

a. b. a. b. c. d. e.

Liver enlargement Ascites Polyuria Diarrhea Nonpitting edema Dysrhthmias Projectile vomiting

INTERVENTIONS: Monitor CV, Respi, Neuromuscular, Renal, Integ and GI status. Prevent further fluid overload and restore normal fluid balance Admin diuretics, OSMOTIC DIURETICS typically are prescribed first to prevent severe electrolyte imbalances. Restrict fluid and sodium intake Monitor I&O and weight. Monitor electrolyte values and prep to admin med to treat imbalance if present

[See table 2 for HYPO and HYPER KALEMIA] [See Table 1 for HYPO and HYPER NATREMIA]

CALCIUM
Normal value: 8.6- 10.0 mg/dL Common Food sources: Cheese Collard greens Milk and soymilk Rhubarb Sardines Spinach Tofu Yogurt, low fat