Professional Documents
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F M
E A
M L
A E
L
E
Sources
Oral liquids, water in food & by food oxidation
Recommended dietary allowance:
Average adult intake 2500 mL/24 hrs
Men: avg. 3L/day
Women: avg. 2.2 L/day
(McCarron, 2007)
infobarrel.com
Fluid & Electrolyte Imbalance
Threat to life
Loss of body water
Sensible Water Loss
catalog.nucleusinc.com
urologyhealth.org
healthcare9.com
123rf.com
How many pounds is 1 kg?
Body Fluid Compartments 2/3
Intracellular fluid (ICF)
Inside the cell
facweb.northseatle.edu
1/3
Extracellular fluid (ECF)
Plasma
Interstitial Fluid
Outside the cell Transcellular Fluid
Rich in oxygen, carbon dioxide, nutrient and waste exchange
Extracellular Fluid
Interstitial Transcellular
Plasma
Fluid Fluid
nlm.nih.gov
Composition of Body Fluids
Body fluids are comprised
of solute and solvent
Substance
H2O
scienceiscool.org
www.toltec.biz
Concentration of solutes in solution
Pressure pulling fluid into the vessel
Osmotic Draws water through membrane to
the higher concentrated side
Proteins attract water and are major
contributor to osmotic pressure
Osmolality
Osmotic pull or pressure exerted by
all particles per unit of water
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spill-training.co.uk
weight Expressed
Expressedasas
of solvent milliosmoles/kg
milliosmoles/kgofofwater
water
Osmolarity
Osmotic pull or pressure exerted by all
particles per unit of solution
Describesfluids
Describes fluids
outside the body
outside the body
Expressed
milliosmoles/liter of solution spservices.co.uk
Tonicity
Concentration of solution in relation to plasma
holytaco.com
280-300 mOsm/L
Average: 290 mOsm/L
Classification of IV Fluids
(Infusates)
Crystalloids
austincc.edu
Solutions that contain electrolytes
May be used for fluid volume replacement
True solutions
Diffuse through membranes easily
May be isotonic, hypotonic, or hypertonic
Primary fluid used for IV infusions in the
hospital and outpatient clinics
Hypotonic Solutions
Used to lower sodium, hydrate ICF, &
interstitial spaces
Less solute & more water than isotonic sol.
Lower osmolarity than body fluids
Moves water into cells by osmosis
Examples:
0.45% sodium chloride
Lowerdextrose
2.5% concentration
in water
of solutes
D5W than body
(5% dextrose fluids
in water)
After infused
http://www.slideshare.net/nclexvideos/third-
D5W
Isotonic before infused
As the body quickly uses the dextrose for
energy, the solute (dextrose) is depleted
This leaves only water
which then makes
the solution hypotonic
http://www.slideshare.net/nclexvideos/third-
Fluids need to
be on IV pump
Hypertonic Solutions
Higher osmolarity than body fluids
Used for severe sodium depletion, replace fluid loss
from burns
Causes water to move out of cells into ECF
Administer slowly to prevent overload and rapid fluid shifts
Greatly expand intravascular compartment
Examples:
3% NaCl
higher concentration
D5NS
of solutes than body fluids
D5 in.45%NS
10% dextrose in water
http://www.slideshare.net/nclexvideos/third-
http://www.tumblr.com/tagged/nclex?
before=1337817600
Plasma Osmolality
Standard for comparing
tonicity of IV infusions
Isotonic
holytaco.com
280-300 mOsm/L
Average: 290 mOsm/L
Determining Serum Osmolarity
Osmolarity of IV infusion is determined
by average serum osmolality 290 mOsm/L
250-375 mOsm/L
Formula to calculate
serum osmolality
Glucose 50 mg/dL
(115 x 2) + 1 + 50 = serum osmolality
318
psychcentral.com
psychcentral.com
eprognosis.org
BUN 66 mg/dL
Glucose 612 mg/dL
(160 x 2) + 66 + 612 = serum osmolality
3 18
eprognosis.org
376 mOsm/L
Hypertonic: >375 mOsm/L
eprognosis.org
codingnews.inhealthcare.com
Second Spacing
Excess accumulation of fluid in interstitial spaces
en.wikipedia.org
Pitting Edema
+1: (trace) rapid return to normal
+2 (4 mm) rebounds in seconds
+3 (6 mm) 10-20 second return to normal
+4 (8mm) > 30 second return to normal
Third Spacing
Loss of albumin, or protein, in intravascular space leads to
decreased oncotic pressure
Accumulation of trapped extracellular fluid in transcellular and
interstitial fluid compartments
patient.co.uk