FLUIDS AND

ELECTROLYTES
60% of the weight of a typical adult
consists of fluid

Factors that influence the amount of body

fluid are age, gender, and body fat

Body fluids is located in two fluid

compartments: intracellular space and
the extracellular space
The ECF compartment is further divided
into the intravascular, interstitial, and
transcellular spaces

Loss of ECF into a space that does not

contribute to equilibrium between the ICF
and ECF is referred to as a third-space
fluid shift or third spacing
Earlyevidence of a third-space fluid shift
is a decrease in urine output despite
adequate fluid intake

Other signs and symptoms of third

spacing that indicate an IVF volume
deficit include increased heart rate,
decreased BP, edema, increased body
weight, decreased CVP, and imbalances in
fluid intake and output
Electrolytes in body fluids are active
chemicals

Major cations are: sodium, potassium,

calcium, magnesium, and hydrogen ions

The major anions are: chloride,

bicarbonate, phosphate, sulfate, and
proteinate ions
Regulation of Body Fluid
Compartments
Osmosis and Osmolality
Osmosis occurs when fluid shifts through
the membrane from the region of low
solute concentration to the region of high
solute concentration until the solutions are
of equal concentration
Diffusion
Is the natural tendency of a substance to
move from an area of higher
concentration to one of lower
concentration
Filtration
Movement of water and solutes occur
from an area of high hydrostatic pressure
to an area of low hydrostatic pressure
Sodium – Potassium Pump
Located in the cell membrane and
actively moves sodium from the cell into
the ECF
 Maintaining Fluid
and Electrolyte Balance
Homeostasis is a term that indicates the
relative stability of the internal
environment

Concentration and composition of body

fluid must be nearly constant

If a substance must be deficient it must be

replaced normally
The kidneys play a major role in
controlling all types of balance in fluid
and electrolytes

The adrenal glands, through the secretion

of aldosterone, also aids in controlling
extracellular fluid volume by regulating
the amount of sodium reabsorbed by the
kidneys
Antidiuretic hormone from the pituitary
gland regulates the osmotic pressure of
extracellular fluid by regulating the
amount of water reabsorbed by the kidney
FLUID VOLUME DEFICIT
Dehydration occurs when the fluid intake
of the body is not sufficient to meet the
fluid needs of the body

The goal of treatment is to restore fluid

volume, replace electrolytes as needed,
and eliminate the cause of the fluid
volume deficit
Types of Fluid Volume Deficits
1. Isotonic Dehydration – water and
dissolved electrolytes are lost in equal
proportion

2. Hypertonic Dehydration – water loss

exceeds electrolyte loss, shrinks cells

3. Hypotonic Dehydration – electrolyte

loss exceeds water loss, cells swell
Causes of FVD
Isotonic dehydration
 Inadequate intake of fluids and solutes
 Fluid shifts between compartment

Hypertonic dehydration
Excessive perspiration
Hyperventilation
Diarrhea
ESRD
Diabetes insipidus
Hypotonic dehydration
Excessive fluid replacement
Renal failure
Chronic malnutrition
Chronic illness
Assessment findings
Increased pulse rate
Decreased BP and orthostatic (postural)
hypotension
Diminished peripheral pulses
Fever
Decreased urinary output
Dry skin
Poor skin turgor
Dry mouth
Constipation
Increased rate and depth of respirations
Thirst
Decreased body weight
Increased hematocrit
Interventions
Monitor cardiovascular, respiratory,
neuromuscular, renal, integumentary, and
gastrointestinal status

Prevent further fluid losses and increase

fluid compartment volumes to normal
ranges

Monitor intake and output

Provide oral rehydration therapy and IV
fluid replacement

Administer medications as prescribed

such as antidiarrheal, antimicrobial,
antiemetic, and antipyretic medications

Administer oxygen as prescribed

Monitor electrolyte values

FLUID VOLUME EXCESS
Fluid intake or fluid retention exceeds the
fluid needs of the body

Also called overhydration or fluid overload

The goal of treatment is to restore fluid

balance, correct electrolyte imbalances if
present, and eliminate or control the
underlying cause of the overload
Types of Fluid Volume Excess
1. Isotonic Overhydration – known as
hypervolemia, results from excessive fluid in
the extracellular fluid compartment, causes
circulatory overload and interstitial edema

2. Hypertonic Overhydration – caused by

excessive sodium intake

3. Hypotonic Overhydration – water

intoxication; electrolyte imbalance due to
dilution
Causes
Isotonic overhydration
Inadequately controlled IV therapy
Renal failure
Long term corticosteroid therapy

Hypertonic overhydration
Excessive sodium ingestion
Rapid infusion of hypertonic saline
Hypotonic overhydration
Congestive heart failure
SIADH
Inadequately controlled IV therapy
Assessment findings
Bounding, increased pulse rate
Elevated BP
Distended neck and hand veins
Elevated CVP
Dyspnea
Moist crackles on auscultation
Pitting edema in dependent areas
Skin pale and cool to touch
Increased motility of the GI tract
Polyuria
Projectile
vomiting
Decreased hematocrit
Interventions
Monitor cardiovascular, respiratory,
neuromuscular, renal, integumentary, and
gastrointestinal status

Prevent further fluid overload, and restore

normal fluid balance

Administer diuretics as prescribed

Control fluid and sodium intake

Monitor intake, output, and weight

Monitor electrolyte values

DIURETIC
D – diet; increase sodium for all except
aldactone

I – intake and output, daily weight

U – undesirable effects: F&E imbalance

R – review HR, BP, and electrolytes

E – elderly careful, evening dose not

recommended
T – take with or after meals and in AM

I – increase risk of orthostatic hypotension’

move slowly

C – cancel alcohol, cigarettes

Loop Diuretics
Inhibits sodium, chloride, and water
reabsorption in the proximal portion of
the ascending loop of Henle

Edema associated with CHF, ascites,

hypertension (furosemide)

Bumetanide (Bumex, Furosemide (Lasix),

Torsemide (Demadex)
Thiazides
Increases urine output by inhibiting
reabsorption of sodium, chloride, and water in
the distal portion of the ascending loop of
Henle

Edema associated with CHF, ascites,

hypertension

Chlorothiazide (Diuril), Hydrochlorothiazide

(Hydrodiuril)
Potassium Sparing Diuretics
Promotes excretion of sodium and water,
but retains potassium in the distal renal
tubule

Used with loop or thiazide diuretics in

treating CHF and hypertension, edema

Spironolactone (Aldactone)
Osmotic Diuretics
Increases osmotic pressure of glomerular
filtrate, thus preventing reabsorption of
water

Oliguria, edema, increased ICP, increased

IOP

Mannitol (Osmitrol)
Assignment
Form 4 groups, do a drug study of the
chosen class of diuretic, and make your
own mnemonic for that chosen class

Be creative in presenting your work, use

of powerpoint is not allowed

Presentation will be next week, indicate

your reference