Fluids and Electrolytes IVT

Fluids and Electrolytes

Fluid and Electrolytes

Fluid and Electrolytes

• Fluids

• Solvent

• Solute

• Solution

Body Fluids

I. watera. the most important nutrient of life

primary function of water in the body•provides a medium for transport•facilitates cellular metabolism

•acts as a solvent•helps maintain normal body temperature•facilitates digestion and promotes elimination

•Lubricant•Insulator

Water overview*Water comprises about 50% -70% of the total body weight *Varies with

ageweightgender

Normal Composition in Average Man

•When a person loses more than 10% of his total body fluids,he can DIE!!!

Body Fluids Compartment

I. intracellular fluid (ICF) compartment

a. contains fluid within the cells

• Potassium (K+): most prevalent intracellular cation

• Phosphate (PO4-): most prevalent intracellular anion

Body Fluids Compartment

II. extracellular fluid (ECF) compartmenta. contains fluid outside the cells

includes:i. intravascular fluid

ii. interstitial fluid

Body Fluids Compartment

• Interstitial• (Cl-): most prevalent anion • (Na+):most prevalent cation

•Intravascular (IV)• Within vascular space

III. Transcellular Fluid• Small but important fluid compartment

Body Fluids Compartment

III. total-body water

in the normal adult, total-body water:i. represents 50% - 70% of the body weight of a normal adultii. total-body water is divided as follows:

a. cell fluidsb. ECFc. plasmad. interstitial fluid

Body Water50-70% of body weight is Water

• Intracellular (ICF)• Fluid located within

cells• Most stable, fairly

resistant to major fluidshifts

• Extracellular (ECF)• Consists of interstitial

fluid, plasma, andtranscellular water

TOTAL BODY FLUID (70 KG.) = 40 LITERS

CELL FLUID EXTRACELLULAR FLUID25 LITERS 15 LITERS

PLASMA INTERSTITIAL & TRANSCELLULAR 3 LITERS 12 LITERS

Distribution of Body Solids & Fluids

Intracellular Extracellular TranscellularWithin Cells Outside cells Contained in body

cavities55% or 2/3 TBW 42.5% or 1/3 TBW 2.5%

Potassium* Phosphates Magnesium

Sodium*Bicarbonates

Chloride

CSF, Pleural fluid, Synovial Fluid and

peritoneal fluidSecreted by epithelial

cellsInterstitial Intravascular Bound

Fluid surrounding the cells

Within the blood vessels

20%TBW or 2/3 of ECF

1/3 of ECF Plasma 7.5%

Higher protein content

Bone and Cartilage 7.5%

Dense Connective

tissues 7.5%

Body Fluid Compartments

Variations in fluid content

a. a person's age

a. infants have considerably more body fluid and ECF than adults

b. lean body massi. fat cells

a. contain little waterii. lean tissue

a. is rich in water

c. genderFEMALES VS. MALES

Total Body Water

• Total body water = 0.6 X weight (kg) for children and adults and 0.78 X weight (kg) for neonates and infants

Tonicity of Body Fluids

A. isotonic solutions - have the same osmolality as body fluids

B. Hypotonic- have a lesser or lowers solute concentration than plasma

hypotonic solutions - have a lower osmolality than body fluids

C. Hypertonic- higher or greater concentration of solutes

hypertonic solutions - have a higher osmolality than body fluids

Electrolytes

• I. substances capable of breaking down into electrically charged ions when dissolved in solution

• II. ion• a. atom or molecule carrying an electrical charge• b. types of ions

i. cations ii. Anions

  Plasma/Intravascula

rInterstitial

FluidIntracellular

fluid

Cations (mmol per litre)

Sodium 140 144 10

Potassium 4 4 155

Calcium 2.5 2 1

Magnesium 1 1 15

Anions (mmol per litre)

Chloride 102 114 5

Bicarbonate 27 30 10

Phosphate 1 1 50

Sulphate 0.5 0.5 10

Protein 2 0.1 8

Organic Anions 3 6 2

Normal Composition in Average Man

Major Electrolytes

SodiumPotassium CalciumMagnesiumChloride BicarbonatePhosphate

Non-electrolytes

• substances incapable of breaking down into electrically charged ions when dissolved in solution and, consequently, remain intact

Measurement of Electrolytes

• measured in terms of their chemical combining power, or chemical activity

• unit of measurement of electrolytesi. the milliequivalent (mEq) - describes the

chemical activity of electrolytes

Fluid Exchange Processes

- movement of water and electrolytes between fluid compartments takes place by a variety of processes

Fluid Intake

•Healthy adult ingests fluid as part of the dietary intake.

•90% of intake is from the ingested food and water

•10% of intake results from the products of cellular metabolism

Fluid Output• The average fluid losses amounts to 2, 500 ml per day,

counterbalancing the input. • The routes of fluid output are the following: • SENSIBLE LOSS• INSENSIBLE LOSS

Water MetabolismDaily Balance: turnover ~ 2500 ml

• a. Intake• i. drink ~ 1500 ml• ii. food ~ 700 ml• iii. metabolism ~ 300 ml

• b. Losses• i. urine ~ 1500 ml• ii. skin ~ 500 ml

• insensible losses ~ 400 ml• sweat ~ 100 ml

• iii. lungs ~ 400 ml• iv. faeces ~ 100 ml

Water Loss

ROUTES OF WATER LOSS

-SENSIBLE -INSENSIBLE Urine Lungs Feces Sweat

Causes of Increased Water Loss

•Fever•Diarrhea•Diaphoresis•Vomiting•Gastric suctioning•Tachypnea

Causes of Increased Water Gain

•Increased sodium intake•Increased sodium retention•Excessive intake of water•Excess secretion of ADH

Fluid Spacing

•First spacing•Second spacing•Third spacing

Fluid Imbalances

FLUID VOLUME DEFICIT or HYPOVOLEMIA

• This is the loss of extra cellular fluid volume that exceeds the intake of fluid. The loss of water and electrolyte is in equal proportion. It can be called in various terms- vascular, cellular or intracellular dehydration. But the preferred term is hypovolemia.

Nursing Process in Fluid Volume Deficit

ASSESSMENT:• Physical Examination

• Weight loss, tented skin turgor, dry mucus membrane• Hypotension • Tachycardia• Cool skin, acute weight loss• Flat neck veins• Decreased CVP

Nursing Process in Fluid Volume Deficit

• NURSING MANAGEMENT• 1. Assessment• 2. Monitor daily weights• 3. Monitor Vital signs, skin and tongue turgor, urinary

concentration, mental function and peripheral circulation• 4. Prevent and Correct Fluid Volume Deficit

• 5. Maintain skin integrity• 6. Provide frequent oral care• 7. Teach patient to change position slowly to avoid

sudden postural hypotension

FLUID VOLUME EXCESS: HYPERVOLEMIA

• Refers to the isotonic expansion of the ECF caused by the abnormal retention of water and sodium

• There is excessive retention of water and electrolytes in equal proportion.

Nursing Process in Fluid Volume Excess

ASSESSMENT• Physical Examination

• Increased weight gain• Increased urine output• Moist crackles in the lungs• Increased CVP• Distended neck veins• Wheezing • Dependent edema

Nursing Process in Fluid Volume Excess

• NURSING MANAGEMENT• Continually assess the patient’s condition• Prevent Fluid Volume Excess• Detect and Control Fluid Volume Excess• Teach patient about edema, ascites, and fluid therapy. • Instruct patient to avoid over-the-counter medications without first checking with the

health care provider

Electrolyte Imbalances

ElectrolytesSodium (Na+)

• chief electrolyte in the ECF

• average daily requirement:a. average daily requirement

i. not known

• sodium-rich foods:a. baconb. mustardc. processed cheesed. canned vegetablese. salted snack foods

Electrolytes Sodium (Na+)

• losses:a. eliminated primarily by the kidneys

• normal range for serum sodium???

HYPERNATREMIA

• sodium excess in the ECF

Nursing Process in HYPERNATREMIA

Clinical Manifestations• primarily neurologic. • Hypernatremia results in a relatively concentrated ECF, causing water to be

pulled from the cells.• If hypernatremia is severe, permanent brain damage can occur (especially in

children).

Nursing Process in HYPERNATREMIA

ASSESSMENT• Physical Examination

• Restlessness, elevated body temperature• Disorientation• Dry, swollen tongue and sticky mucous membrane, tented skin turgor• Flushed skin• Increased muscle tone and deep reflexes• Peripheral and pulmonary edema

Nursing Process in HYPERNATREMIA

• NURSING MANAGEMENT• Continuously monitor the patient• Prevent hypernatremia• Monitor serum sodium level.• Reposition client regularly• Provide teaching to avoid over-the counter medications without consultation

as they may contain sodium

HYPONATREMIA

• Refers to a Sodium serum level of less than 135 mEq/L.

• This may result from excessive sodium loss or excessive water gain.

Nursing Process in HYPONATREMIA

• Clinical manifestations of hyponatremia depend on the cause, magnitude, and rapidity of onset.

• Physical Examination• Altered mental status• Vomiting• Lethargy• Muscle twitching and convulsions (if sodium level is below 115 mEq/L)• Focal weakness

•

Nursing Process in HYPONATREMIA

NURSING MANAGEMENT• Provide continuous assessment• Maintain seizure precaution• Detect and control Hyponatremia

Electrolytes Potassium (K+)

• chief electrolyte in the ICF• average daily requirement:

b. intake of 50 - 100 mEq maintains K+ balance

• potassium rich foods:a. bananasb. orangesc. prunesd. broccolie. potatoes

Electrolytes Potassium (K+)

• losses:a. excreted primarily by the kidneys

b. gastrointestinal excretionsc. some perspiration and saliva

• normal range for serum potassium???

HYPOKALEMIA

• potassium deficit in the ECF, or serum potassium level less than 3.5 mEq/L

Nursing Process in Hypokalemia

Clinical Manifestations• Potassium deficiency can result in widespread derangements in physiologic

functions and especially nerve conduction. • Clinical signs rarely develop before the serum potassium level has fallen

below 3 mEq/L unless the rate of fall has been rapid.

Nursing Process in Hypokalemia

• Manifestations of hypokalemia include fatigue, anorexia, nausea, vomiting, muscle weakness, decreased bowel motility, paresthesias, dysrhythmias, and increased sensitivity to digitalis.

• If prolonged, hypokalemia can lead to impaired renal concentrating ability

Nursing Process in Hypokalemia

ASSESSMENT• Physical examination

• Muscle weakness• Decreased bowel motility and abdominal distention• Paresthesias• Dysrhythmias• Increased sensitivity to digitalis

Nursing Process in Hypokalemia

ASSIST IN THE MEDICAL INTERVENTION• Provide oral or IV replacement of potassium

NURSING MANAGEMENT• Continuously monitor the patient• Prevent hypokalemia• Correct hypokalemia by administering prescribed IV potassium replacement.

• Administer IV potassium no faster than 20 mEq/hour and hook the patient on a cardiac monitor.

• A concentration greater than 60 mEq/L is not advisable for peripheral veins.

HYPERKALEMIA

• potassium excess in the ECF, or serum potassium level greater than 5.0 mEq/L

Nursing Process in Hyperkalemia

Clinical Manifestations• By far the most clinically important effect of hyperkalemia is its effect on the

myocardium. • Cardiac effects of an elevated serum potassium level are usually not

significant below a concentration of 7 mEq/L (SI: 7 mmol/L)• As the plasma potassium concentration is increased, disturbances in cardiac

conduction occur.

Nursing Process in Hyperkalemia

ASSESSMENT• Physical Examination

• Diarrhea• Skeletal muscle weakness• Abnormal cardiac rate

Nursing Process in Hyperkalemia

IMPLEMENTATION• ASSIST IN MEDICAL INTERVENTION

• Monitor the patient’s cardiac status with cardiac machine• Institute emergency therapy to lower potassium level by:

• Administering IV calcium gluconate• Administering Insulin with dextrose• Administering sodium bicarbonate• Administering Kayexalate (cation-exchange resin)

Nursing Process in Hyperkalemia

NURSING MANAGEMENT• Provide continuous monitoring• Assess for signs of muscular weakness, paresthesias, nausea• Evaluate and verify all HIGH serum K levels• Prevent hyperkalemia

• Correct hyperkalemia by administering carefully prescribed drugs. • Assist in hemodialysis if hyperkalemia cannot be corrected.• Provide client teaching. • Monitor patients for hypokalemia who are receiving potassium-

sparing diuretic

Electrolytes Calcium (Ca++)

• most abundant electrolyte in the human bodya. 99% is in the bones and 1% is in the ECF

• a. average daily requirementi. 1 g for adults

Electrolytes Calcium (Ca++)

•calcium rich foods:a. milkb. cheesec. calcium-fortified tofud. almonds

•losses:a. urine, feces, bile, digestive secretions, perspiration

•normal range for serum calcium???

HYPOCALCEMIA

• calcium deficit in the ECF, or serum calcium level less than 8.5 mEq/L

HYPOCALCEMIA

• signs/symptoms• mental changes• convulsions• spasm of larygneal muscles• ECG changes

• Management• Dependent on the presenting SSx• Administration of medications such as Calcium Gluconate

(IV)• Calcium Chloride if severe• Calcium carbonate

HYPERCALCEMIA

• calcium excess in the ECF, or serum calcium level greater than 10.5 mEg/L

HYPERCALCEMIA

• signs/symptoms• muscular weakness• constipation• anorexia, nausea, vomiting• decreased memory and attention span• polyuria and polydipsia• renal stones• neurotic behavior• cardiac arrest

HYPERCALCEMIA

•The need for treatment of hypercalcemia depends on the degree of hypercalcemia and the presence or absence of clinical symptoms.

Electrolytes Magnesium

• second most important cation in the ICFa. primarily found in the ICF

• average daily requirement:i. 18 - 30 mEq for adultsii. higher amounts are required for:a. children

• magnesium rich foods:a. vegetablesb. nutsc. fish

Electrolytes Magnesium

• losses:a. excreted by the kidneys

• normal range for serum magnesium:a. 1.3 - 2.1 mEg/L (mmol/L) with 1/3 of that bound to plasma proteins

HYPOMAGNESEMIA

• magnesium deficit in the ECF, or serum magnesium level less than 1.3 mEg/L

HYPOMAGNESEMIA

• signs/symptoms• neuromuscular irritability• increased reflexes• coarse tremors• convulsions• cardiac manifestations• tachyarrythmias• increases susceptibility for digitalis toxicity• mental changes• disorientation• mood changes

HYPOMAGNESEMIA

• Management

• Treatment of hypomagnesemia depends on the degree of deficiency and the clinical effects.

HYPERMAGNESEMIA

• magnesium excess in the ECF, or serum magnesium level greater than 3.0 mEg/L

HYPERMAGNESEMIA

• signs/symptoms• flushing a sense of skin warmth• hypotension• depressed respirations• drowsiness, hypoactive reflexes,

and muscular weakness• cardiac abnormalities

• Management

• Dialysis• Cardiotoxicity Management • Calcium Gluconate 10% 1-10 ml IV

Electrolytes Phosphate (PO4-)

• chief anion in the ICFa. present also in the ECF, bone, skeletal muscle, and nerve tissue

• average daily requirement:a. 1 g for adultsb. higher amounts are required for:

i. childrenii. pregnant and lactating

womeniii. post-menopausal women not taking

estrogeniv. people over 65

• phosphate rich foods

ElectrolytesPhosphate (PO4-)

• losses:a. excreted by the kidneys

• normal range for serum phosphate: 2.5 - 4.5 mEg/L (mmol/L)

HYPOPHOSPHATEMIA

• phosphate deficit in the ECF, or serum phosphate level less than 2.5 mEg/L

• signs/symptoms

• cardiomyopathy• acute respiratory failure• seizures• decreased tissue oxygenation• joint stiffness

HYPOPHOSPHATEMIA

• Standard intravenous preparations of potassium phosphate are available and are routinely used in malnourished patients and alcoholics.

• Oral supplementation also is useful where no intravenous treatment is available.

• Historically one of the first demonstrations of this was in concentration camp victims who died soon after being re-fed: it was observed that those given milk (high in phosphate) had a higher survival rate than those who did not get milk.

HYPERPHOSPHATEMIA

• phosphate excess in the ECF, or serum phosphate level greater than 4.5 mEg/L

• signs/symptoms• symptoms of tetany, • tingling of the fingertips and

around the mouth• numbness• muscle spasms

HYPERPHOSPHATEMIA

• Management

• High phosphate levels can be avoided with phosphate binders and dietary restriction of phosphate.

ElectrolytesChloride (CL-)

• chief electrolyte in the ECFa. present in the blood, interstitial fluid, lymph, and in minute amounts in the ICF

• chloride rich foods:a. foods high iN sodiumb. dairy productsc. meat

Electrolytes Chloride (CL-)

• losses:a. excreted by the kidneys

• normal range for serum chloride:a. 95 - 105 mEg/L (mmol/L)

THANK YOU!!!