Fluids and Electrolytes

1. Fluids and Electrolytes Staying Balanced

2. Water – H2O • “Universal solvent” • 60% of body’s weight • Cells “haf to have it.” • –Arnold Schwartzenneger

3. How much is that? • 154# Person x .60 (60%) = • 92# • Water is approx 8# per gallon • 11 ½ gallons water • (Obese people/ less) • (Thin people/ more)

4. Basic Cellular Review • The fundamental unit • Requires: • Cell membrane • Enzymes • Internal membranes • Genetic material

5. Basic tissue types • Epithelial • Connective • Muscle • Nervous

6. The cellular environment • All metabolic reactions occur • The precise regulation of volume and composition of body fluid is essential to health.

7. Body fluid compartments • Intracellular Fluid - ICF • Extracellular Fluid – ECF • Intravascular Fluid- Plasma • Interstitial Fluid

8. Intracellular - ICF • 75% of the water (60%) • 31.50 L (70 kg adult) • 40% of body weight

9. Extracellular - ECF • 20% of water (60%) • 10.50 L (70 kg adult))

10. ECF • Intravascular • 4% of (60%) • 7.5 L

11. ECF • Interstitial • 16% of (60%) • 17.5 L

12. Hydration • Water - Universal solvent • Intake & Output

13. Hydration • Homeostasis • The body’s need for balance

14. Food - 1200 ml Drink - 1000 ml Metabolic sources - 300 ml = 2500 ml Lungs - 400 ml Kidneys - 1500 ml Skin - 400 ml Intestine (Feces) - 200 ml = 2,500 ml Intake vs Output

15. Hydration • Osmoreceptors - anterior hypothalamus • Baroreceptors - carotid sinus, aortic arch, kidneys • High and low blood pressure

16. Hydration • Anti-diuretic hormone (ADH) • If tide goes out • Pituitary Gland Excretes • Tide comes in!!! • Re-absorb from kidneys • Decrease urine • Thirst also regulates

17. Dehydration • Abnormal decrease in TBW • Thus the weigh-in at fires • Rarely involves only water loss • Electrolyte loss

18. Dehydration causes • Signs and symptoms • Treatment?

19. Causes of dehydration • GI losses • N/V/D • Insensible losses • Normal losses + with fever • Hyperventilation • High Environmental Temps • Increased sweating

20. Causes of dehydration • Internal losses • “Third”spacing • Peritonitis • Pancreatitis • Malnourished • No protein to retain water

21. Causes of Dehydration • Plasma losses • Burns • Surgical Drains • Open wounds

22. Signs and symptoms • Signs of shock • Skin changes (turgor) • Orthostatic hypotension • Thirst • Increased PR

23. S/S, cont. • Decreased BP • Dry mucosa • Infants: Anterior fontanelle sunken • Dry diapers • Absent tears • Cap refill > 2 seconds • Dry mucosa

24. Treatment • ABCs • O2 • Fluids • Flavor? • Consider PASG • ECG

25. Overhydration – “No thanks I’m full.” • Edema • Peripheral vs. central (more later…) • Aggressive tx if Pulm. Edema

26. Overhydration • ABCs • O2 • Consider ETT • Meds: • NTG. • Lasix • M.S.

27. Medical causes Diabetes Heat Emergencies Blood Loss Traumatic causes Blood loss Fluid & Electrolyte Disturbances

28. Electrolytes • In H2O dissociate into ions • Cations = positive • Anions = negative

29. Sodium (Na+) Prevalent inECF “Water follows it” Nerve impulses hyper/ hyponatremia Potassium (K+) Prevalent in ICF Nerve impulses hypo/ hyperkalemia Principle CationsSodium-Potassium Pump

30. Other Cations • Calcium (Ca++) • Prevalent in ICF • Muscle contraction • Nerve impulse • hypo/hypercalcemia

31. Other Cations • Magnesium (Mg++) • Present in ICF • Necessary for many processes • Found in some: • Antacids • Laxatives • Most associated with phosphate • Renal Functions

32. Principal Anions • Chloride (Cl-) • Present in ECF • Balances cations • Fluid balance • Renal function • Usually found hanging around sodium

33. Principal Anions • Bicarbonate (HCO3-) • Found in ECF • The Buffer • Neutralizes Acidic (H+) • Tx for acidosis

34. Anions • Phosphate (HPO-4) • Found in ICF - buffer • Energy stores • Mg++ in renal function

35. Electrolytes - mEq/L • Non-Electrolytes - • Glucose • Urea • Proteins

36. How does it get there? • Osmosis • Diffusion • Active Transport • Facilitated Diffusion

37. Isotonic • Hypertonic • Hypotonic • Osomotic gradient - difference in concentration

38. Osmosis • Movement of water (solvent) • Semi-permeable membrane • Towards highersoluteconcentration

39. Diffusion • Movement of solutes • Across membrane • Towards lesser solute concentration

40. Active transport • Movement of solutes • Across membrane • Against osmotic gradient • Requires energy (ATP) • Sodium-potassium pump

41. Facilitated diffusion • Helper proteins • Insulin • Open gate • Glucose

42. Osmotic Pressure • Governs movement of water and solutes across cell membrane • Pressure exerted by concentration of solutes • Pulls from other side of membrane

43. Blood Plasma • Colloid osmotic pressure • Plasma • Hydrostatic pressure • Blood pressure • Filtration

44. Edema • Localized • Site of injury • Organ systems - brain, lungs, heart, abdomen • Generalized • Dependent edema • Pitting edema

45. RELATIVE HYDRATION • Body water in interstitial spaces not available for metabolism • Relative dehydration

46. Edema • Decrease in production of plasma proteins • Liver disorder • Burns • Open wounds

47. More about Edema • Increase in hydrostatic pressure • Venous obstruction • Salt and water retention • Thrombophlebitis • Liver obstruction • Tight clothing • Prolonged standing

48. And more about edema • Increased capillary permeability - plasma proteins escape • Inflammation and immune response • Allergic reactions • Burns • Trauma • Cancer

49. And still more edema • Lymphatic channel obstruction • Infection • Surgery

50. Blood Components • Plasma • Formed Elements • Leukocytes (WBCs) • Erythrocytes (RBCs) >99% • Thrombocytes