Fluids and Electrolytes Balance

1. Fluids and Electrolytes Balance Josierina Y. Sarmiento, M.D. Nephrologists Asian Hospital and Medical Center

2. Body Fluids • Man have 60% • Woman have 50% • Fat contains little water • % of body weight that is water decreases with age

3. Body Fluid Compartment

4. Extracellular Fluids (ECF) • Supplies the food, oxygen, water, vitamins and electrolytes and takes away body waste.

5. Fluid Spacing • First spacing – normal amount of fluids in both the extracellular and intracellular compartments. • Second spacing – an excess accumulation of intestinal fluid (edema). • Third spacing – fluid accumulation in areas that normal have no fluids or minimal amount of fluids. (Ascites)

6. Electrolytes • Solutes and substances that are dissolved in body fluids. • Electrolytes • Non – electrolytes • Compounds that do not separate into charged particles when dissolved in water……GLUCOSE

7. Electrolytes • Electrolytes are compounds that do not separate into charged particles called ions. • Cations – positively charged ions such as Na+. • Anions – negatively charged ions such as Cl-.

9. Electrolytes • Electrolytes are found inside and outside of the cell.

10. Normal Fluid Intake and Losses in Adults Insensible losses

12. Fluid and Electrolyte Exchange

13. Diffusion • Molecules and ions flow through a semi permeable membrane from an area of higher concentration to an area of lower concentration.

14. Osmosis • Movement of water through a semi permeable membrane from a weaker solution to the more concentrated solution • The in intent is to equalize the strength of solution.

15. Osmotic Pressure • Osmotic pressure – is the pulling of water in the process of osmosis. • Osmolarity – an indication of whether a person is adequately hydrated, over by drated or dehydrated. Normal: 275 – 295 mOsm/kg

16. Osmotic Movement of Fluids • Isotonic – fluids that have the same osmolarity as the fluid inside the cell. Example: Plain LR and plain NSS • Has the same concentration as inside the cells

17. Hypotonic / Hypoosmolar • Hypotonic – fluids that contain more water than the intercellular fluids. Example: ½ NSS • Hypotonic fluid surrounds the cells and causes the water to move inside the cell until it burns.

18. Hypertonic Solution • Hypertonic solutions – are fluids that contain less water (more concentrated) than intracellular fluids. • Hypertonic solution around the cells draws water from the cell until it shrinks.

19. Hypotonic Solution Water ½ NSS Burst

20. Hypertonic Solution 3% NaCl Shrinks

21. Hydrostatic Pressure • Hydrostatic Pressure – is the force exerted by fluids against the wall of it containers. • Hydrostatic Pressure – is the major force in the movement of water out of the capillaries.

22. Oncotic Pressure • Oncotic pressure – is also known as colloidal osmotic pressure that is the presence caused by colloids in the solution. • Colloids – are particles that are too large to pair through a semi permeable membrane. Example: protein

23. Capillary Fluid Movement • The amount and direction of fluid movement is based on the hydrostatic pressure and oncotic pressure.

24. Capillaries Hydrostatic Pressure Oncotic Pressure Venous End Arterial End

25. Fluid Shift • Edema – imbalance between hydrostatic and oncotic pressure. •  Hydrostatic pressure • CHF, tourniquet •  Oncotic pressure • Malnutrition • Nephrotic syndrome

26. Regulation of Fluids and Electrolytes • Hypothalamus – the thirst mechanism that stimulates us to drive. It is stimulated by increased in serum osmolality. • Hormones: • ADH (antidiuretic hormone) – acts on the renal tubules to retain water and decrease urinal outputs • Aldosterone – increases sodium and water reabsorption.

27. Fluids and Electrolytes Imbalances • Hypovolemia – decreased in intravascular fluid volume. • Occurs when water and electrolytes are lost or unavailable to circulation. • Diarrhea, massive bleeding, excessive sweating (marathon, runners), vomiting.

28. Decreased body temperature Low blood pressure Tachycardia Weak pulse Increased respiration Weakness Weight loss Decreased urine output Increased Hab/Hct Assessment of Hypovolemia

29. Treatment of Hypovolemia • Fluids

30. Hypervolemia Hypervolemia is the excess of water and electrolytes in the ECF. • Renal failure • Congestive heart failure

31. Acute weight gain Cardiac enlargement, cyanosis Decreased Hct, Hab, RBC’s Skin warm and moise Pitting edema Puffy eyelids Bounding pulse Dyspnea, increased respiratory rate Distended neck vein Assessment of Hypervolemia

32. Treatment for Hypervolemia • Sodium restriction • Limit fluid intake • Diuretics

33. Electrolyte Balance • Each electrolyte has its very own function. • Too much or too little may alter the function. • Electrolytes concentration may be altered by changing the quantity of the electrolyte or by altering the quantity of water in the ECF in which electrolytes is found.

34. Sodium • Sodium is the chief cat ion in the ECF. NV = 135 – 145 mEq/L • Sodium function include transmission of nerve impulses, maintain acid-base balance, regulate water reabsorption and excretion in kidney tubules.

35. Sodium • Normal Na intakes is 2 to 4 grams • Hypernatremia – too much Na in the intravascular space; cause cell to shrink • Hyponatremia – too little Na in the intravascular space, cause the cell to swell. • Aldosterone – reabsorbs Na in the kidney tubules

36. Defining Characteristics of Hyponatremia • Serum Na < 135 mEq/L •  Serum osmolality • Anorexia and nausea • Lethargy • Confusion, seizures, coma • Muscle twitching

37. Nursing Intervention for Hyponatremia • Encourage diet high sodium • Weigh daily • Monitor neurological status • Monitor serum Na levels • Maintain free water intake

38. Food High in Sodium • Potato chips • Bacon / catsup • Table salt • Crackers • Cheese • Pretzels, etc. • Luncheon meat

39. Hypernatremia • Serum Na greater than 145 mEq/L • Due to water deficit • Serum osmolality > 295 mOsm/kg.

40. Defining Characteristic of Hypernatremia • Dry tongue • Thirst • Fever • Oliguria • CNS symptoms including focal or grand mal seizures

41. Nursing Intervention for Hypernatremia • Encourage low Na diet • Accurate I;O • Hypotonic fluids • Observe for seizure

42. Chloride • Chloride is the major extracellular anion • Part of hydrochloric acid in the stomach • When Na is reabsorbed so is Cl

43. Potassium • Potassium is the major intracellular cat ion. • Function: • ICF balance • Maintain regular heart rhythm • Conducts neuromuscular impulses • Regulation of acid-base balance • Normal potassium range: 3.5 – 5.0 mEq/L

44. Reasons for Hypokalemia • Diarrhea • Ostomies • Loop diuretics • Poor intake of K rich foods • Stress

45. Defining Characteristics Hypokalemia • Serum K+ level less than 3.5 mEq/L • Muscle weakness • Cardiac arrhythmias • Increased sensitivity to digitalis toxicity • Muscle weakness • Fatigue • ECG changes: ST depression / U wave

46. Nursing Intervention for Hypokalemia • Encourage high K foods • Monitor EKG results • IV/oral Potassium replacement

47. Foods high in Potassium • All dried fruits/banana • Spinach • Beef • Chocolate • Potato’s • Tomato’s

48. Hyperkalemia • Renal insufficiency. • High potassium intake. • Shift of potassium out of the cell as in acidosis.

49. Defining Characteristics of Hyperkalemia • Potassium levels greater than 5.0 mEq/L • Neuromuscular weakness • EKG changes – peaked T waves widened QRS complex • Flaccid muscles paralysis • Heart block

50. Nursing Intervention for Hyperkalemia • Monitor EKG changes • Administer calcium solutions to neutralize the potassium • Monitor muscle tone • Give kayexalate • Glucose + insulin solution • Diuretics