Fluid and Electrolytes
Fluid and Electrolytes
Fluid and Electrolytes
Electrolytes
CANDICE RACHEL U. CANLAS, LPT-MD
SCHOOL OF NURSING
Functions of Water
✓Acts as a solvent to dissolve solutes
✓Acts as a medium for metabolic reactions
Internal Control Mechanisms for Fluid Balance
✓Thirst
✓Antidiuretic hormone (ADH)
✓Aldosterone
Goal: Maintain homeostasis
Homeostasis
✓Fluid intake is equal to fluid output
✓Fluid intake: liquids, solid foods, IV fluids, or parenteral fluids
✓Fluid output: urine, emesis, or feces
✓Insensible losses: skin, lungs, GI tract
✓Measurable losses: fistulas, drains, or GI suction
✓Overhydration: sudden weight gain is strong indicator
✓Edema: Fluid excesses that accumulate in interstitial spaces, such as the
pericardial sac, joint capsules, and lower extremities
✓Dehydration: Quantity of water lost exceeds water gained; water deficit;
Death occurs when 20-25% of TBW is lost
✓Sodium is the principal extracellular electrolyte that plays primary role in
water concentration
Types of Dehydration
Conditions Leading to Dehydration
Tonicity and
Osmolality
Osmolality
✓ Used in reference to body fluids and is the concentration of
the particles in a solution
✓ Normal osmolality of body fluids: 290-310 mOsm/kg
Tonicity
✓ Used in reference to IV fluids and is the measurement of the
concentration of the IV fluids as compared with the
osmolality of body fluids
✓ Measure of osmotic pressure
❖ Isotonic – osmotic pressure inside and outside the cell is
equal; normal saline (0.9% NaCl) or lactated Ringers
solution; no net fluid movement
❖ Hypotonic – solution outside the cell has lower osmotic
pressure than inside the cell; 0.45% NaCl solution; causes
fluid to move out of the vein and into the tissues and cells
❖ Hypertonic – solution outside the cell has higher osmotic
pressure than inside the cell; 3% NaCl injection; causes fluid
to move from ISF into the veins
Solutions
Acid-Base Balance
✓ Regulated by the respiratory system and
kidneys
✓ Acid – substance that can donate or
release H+
✓ Base – substance that can accept H+,
such as bicarbonate
✓ pH – measure of the degree of acidity
and alkalinity; inversely related to
hydrogen ion concentration
✓ Normal pH range – 7.35 to 7.45; Acidosis
pH below 7.35 and alkalosis pH above
7.45
Regulation of Acid-Base Balance
✓Respiratory system compensates for metabolic problems and
pH imbalances by regulation of carbon dioxide (CO2)
✓Kidney compensates for metabolic problems by regulating of
reabsorption of bicarbonate (HCO3-) and excretion of
hydrogen ion (H+)
Laboratory Tests
✓Arterial Blood Gas (ABG) – influence of the respiratory system
✓Blood Test to determine Acid-Base balance – measures total
body CO2 and is usually represented as HCO3
Acid-Base
Imbalance
Causes of
Acid-Base
Imbalance
Acid-Base Disorders and
Compensation
Crystalloids
Colloids
Blood Products
Electrolytes
DIFFERENT FLUID &
ELECTROLYTE THERAPIES
Crystalloids
✓ Fluids given by IV injection that supply
water and sodium to maintain
osmotic gradient between the
extravascular and intravascular
compartments
✓ Short-term plasma volume –
expander (related to their sodium
concentration)
✓ Normal saline (0.9% NaCl) and
lactated Ringers solution
❖Serum is a term closely related to
plasma
Mechanism of Action:
✓ Contain fluids and electrolytes that are normally found in
the body
✓ Do not contain proteins (colloids)
✓ Distributed faster into the interstitial and intracellular
compartments than colloids
✓ Better for treating dehydration than expanding plasma
volume alone
✓ Much less expensive than colloids and blood products
✓ No risk for viral transmission or anaphylaxis and no alteration
Crystalloids of coagulation profile associated with blood products
Indications:
✓ Maintenance fluids
✓ Compensate for insensible fluid losses, to replace fluids, and
to manage specific fluid and electrolyte disturbances
✓ Promote urinary flow
✓ Used for liver failure, burns, cardiopulmonary bypass surgery,
hypoproteinemia, renal dialysis, and shock
Contraindications:
✓ Drug allergy to a specific product, hypovolemia, and
electrolyte disturbance depending on the crystalloid used
Adverse Effects:
✓ Do not stay within the blood vessels
and can leak out of the plasma into
the tissues and cells (because they
don’t have large particles like proteins)
→ peripheral edema and pulmonary
edema
Crystalloids ✓ Dilute proteins in the plasma →
reduces colloid oncotic pressure
✓ Prolonged use can cause fluid
overload
✓ Effects are relatively short-lived
Interactions:
✓ Rare
Physiological electrolyte
HYPERTONIC
ISOTONIC
- 3% and 5%
- 0.9% is the most
common - High-alert drug
HYPOTONIC
- Physiologically normal - Contraindicated in
- 0.45% and 0.25 increased, normal, or
concentration of
sodium chloride - Correcting to rapidly slightly decreased
can cause hemolysis of sodium concentrations
- Referred to normal
RBC - Correcting to rapidly
saline (NS)
can lead to osmotic
- Contains 154 mEq of
demyelination
sodium per liter
syndrome (fatal)
Colloids
Sodium
Hyponatremia – sodium loss or deficiency than 135
mEq/L; manifested as lethargy, hypotension, stomach
cramps, vomiting, diarrhea, and seizures