FLUID AND ELECTROLYTE BALANCES Ms. Ida Anitha Lecturer College of Nursing CMC, Vellore

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FLUID AND ELECTROLYTE BALANCESMs. Ida
AnithaLecturerCollege of NursingCMC, Vellore
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WHY IS IT IMPORTANT FOR NURSES TO KNOW ABOUT
FLUID ELECTROLYTE BALANCE
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INTRODUCTION

• Water is found everywhere on earth including
  human body
• In an adult 60 of the weight is water
• Two third of the bodys water is found in the cell

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DISTRIBUTION OF BODY FLUIDS

• Body fluids are distributed in two distinct
  compartments
• 1.Extracellular fluidsECF Which includes
  interstitial fliud intravascular fluid
• 2.Intracellular fluidsICF

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COMPOSITION OF BODY FLUIDS

• The fluids circulating throughout the body in
  extracellular and intracellular fluid spaces
  contain
• 1.Electrolytes
• 2.Minerals
• 3.Cells

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MOVEMENT OF BODY FLUIDS

• Diffusion
• Osmosis
• Filtration
• Active transport

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REGULATION OF BODY FLUIDS

• Fluid intake
• Fluid output
• Hormonal influence
• Lymphatic influences
• Neurologic influences
• Renal influences

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ACID-BASE BALANCE

• Chemical regulation
• Biologic regulation
• Physiological regulation
• 1.Lungs
• 2.Kidneys

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FLUID ,ELCTROLYTE AND ACID-BASE IMBALANCES
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FLIUD IMBALANCES

• The five types of fluid imbalances that may occur
  are
• Extracellular fluid imbalances(EVFVD)
• Extracellular fluid volume excess(ECFVE)
• Extracellular fluid volume shift
• Intracellular fluid vloume excess(ICFVE)
• Intrcellular fluid volume deficit(ICFVD)

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EXTRACELULLAR FLUID VOLUME DEFICIT

• An ECFVD, commonly called as dehydration , is a
  decrease in intravascular and interstitial fluids
• An ECFVD can result in cellular fluid loss if it
  is sudden or severe

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THREE TYPES OF ECFVD

• Hyperosmolar fluid volume deficit- water loss is
  greater than the electrolyte loss
• Isosmolar fluid volume deficit equal proportion
  of fluid and electrolyte loss
• Hypotonic fluid volume deficit electrolyte loss
  is greater than fluid loss

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ETIOLOGY AND RISK FACTORS

• Severe vomiting
• Diaphoresis
• Traumatic injuries
• Third space fluid shifts percardial, pleural,
  pertonial and joint cavities
• Fever
• Gatrointestinal suction
• Ileostomy
• Fistulas
• Burns

• Hyperventilation
• Decresed ADH secretions
• Diabetes insipidus
• Addisons disease or adrenal crisis
• Diuretic phase of acute renal failure
• Use of diuretics

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ELDERLY ARE HIGH RISK OF ECFVD DUE TO

• Decreased thirst response
• Decreased renal concentration of urine
• Altered ADH response
• Increased drug drug interaction
• Multiple chronic diseases
• Decreased access to fluids due to financial or
  transportation barriers
• Debilitation
• Chemical or physical restraint
• Changes in mental status

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CLINICAL MANIFESTATION

• In Mild ECFVD, 1to 2 L of water or 2 of the body
  weight is lost
• In Moderate ECFVD, 3 to 5L of water loss or
  5weight loss
• IN Severe ECFVD , 5 to 10 L of water loss or 8
  of weight loss

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CLINICAL MANIFESTATION

• Peripheral vein fillinggt 5 seconds
• Postural systolic BP falls gt25mm Hg and
  diastolic fall gt 20 mm Hg , with pulse increases
  gt 30
• Narrowed pulse pressure, decreased CVPPCWP
• Flattened neck veins in supine position
• Weight loss
• Oliguria(lt 30 mlper hour)
• Decreased number and moisture in stools

• Thirst
• Muscle weakness
• Dry mucus membranedry cracked lips or furrowed
  tongue
• Eyeballs soft and sunken (severe deficit)
• Apprehension , restlessness, headache ,
  confusion, coma in severe deficit
• Elevated temperature
• Tachycardia, weak thready pulse

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LABORATORY FINDINGS

• Increased osmolality(gt 295 mOsm/ kg)
• Increased or normal serum sodium level (gt 145mEq/
  L )
• Increase BUN (gt25 mg / L )
• Hyperglycemia ( gt120 mg /dl )
• Elevated hematocrit (gt 55)
• Increased specific gravity ( gt 1.030)

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MANAGEMENT

• Mild fluid volume loss can be corrected with oral
  fluid replacement
• -if client tolerates solid foods advice to take
  1200 ml to 1500ml of oral fluids
• -if client takes only fluids, increase the total
  intake to 2500 ml in 24 hours

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Management of Hyperosmolar fluid volume deficit

• Administration of hypotonic IV solution , such
  as 5 dextrose in 0.2 saline
• If the deficit has existed for more than 24
  hours,avoid rapid correction of fluid sodium
  solution to be infused at the rate of 0.5 to 0.1m
  Eq/ L/ hr

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If heamorrhage is the cause for ECFVD

• Packed red cells followed by hypotonic IV fluids
  is administered
• In situations where the blood loss is less than 1
  L normal saline or ringer lactate may be used
• clients with severe ECFVD accompanied by severe
  heart , liver, or kidney disease cannot tolerate
  large volumes of fluid and sodium

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EXTRACELLULAR FLUID VOLUME EXCESS

• ECFVE is increased fluid retention in the
  intravasular and interstitial spaces

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ETIOLOGY AND RISK FACTORS

• Heart failure
• Renal disorders
• Cirrhosis of liver
• Increased ingestion of high sodium foods
• Excessive amount of IV fluids containing sodium
• Electrolyte free IV fluids
• SIADH,Sepsis
• decreased colloid osmotic pressure
• lymphatic and venous obstruction
• Cushings syndrome glucocorticoids

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CLINICAL MANIFESTATION

• Constant irritating cough
• Dyspnea crackles in lungs
• Cyanosis, pleural fffusion
• Neck vein obstruction
• Bounding pulse elevated BP
• S3 gallop
• Pitting sacral edema
• Weight gain
• Increased CVP PCWP
• Change in level of consiousness

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LAB INVESTIGATION

• serum osmolality lt275mOsm/ kg
• Low , normal or high sodium
• Decreased hematocrit lt 45
• Specific gravity below 1.010
• Decreased BUN lt 8mg/ dl

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MANAGEMENT

• Diuretics combination of potassium sparing and
  potassium depleting diuretics
• In people with CHF, ACE inhibitors and low dose
  of beta blockers are used
• A low sodium diet

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EXTRACELLULAR FLUID VOLUME SHIFT THIRD SPACING

• Fluid that shifts into the interstitial spaces
  and remain there is called as third space fluid
• Common sites are abdomen , pleural cavity,
  peritoneal cavity and pericardial sac

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RISK FACTORS

• Crushing injuries, major tissue trauma
• Major surgery
• Extensive burns
• Acid base imbalances and sepsis
• Perforated peptic ulcers
• Intestinal obstruction
• Lymphatic obstruction
• Autoimmune disorders
• Hypoalbunemia
• GI tract malabsorption

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CLINICAL MANIFESTATION

• skin pallor
• Cold extremities
• Weak and rapid pulse
• Hypotension
• Oliguria
• Decreased levels of consiousness
• LAB INVESTIGATION
• Elevated hematocrit BUN level

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MANAGEMENT

• Treat the cause
• For burns and tissue injuries large volume of
  isosmolar IV fluid is administered
• Albumin is administered for protein deficit
• IV fluid intake is maintained after major
  surgery to maintain kidney perfusion
• Pericardiocentesis if pericarditis is the result
• Paracentesis for ascitis

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INTRACELLULAR FLUID VOULME EXCESSWATER
INTOXICATION

• ICFVE is increase in amount of water inside the
  cells

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ETIOLOGY

• Administration of excessive amount of hyposmolar
  IV fluids0.45saline or 5dextrose in water
• Consumption of excessive amount of tap water
  without adequate nutritional intake
• SIADH
• Schizophreniacompulsive water consumption

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CLINICAL MANIFESTATIONS

• Headaches
• Behavioral changes
• Apprehension
• Irritability, disorientation and confusion
• Increased ICP pupillary changes and decreased
  motor and sensory function
• Bradycardia, elevated BP, widened pulse pressure
  altered respiratory patterns, Babinskis
  response flaccidity, projectile vomiting,
  Papilledema, delirium, convulsions coma

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LABORATORY FINDINGS

• High serum sodium level- 125 mEq/L
• decreased hamatocrit

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MANAGEMENT

• Early administration of IV fluids containing
  sodium chloride cam prevent SIADH
• oral fluids such as juices or soft drinks can be
  given orally every hour
• Perform neurologic checks every hour to see if
  cranial changes are present
• Monitor fluid intake , IV fluids and fluid output
  hourly and weight daily
• Administer antiemetics for food and fluid
  retention

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INTRACELLULAR FLUID VOLUME DEFICIT

• Severe hypernatremia and dehydration can cause
  ICFVD
• Relatively rare in healthy adults
• common in elderly people and in those conditions
  that result in acute water loss
• Symptoms include confusion, coma, and cerebral
  hemorrhage

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CONCLUSION

Thank you