Fluid and Electrolyte Balance KNH 413 Maintaining homeostasis Water/fluid balance Electrolyte balane

Interstitial = tissue Water balancing issue between all these parts of the body Food sources; aboout 700 cc fluid 200 cc fluid by product 2300 total ccs Maintaining water balance 1400 ccs taking in liquid 700 ccs from foods 200 ccs byproduct of metablosim Total 2300 ccs

1,000 ccs = 1L INFANTS: 30 ccs per ounce 40-60 for adolescents because they are more active than adults Adults: manage based on their activity level

Body Solutes Types of solutes Electrolytes Other molecules Sodium, potassium, calcium, magnesium, chloride, bicarbonate, phosphate, sulphate Ions dissociate to form charged particles Other molecules Glucose, protein, urea, lactate, organic acids Remain stable Extracellular: Na, Ca, bicarb, Cl, S Intracellular: K, Mg, Phosphate Glucose pulls out fluids, Protein is susceptible to hydration status

Body Solutes Distribution of solutes Sum of cations must be equal to sum of anions within a given compartment Movement of solutes influenced by: maintaing fluid balance and removing waste between blood as well as tissue Molecular size Electrical charge of the molecule Hydrostatic pressure Method of solute transport Cations positive charge Anion negative charge Measured by molecular charge

plasma5 % water Interstitial fluid 15% water Intracellular water 40% water

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Regulation of Fluid and Electrolytes Osmotic and hydrostatic pressure: Thirst: Renal: Hormonal influence – RAAS: Electrolyte regulation:

Regulation of Fluid and Electrolytes Thirst: triggered by hypothalamus, don’t want to get to point where you feel thirst Renal function: Renin-Angiotension-Aldosterone System: influencing kidneys to retain sodium, pull fluid back into the blood

GFR of kidneys Low sodium load and what your body will do to adjust it

Increased blood calcium body tries to inhibit D uptake; eg Increased blood calcium body tries to inhibit D uptake; eg. Osteoporosis, renal-prescribe phosphate binders, Decreased blood calcium body needs to increase D intake; eg. Premature infants,

Disorders of Fluid Balance Alterations in volume Hypovolemia: fluid volume Hypervolemia: fluid volume Alterations in osmolality: electolyte imbalance Sodium imbalances composition of fluid chem 7 panal; acid base balance Hyponatremia Hypernatremia Potassium imbalances Hypokalemia look at albumen levels; eg. Bone abnormalities, blood clotting Hyperkalemia: renal status

Disorders of Fluid Balance Calcium imbalance: bone Hypocalcemia Hypercalcemia Phosphorus imbalance: acid base balance Hypophosphatemia Hyperphosphatemia Magnesium imbalance: kidneys regulating, bone, Hypomagnesemia Hypermagnesemia

Disorders of Fluid Balance What are the… Causes ? Clinical manifestations ? Laboratory findings ? Treatment ? Identify underlying cause #1 reason for acid/base imbalance: kidneys Pitting Adema Fluid overload: low sodium Treatment: underlying cause; might have to change Na, K, fluid,

Rapid changes in weight, look at hair, lips, eyes Acid/base changes, osmolality Urin panal: fluid status, look at color, volume, waste of Na, K, Cl © 2007 Thomson - Wadsworth

Rehydration; 300 mOsm is normal for blood

Fluid and Electrolyte Balance Assess for factors that affect fluid and electrolyte balance: Disease or injury: burn patient, diabetic in DKA, Medication or treatment: lacics (heart meds), fluid removing drugs Fluid loss: severe trauma; gun shot wound Nutrient restriction: cardiovascular disease, renal disease, Oral intake: not adequate Intake vs. output: