1. 1 Fluid & Electrolytes FA 08

2. Otten, F&E2 Introduction  Fluid, electrolyte, and acid-base balances within the body are necessary to maintain health and function of all body systems  These balances are maintained by the intake and output of water and electrolytes and regulation by the renal and pulmonary systems.

3. Otten, F&E3  Water is the largest single component of the body. 60% of the average adult’s weight is fluid. 1 kg=1L  A healthy mobile and well oriented adult can usually maintain normal fluid, electrolyte and acid/base balance.

4. Otten, F&E4 Distribution of body fluids  Compartments Intracellular (ICF)—all fluid within body cells. Extracellular (ECF)—all fluid outside a cell, divided into smaller compartments Interstitial fluid—between the cells and outside the blood vessels Intravascular fluid—blood plasma Transcellular—found in the spaces of the GI tract, cerebrospinal fluid and intraocular space

5. Otten, F&E5 Fluid Compartments in the Adult

6. Otten, F&E6 Body Water

7. Otten, F&E7 ECF check….  When a person loses water sweating, the ECF volume is decreased  A message is sent to the hypothalamus in the brain  Thirst center stimulated

8. 8 Composition of body fluids  Water  Electrolytes—minerals or salts Element or compound when melted or dissolved in water separates into ions and is able to carry an electrical current Vital to body function Value expressed as mEq/L-milli equivalents per liter, is the number of grams of the specific electrolyte dissolved in a liter of plasma

9. Otten, F&E9 Charge  Negatively charged electrolytes are Anions Chloride Bicarbonate Sulfate  Positively charged electrolytes are Cations Sodium Potassium Calcium

10. Otten, F&E10 Composition of body fluids  Minerals Act as a catalyst in nerve response, muscle contraction, and metabolism of nutrients in foods Regulate electrolyte balance and hormone production and strengthens skeletal structures

11. Otten, F&E11 Movement of body fluids  Fluids and electrolytes constantly shift from compartment to compartment to facilitate body processes—tissue oxygenation, acid-base balance, urine formation

12. Otten, F&E12 Osmosis  Osmosis—movement of a pure solvent thru a semipermeable membrane from an area of lesser solute concentration to an area of greater solute concentration  Osmotic pressure—drawing power for water and depends on number o molecules in solution Osmolarity—measure used to evaluate serum and urine in clinical practice

13. Otten, F&E13 Osmosis: Water molecules move from lower to higher concentrations Solutes (Electrolytes) H2OH2O H2OH2O H2OH2O H2OH2O H2OH2O Water Molecules

14. Otten, F&E14 Classification  Isotonic—same osmolarity as blood plasma Expands the body’s fluid volume without causing a fluid shift from one compartment to another 0.9% Sodium Chloride = Normal Saline

15. Otten, F&E15 Classification  Hypertonic—a solution of higher osmotic pressure; pulls fluid from the cell (shrink) 3% NS 5% NS D 5 NS

16. Otten, F&E16 Classification  Hypotonic—solution of lower osmotic pressure; moves fluid into the cells causing them to enlarge (swell) 0.45% NaCl 0.5% NaCl

17. Otten, F&E17 Diffusion  Process during which a solid in a fluid moves from an area of higher concentration to an area of lower concentration  Even distribution

18. Otten, F&E18 Regulation of body fluids  Regulated by fluid intake, hormonal controls, and fluid output  Homeostasis—physiological balance

19. Otten, F&E19 Fluid intake  Regulated primarily through the thirst mechanism  Thirst control is located in the hypothalamus  Thirst is the conscious desire for water

20. Otten, F&E20 Compensatory Mechanisms: Thirst

21. Otten, F&E21 Hormone Regulation  ADH—antidiuretic hormone Water is saved in the kidneys thru the pituitary gland’s secretion of ADH  Aldosterone Water reabsorption is also regulated by aldosterone produced by the adrenal cortex, which increases sodium and water reabsorption in the body and decreases sodium and water excretion in the urine

22. Otten, F&E22 Hormone Regulation  Renin Secreted by the kidney Responds to decreased renal perfusion secondary to decrease in ECF Angiotensin I  vasoconstriction Angiotensin II  massive selective vasoconstriction And stimulates release of aldosterone when Na + concentration is low

23. Otten, F&E23 Fluid Regulation  Kidneys 1200-1500  Skin 500-600  Lungs 400  GI 100-200

24. Otten, F&E24 Fluid Regulation  Kidneys Major regulatory organ of fluid balance Receive approximately 180L of plasma to filter each day and produce 1200-1500 ml of urine

25. Otten, F&E25 Fluid Regulation  Skin Regulated by the sympathetic nervous system, which activates sweat glands Water loss from skin can by sensible or insensible Insensible—continuous/not perceived Sensible—through excess perspiration

26. Otten, F&E26 Fluid Regulation  Lungs Change with rate and depth of respirations  GI Tract 3-6L of isotonic fluid is moved into GI tract and then returns again to the extracellular fluid Average loss is 100-200 ML of the 3-6L each day thru feces Diarrhea, GI tract may become a site of a large amount of fluid loss.

27. Otten, F&E27 At risk population  Infants, clients with neurological or psychological problems and some older adults who are unable to perceive or respond to the thirst mechanism are at risk for dehydration.

28. Otten, F&E28 Fluid & Electrolyte Homeostasis In Older Adults Older Adults  As percentage of body water decreases, less water is present in interstitial spaces thus at risk for F&E imbalances  Renal changes associated with aging include a 50% decrease in blood flow through kidneys (decreased cardiac output) thus causing decreased ability to concentrate urine and F&E imbalances  Note, too, that elderly clients are at risk for dehydration and F&E imbalances due to decreased oral intake of the same

29. Otten, F&E29 Fluid & Electrolyte Homeostasis In Adults Adults  Young and middle adults have very responsive regulatory mechanisms (aldosterone/ADH)  Least susceptible to F&E imbalances due to ability to evaluate own fluid needs  Pregnant women are one exception: Increased blood volume (30-50% near term) is associated with increased aldosterone section which causes Na + to be reabsorbed and water retention, increased cardiac output is usually able to keep swelling down (30% of preg. women experience swelling)

30. Otten, F&E30  Hypovolemia—loss of fluid (excess vomiting, hemorrhage)  Dehydration Skin turgor Dryness of lips or oral cavity Decreased daily intake of fluids Concentrated urine (elevated specific gravity)

31. Otten, F&E31 Hydration Assessment Hypovolemia  Postural hypotension  Weight change 2-5% loss  Tachycardia  Dry mucous membranes  Poor skin turgor  Burns, diarrhea, diabetes, vomiting, sweating, diuretics, laxatives

32. Otten, F&E32 Dehydration  Water loss results in tachycardia  Lowering of BP  Decreased cardiac output  Weakness  Confusion/disorientation/personality changes  Check labs Hemoconcentration of RBCs

33. Otten, F&E33 Hydration Assessment Hypervolumia  Excess water gain  Heart failure  Renal failure  High salt intake  Pancreatitis  Rapid weight gain, edema, HTN, polyuria, NVD

34. Otten, F&E34 Interventions for Fluid Overload  Restrict intake  Daily weight  I & O record—divide fluids  Oral care  Education what is considered intake Ice chips, gelatin, ice-cream

35. Otten, F&E35 Regulation of Electrolytes  Cations + charge Na Most abundant cation Maintain water balance thru efforts on serum osmolality, nerve impulse transmission, regulation of acid-base balance

36. Otten, F&E36 Regulation of Electrolytes  K+ Potassium Major electrolyte and principle cation in intracellular compartment Regulates metabolic activities Necessary for glycogen deposits in liver and skeletal muscles, nerve impulse transmission and conduction, normal cardiac conduction and skeletal and smooth muscle contraction Dietary intake/renal excretion Release with injury

37. Otten, F&E37  Calcium Stored in bones, plasma, and body cells (99% is located in bones) Necessary for bone and teeth formation, blood clotting, hormone secretion, cell membrane integrity, cardiac conduction, transmission of nerve impulses and muscle contraction

38. Otten, F&E38  Mg2+ Magnesium Essential for enzyme activities, neurochemical activities, and cardiac and skeletal muscle excitability Regulated by dietary intake, renal mechanisms, and actions of parathyroid hormone 50-60% in bone

39. Otten, F&E39 Anions  Chloride Regulated by dietary intake and kidneys  Bicarbonate Chemical buffer Essential for acid-base balance Regulated by kidneys

40. Otten, F&E40  Phosphate Buffer in ECF Acid-base With Ca= develop and maintain bones/teeth Neuromuscular action GI tract Diet, renal, intestinal

41. Otten, F&E41 Lab Values  Know the ranges and abbreviations  Sodium  Potassium  Calcium  Magnesium  Chloride  Bicarbonate  Phosphate

42. Otten, F&E42 Electrolyte Imbalance  Na Hyponatremia—neuro, tachy, hypo Hypernatremia—mucous membranes dry Flushed skin, thirst

43. Otten, F&E43  K Potassium Hypokalemia decreased muscle tone, ventricular dysarrhythmias and cardiac arrest Hyperkalemia cardiac arrest, QRS widens, heart block, bradycardia

44. Otten, F&E44  Mg Magnesium Hypomagnesemia—muscle tremors, hyperactive Deep Tendon Reflexes Hypermagnesemia—hypoactive DTR’s, low BP, decreased RR

45. Otten, F&E45  Ca Calcium Hypocalcemia—muscle cramps, numbness and tingling of fingers and tetany Hypercalcemia—anorexia, lethargy, decreased LOC

46. Otten, F&E46 Chovosteks  Contraction of facial muscles with facial nerve is tapped Tetany, muscle cramps and muscle tremors, dysrhythmias

47. Otten, F&E47 Trousseau  Carpopedal spasm with hypoxia  Seen with hypocalcemia or hypomagnesia Muscle tremors, dysrhythmias, etc

48. Otten, F&E48 Specific Gravity  Urine 1.010-1.025  Weight of a substance compared to the weight of an equal amount of water  H2O specific gravity is 1.0  Urine 95% water 5% solids

49. 49 Regulation of Acid-Base Balance Chemical: Carbonic acid and bicarbonate buffer system Biological: Occurs when hydrogen ions are absorbed or released by cells Physiological : Buffers are located in lungs and kidneys

50. 50 Disturbances in Electrolyte, Fluid, and Acid-Base Balances Electrolyte: Hyponatremia Hypernatremia Hypocalcemia Hypercalcemia Hypomagnesemia Hypermagnesemia Hypochloremia Hyperchloremia Fluid: Isotonic Osmolar Acid-Base: Respiratory acidosis Respiratory alkalosis Metabolic acidosis Metabolic alkalosis

51. 51 IV Therapy  Crystalloids  Vascular access devices  Types of solutions

52. 52 IV Therapy  Crystalloids  Vascular access devices  Types of solutions

53. 53 Blood Replacement Colloids  Plasma  RBCs  Platelets  Blood group types  Blood transfusions