FLUID AND

ELECTROLYTE
IMBALANCE,ACID-BASE
BALANCE
AXSA ALEX
1ST YEAR MSC NURSING
INTRODUCTION

 ELECTROLYTE IMBALANCE OR WATER ELECTROLYTE BALANCE,IS

AN ABNORMALITY IN THE CONCENTRATION OF ELECTROLYTES IN
THE BODY

 ELECTROLYTES PALY A VITAL ROLE IN MAINTAINING

HOMEOSTASIS WITHIN THE BODY.

 THEY HELP TO REGULATE HEART AND NEUROLOGICAL

FUNCTION ,FLUID BALANCE,OXYGEN DELIVERY,ACID BASE
BALANCE AND MUCH MORE.
HOMEOSTASIS

 ELECTROLYTES PALY A VITAL ROLE IN MAINTAINING HOMEOSTASIS

WITHIN THE BODY.

 HOMEOSTASIS IS THE ABILITY OF A SYSTEM OR LIVING ORGANIM TO

ADJUST ITS INTERNAL ENVIRONMENT TO MAINTAIN A STABLE
EQUILIBRIUM .

 ELECTROLYTES ARE IMPORTANT BECAUSE THEY ARE WHAT CELLS USE

TO MAINTAIN VOLTAGES ACROSS THEIR CELL MEMBRANES AND TO
CARRY ELECTRICAL IMPULSES ACROSS THEMSELVES AND TO OTHER
CELLS
WATER CONTENT OF THE BODY

 INTRACELLULAR FLUID-40% BODY WEIGHT

 EXTRACELLULAR FLUID-20% BODY WEIGHT

 INTERSTETIAL FLUID-15% BODY WEIGHT

 PLASMA-5% BODY WEIGHT

ELECTROLYTES

 A ELECTROLYTE IS A SUBSTANCE THAT PRODUCES AN

ELECTRICALLY CONDUCTING SOLUTION WHEN DISSOLVED INA
POLAR SOLVENT SUCH AS WATER.

 IONS- ANION

CATION

 CATIONS (POSITVE) - SODIUM,POTTASIUM,MAGNESIUM,HYDROGEN

IONS

 ANIONS (NEGATIVE)-CHLORIDE,BICARBONATE,PHOSPHATE SULFATE

MECHANISMS CONTROLLING
FLUID ELECTROLYTE MOVEMENT
 DIFFUSION

 FACILITATED DIFFUSION

 ACTIVE TRANSPORT

 OSMOSIS

 HYDROSTATIC PRESSURE

 ONCOTIC PRESSURE
REGULATION OF WATER BALANCE

 HYPOTHALAMIC REGULATION

 PITUITARY REGULATUION

 ADRENAL CORTICAL REGULATION

 RENAL REGULATION

 CARDIAC REGULATION

 GASTRO-INTESTINAL REGULATION
ROUTES OF GAINS AND LOSSES

 KIDNEY
 SKIN
 LUNGS
 GI TRACT
FLUID VOLUME DISTURBANCES

 HYPOVOLEMIA Fluid volume deficit

 HYPERVOLEMIA: Fluid volume excess
ELECROLYTE IMBALANCES

 THE MAIN ELECTROLYTE IMBALANCE ARE

 SODIUM DEFICIT: HYPONATREMIA
 EXCESS: HYPERNATREMIA
 POTASSIUM DEFICIT: HYPOKALEMIA
 EXCESS: HYPERKALEMIA
 CALCIUM DEFICIT : HYPOCALCEMIA
 EXCESS: HYPERCALCEMIA
HYPONATREMIA

 It results from loss of sodium containing fluids (or) hypo-

Osmolality with a shift of water into the cells
 CAUSES
 GI LOSS: diarrhoea, vomiting, Ng suction
 RENAL LOSS: Diuretics, adrenal insufficiency, a wasting renal
diseases
 SKIN LOSS: Burns, wound drainage
 MEDICAL MANAGEMENT
 Sodium replacement administration of sodium by mouth who eat
and drink.
 Lactated ringers solution (0.9% sodium chloride) is prescribed
 Serum sodium must not increase greater than 12meq/L in 24
hours to avoid neurological damages
HYPERNATREMIA

 Hyper natremia is a higher than normal sodium level exceeding

(145meq/L)
 CAUSES
 Gain of sodium in excess of water
 Inadequate water intake
 Increased serum sodium concentration
 MEDICAL MANAGEMENT
 Gradual lowering of the sodium level by the infusion of a
hypotonic electrolyte solution 0.3% sodium chloride
 Diuretics also may be prescribed to treat the sodium gain
HYPERKALEMIA

 It may be caused by a massive intake of potassium

 CAUSES:
 Excess potassium intake -excessive or rapid parenateral
administration -potassium containing drugs
 Shift of potassium out of cell -acidosis, crush injury, tissue
catabolism(fever)
 Failure to eliminate potassium -renal disease, adrenal
insufficiency, ACE inhibitors
 MEDICAL MANGEMENT
 Immediate ECG Should be obtained
 Serum potassium level from vein without IV fluid infusion
 Restriction of dietary potassium
 Potassium containing diuretic
 IV calcium gluconate administration in serum potassium level
are dangerously elevated
HYPOKALEMIA

 Hypokalemia can results from abnormal losses of potassium from

a shift of potassium from ECF to ICF or rarely from deficient
dietary potassium intake
 CAUSES
 Potassium loss
 Shifts of potassium into cells
 Lack of potassium intake
 MEDICAL MANAGEMENT
 t is treated with oral or IV replacement
 Administer 40 to 80 mEq/ day of potassium
 When oral administration of potassium is not feasible the IV
route is indicated
 For patient at risk for hypokalemia diet containing potassium
should be provided
HYPOCALCEMIA

 Any condition that causes a decreased in the production of PTH

may result in the development of hypocalcemia
 CAUSES
 Multiple blood transfusion
 Chronic renal failure
 Elevated phosphorous
 Chronic alcoholism
 Alkalosis
 CHVOSTEKS SIGN
 TROUSSEAUS SIGN
 MEDICAL MANGEMENT
 IV Administration of calcium like calcium gluconate calcium
chloride calcium gluceptate
 Vitamin D therapy be initiated to increase calcium absorption
from GI tract
 Increasing the dietary intake of calcium at least 1,000 to
1,500mg/day
HYPERCALCEMIA

 Hypercalcemia [excess of calcium in the plasma] is dangerous

imbalance when severe
 Hypercalcemia crisis has a mortality rate as high as 50% if not
treated properly
 CAUSES
 Multiple myeloma
 Prolonged immobilization
 Vit D over dose
 Thiazide diuretics [slight elevation]
 MEDICAL MANGEMENT
 Administer fluids to dilute serum calcium and promote its
excretion by the kidney
 IV administration of 0.9% sodium chloride solution temporarily
dilutes the serum calcium level
 Administering furosemide increases calcium excretion
 Calcitonin is administered to lower the serum calcium level
ACID BASE BALANCE

 The body normally maintains a steady balance between acid

produced during metabolism and bases that neutralize and
promote the excretion of the acid , many health problems lead to
acid base imbalance in addition to fluid and electrolyte imbalance
 Patient with diabetes mellitus, chronic obstructive pulmonary
disease and kidney disease frequently develop acid-base
imbalance
HYDROGEN ION COCENTRATION

 Acidity or alkalinity of a solution is determined by its

concentration of hydrogen ions (h+)
 The unit used to describe acid base is PH
 The PH scale ranges from 1-4. A neutral solution measures 7
 Normal blood plasma is slightly alkaline and has a normal ph
range of 7.35-7.45
ACIDOSIS
 It is the condition characterized by an excess of H ions or loss of
base ions/bicarbonate in ECF in which the PH falls bellow 7.35
ALKALOSIS
 It occurs when there is a lack of H ions or a gain of based and the PH
exceeds 7.45
ACID BASE REGULATION

 The body’s metabolic processes constantly produce acids.

 These acids must be neutralized and excreted to maintain acid
base balance
 Normally the body has three mechanisms by which it regulates
acid-base balance to maintain the arterial ph 7.35 and 7.45
 BUFFER SYSTEM
 THE RESPIRATORY SYSTEM
 THE RENAL SYSTEM
 The regulatory mechanisms react at different speeds.
 BUFFER reacts immediately
 THE RESPIRATORY SYSTEM responds in minutes and reaches
maximum effectiveness in hours
 THE RENAL RESPONSE takes 2-3 days to responds maximally
ALTERATION IN ACID-BASE
BALANCE
 The acid-base imbalance is produced when the ratio of 1:20
between acid and base content is altered
 A primary disease or process may alter one side of the ratio
 The compensatory process attempts to maintain the other side of
the ratio
 When compensatory mechanism fails, an acid –base imbalance
occurs
CLASSIFICATION

 Acid-base imbalances are classified as

 RESPIRATORY IMBALANCE- It affects carbonic acid concentration
 METABOLIC IMBALANCE- It affects the base bicarbonate
RESPIRATORY ACIDOSIS

 Respiratory acidosis is a clinical disorder in which the PH is less

than 7.35 and the PaCo2 is greater than 42mmHg. It may either
acute and chronic
 CAUSES
 Elevated plasma level
 Elevated carbonic acid
 Acute pulmonary edema
 Atelectasis
 Impaired respiratory muscles
CLINICAL MANIFESTATIONS

 Increased pulse
 Increased respiratory rate
 Increased blood pressure
 Mental cloudiness
 Cerebrovascular vasodilation
 Increased intra cranial pressure
 Papilledema
MANAGEMENT

 Treatment is directed by improving ventilation

 Pharmacologic agent
 bronchodilators
 anti biotic
 anti coagulants
 Pulmonary hygiene measures
 adequate hydration
 mechanical ventilation
RESPIRATORY ALKALOSIS

 Respiratory alkalosis is a clinical condition in which the arterial ph

is greater than 7.45 and the paco2 is less than 38mmhg
CAUSES

 Respiratory alkalosis is always due to hyperventilation

 Anxiety
 Hypoxemia
 Chronic hypocapnia
 Decreased serum bicarbonate levels
 Chronic hepatic insufficiency and
cerebral tumors
CLINICAL MANIFESTATIONS

 Light headedness due to

 vasoconstriction
 Decreased cerebral flow
 Numbness tinnitus,
 Loss of consciousness
 Tachycardia
 Ventricular and arterial dysrhythmias
MANAGEMENT

 Treatment depends on the underlying cause respiratory alkalosis

 Anxiety : patient is instructed to breath more slowly to allow co2
to accumulate
 Sedative may be required to relieve hyperventilation in very
anxious patients
METABOLIC ACIDOSIS

 Metabolic acidosis is a clinical disturbance characterized by a low

pH (increased hydrogen ions)and a low plasma bicarbonate
concentration
 It can be produced by a gain of hydrogen ions or a loss of
bicarbonate
 It can be divided clinically into two forms according to the values
of the serum anion gap
CLINICAL MANIFESTATIONS

 Headache
 Confusion
 Drowsiness
 Increased respiratory rate depth
 Nausea and vomiting
 Decreased blood pressure
 Cold and clammy skin
 Dysrhythmias
 shock
Diagnostic evaluation

 Arterial blood gas analysis

 Change includes a low bicarbonate level (less than 22 meq/l)
 Low ph (less than 7.35)
 Calculation of anion gap is helpful
 ECG will detect dysrhythmias caused by increased potassium
MANGEMENT

 Treatment is directed at correcting the metabolic defect

 If problem results from excessive intake of chloride, treatment is
aimed at eliminating the source of chloride
 Bicarbonate is administered if the ph is less than 7.1
 Serum potassium level is monitored closely and hypokalemia is
corrected as acidosis reversed
METABOLIC ALKALOSIS

 Metabolic alkalosis is a clinical disturbance characterized by a

high ph (decreased H⁺ ions concentration) and a high plasma
bicarbonate concentration. It can be produced by a gain of
bicarbonate or a loss of H⁺ ions
CAUSES

 Vomiting-WITH LOSS OF HYDROGEN AND CHLORIDE IONS

 gastric suction
 Pyloric stenosis
 Diuretic therapy that promotes excretion of
potassium
 Cystic fibrosis
 Chronic ingestion of milk and calcium
carbonate
CLINICAL MANIFESTATIONS

 Tingling of the fingers and toes

 Dizziness
 Symptoms of hypocalcemia is often the
 symptoms of alkalosis
 Ventricular disturbances (ph increase above7.6)
MEDICAL MANAGEMENT

 Sufficient chloride must be supplied for kidney to absorb sodium

with chloride
 Administering sodium chloride fluids
 Histamine-2 receptor antagonists, such as cimetidin (tagamet).
Reduces the gastric hcl, thereby decreasing the metabolic
alkalosis associated with gastric suction
 Input and output should be monitored
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