Fluid and Electrolyte

Fluid and Electrolyte
Balance
Fluid, electrolyte, and acid-base balances within the
body are necessary to maintain health and
function in all body systems
Intake and output of water and electrolytes,

distribution in the body, and regulation of renal
and pulmonary function contribute to homeostasis
Water is the most abundant substance in the body

Homeostasis
Body works best when vital signs, functions, and

chemical balances are kept within range
Homeostasis – keeping conditions as close to
normal as possible to prevent dangerous changes
Homeostasis is concerned with maintaining
normal fluid volume and concentration
Fluid – A&P Review
Solvent – water portion of fluids
Solutes – particles dissolved or suspended in
fluid
Three processes essential to control fluid
and electrolyte balance:
 Filtration
 Diffusion
 Osmosis
Osmolarity
Solutions are classified as:
 Isotonic – have same osmolarity as
blood e.g. 0.9% sodium chloride, NS
 Hypertonic – osmolarity greater than
blood e.g. 3% sodium chloride; will
pull fluid from cells causing them to
shrink
 Hypotonic – osmolarity less than
blood e.g. 0.45% sodium chloride;
moves fluid into cells causing them
to enlarge
Regulation of Body Fluid
Fluid regulation and distribution affected
by:
 Age, gender and amount of body fat
 Thirst drive
Fluid intake
 1500ml water/day
Fluid loss
 Urine – obligatory output
 Insensible loss – diarrhea, vomiting, burns
Composition of Body Fluids
Electrolyte:
 An element or compound that, when
dissolved or dissociated in water or solvent,
separates into ions
Ions:
 Cations: positively charged
 Anions: negatively charged
Ions and Fluid Balance
CATIONS: ANIONS:
Sodium (Na+) Chloride (Cl-)
Potassium (K+) Bicarbonate (HCO-)
Calcium (Ca+) Phosphate (PO4-)
Magnesium (Mg+)
ELECTROLYTES
Extracellular:
Intracellular:
Sodium
Potassium
Calcium
Magnesium
Chloride
Phosphate
Hydrogen
Protein
Bicarbonate
Sodium – Na+
Maintains blood volume
Controls H2O shifting between
compartments by osmotic pressure
Major cation in Na-K pump
Interacts with Calcium to maintain muscle
contractions
Potassium – K+
Major cation in Na-K pump
Nerve impulses conduction
Controls heart rate, rhythm
Assists in conversion of CHO to
energy
Promotes glycogen storage in
the liver
Calcium – Ca2+
Promotes strong bones and teeth

Promotes blood coagulation
Promotes nerve impulse conduction
Increases calcium reabsorption from bone
and GI tract
Magnesium – Mg2+
Promotes metabolism of CHO, fats and
protein
Activates 300 enzyme reactions
Promotes regulation Ca, PO4, K, CHO,
protein
Powers Na-K pump
Chloride – Cl-
Regulates extracellular fluid volume

Promotes acid-base balance
Promotes protein digestion
Maintains nerve transmission, muscle
contraction, relaxation
Phosphate – HPO4-
Promotes bone and teeth rigidity

Promotes acid-base balance
Necessary for ATP production
Parathyroid hormone regulations phosphate
absorption and reabsorption
Laboratory Values
Remember “35-45:
 Na 135-145
 K 3.5-5.0
 Phos 3.0-4.5
 Mg 1.5-2.2 (1/2 of K+)
“9s”
 O2 sat 90-100
 Ca 9.0-10.5
 Cl 98-105
Factors Affecting Fluid Balance
Lifestyle factors
 Nutrition
 Exercise
 Stress
Environmental factors
 Infants and children – high growth rate; increased
body surface area
 Adolescents and middle age – increased hormonal
activity; exercise related activities
 Older adults – chronic illness and decreased thirst
mechanism
Factors Affecting Fluid Balance
Physiological factors
 Acute illness including trauma
 Chronic illness – cardiac,
respiratory, GI, renal, endocrine
 Surgery
 Chemotherapy/cancer
 Medications – IV therapy,
diuretics, glucocorticoids
Fluid Imbalances
Dehydration (hypovolemia) – most common fluid

imbalance
 Intake less than needed to meet body’s fluid needs
 Isotonic dehydration – water and electrolyte loss
*Diarrhea loses both
 Results in inadequate perfusion
 Older patients at risk
Decrease thirst sensation
Less total body water
Fluid Overload
Hypervolemia; water intoxication
 Excess of body fluid
Leads to edema
Best indicator of fluid status - *daily weight
 Most fluid overload problems related to fluid volume
excess in the vascular space
 Can lead to heart failure
Pulmonary edema
*Common symptom hypertension
Characteristics of Fluid Excess
Sudden weight gain – check weight daily
Edema, pitting edema
Pulmonary – crackles, dyspnea, SOB, increased
RR
Cardio - *hypertension, tachycardia, bounding
pulse
Renal – increased output unless kidney cannot
compensate then decreased output
GI – anorexia, N&V
Sodium Imbalances
Hyponatremia
Most common cause – prolonged
use/overuse of diuretics, especially when
also on a low salt diet
Burn patients
Affects:
 *Cerebral function (neurological)
 Neuromuscular function
 Intestinal function
 Cardiovascular – rapid, weak thready pulse
Sodium Imbalances
Hypernatremia
Common causes – renal failure, diabetes,
Cushing's syndrome, excessive IV fluids
Affects:
 Nervous system
 Skeletal muscle
 Cardiovascular
 Respiratory – pulmonary edema, pleural effusion
Potassium Imbalances
Kidneys regulate K+ balance
K+ major cation of intracellular fluid
Any changes seriously affects physiological
activities
K+ also regulates glucose use and storage
Almost all foods contain K+ - bananas,
strawberries, cantaloupe, mango are foods high
in potassium
Hypokalemia
Can be life-threatening
Cardiac –
 EKG changes – flattened T wave and ST segment
 Fatal arrhythmias
Respiratory – apnea, respiratory arrest
Older adults more vulnerable
 Decrease in renal urine concentration
 More likely to use drugs that lead to K+ loss e.g.
diuretics, cardiac drugs and laxatives
Hyperkalemia (cont.)
Usually occurs in hospitalized patients
Heart sensitive to K+ increases – most serious
complication is altered cardiac function – EKG
changes, bradycardia, hypotenstion
Neuromuscular – paresthesia
Intestinal changes – increased motility
Administration of Kayexalate enemas
Calcium Imbalances
Hypocalcemia
Common causes:
 Chronic illness – renal or kidney disease
 Malabsorption – Celiac or Chron’s disease
 Lactose intolerance
 Acute pancreatitis
 Removal of parathyroid glands
Calcium Imbalances
Hypercalcemia
Causes increased clotting times – PE, VTE
Cardiovascular – poor tissue perfusion
Severe muscle weakness
Dialysis utilized when severe hypercalcemia
causes life-threatening cardiac problems
Phosphorus Imbalances
Hypophosphatemia
Part of ATP & ADP to maintain energy for all cell
functions
Seen in malnutrition/starvation
Alcohol abuse
Respiratory alkalosis
Diabetes
May progress to rhabdomyolysis – acute muscle
breakdown
Phosphorus Imbalances
Hyperphosphatemia
Usually associated with hypocalcemia
Contributing factors:
 Malignancy
 Hypoparathyroidism
 Renal insufficiency
 Removal of parathyroids
Magnesium Imbalances
Hypomagnesemia
Usually associated with calcium and
potassium imbalances
Clinical manifestation – neuromuscular, CNS,
intestinal
Hypermagnesemia
Associated with Addison’s disease, prolonged
use of antacids or diuretics, renal
insufficiency
Treatment aimed at correcting underlying
problem
Nutrition and Electrolytes
High K+ foods affect heart conductivity
Foods with high water content affect fluid
balance
Foods high in Na+ include ham, beef,
cheese, salad dressings, mayonnaise

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Intake and output of water and electrolytes,

Water is the most abundant substance in the body

Body works best when vital signs, functions, and

Sodium (Na+) Chloride (Cl-)

Potassium (K+) Bicarbonate (HCO-)

Calcium (Ca+) Phosphate (PO4-)

Promotes strong bones and teeth

Regulates extracellular fluid volume

Promotes bone and teeth rigidity

Dehydration (hypovolemia) – most common fluid

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