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    Fluids & Electrolytes

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    Anam
    Fluids & Electrolytes

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    Fluids & Electrolytes

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    Anam
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    Fluids & Electrolytes

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    Fluids & Electrolytes

    Copyright:

    © All Rights Reserved
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    83 views71 pages

    Fluids & Electrolytes

    Uploaded by

    Anam
    Fluids & Electrolytes

    Copyright:

    © All Rights Reserved
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    You are on page 1of 71

    FLUID &

    ELECTROLYTES
    Fundamnetal of
    nursing 2

    FUNGSI CAIRAN TUBUH


    Sarana untuk mengangkut zat-zat makanan
    ke sel-sel
    Mengeluarkan buangan-buangan sel
    Mmbantu dalam metabolisme sel
    Sebagai pelarut untuk elektrolit dan non
    elektrolit
    Membantu memelihara suhu tubuh
    Membantu pencernaan
    Mempemudah eliminasi
    Mengangkut zat-zat seperti (hormon, enzim,
    SDP, SDM)

    FLUIDS
    50-60% of the human body is water (decreases with
    age)
    Body fluids are classified according to their location
    with most of the bodys fluids found within the cell
    Intracellular
    Extracellular (mainly responsible for transport of nutrients
    and wastes)

    Fluid compartments are separated by selectively


    permeable membranes that control movement of water
    and solutes
    The process of homeostasis involves delivery of oxygen
    and nutrients to the cells and removal of waste

    Body Fluid Compartments


    2/3 (65%) of TBW is intracellular (ICF)
    1/3 extracellular water
    25 % interstitial fluid (ISF)
    5- 8 % in plasma (IVF intravascular fluid)
    1- 2 % in transcellular fluids CSF,
    intraocular fluids, serous membranes, and
    in GI, respiratory and urinary tracts
    (third space)
    7

    Fluid compartments are separated by


    membranes that are freely permeable to
    water.
    Movement of fluids due to:
    hydrostatic pressure
    osmotic pressure\
    Capillary filtration (hydrostatic) pressure
    Capillary colloid osmotic pressure
    Interstitial hydrostatic pressure
    Tissue colloid osmotic pressure
    9

    10

    Balance

    Fluid and electrolyte homeostasis is


    maintained in the body
    Neutral balance: input = output
    Positive balance: input > output
    Negative balance: input < output

    11

    12

    13

    Solutes dissolved particles


    Electrolytes charged particles
    Cations positively charged ions
    Na+, K+ , Ca++, H+
    Anions negatively charged ions
    Cl-, HCO3- , PO43-

    Non-electrolytes - Uncharged
    Proteins, urea, glucose, O2, CO2
    14

    Body fluids are:


    Electrically neutral
    Osmotically maintained
    Specific number of particles per
    volume of fluid

    15

    Homeostasis maintained by:


    Ion transport
    Water movement
    Kidney function

    16

    MW (Molecular Weight) = sum of the


    weights of atoms in a molecule
    mEq (milliequivalents) = MW (in mg)/
    valence
    mOsm (milliosmoles) = number of particles
    in a
    solution

    17

    Tonicity
    Isotonic
    Hypertonic
    Hypotonic

    18

    19

    Cell in a
    hypertonic
    solution

    20

    Cell in a
    hypotonic
    solution

    21

    Movement of body fluids


    Where sodium goes, water follows.
    Diffusion movement of particles down a
    concentration gradient.
    Osmosis diffusion of water across a
    selectively permeable membrane
    Active transport movement of particles up
    a concentration gradient ; requires energy
    22

    ICF to ECF osmolality changes in ICF not


    rapid

    IVF ISF IVF happens constantly due


    to changes in fluid pressures and osmotic
    forces at the arterial and venous ends of
    capillaries

    25

    26

    Regulation of body water


    ADH antidiuretic hormone + thirst
    Decreased amount of water in body
    Increased amount of Na+ in the body
    Increased blood osmolality
    Decreased circulating blood volume

    Stimulate osmoreceptors in hypothalamus


    ADH released from posterior pituitary
    Increased thirst
    27

    28

    Regulation of Fluid Volume


    Kidneys
    Capillary pressure forces fluid through the
    walls and into the tubule
    At this point H2O or electrolytes are then
    either retained or excreted
    The urine becomes more dilute or more
    concentrated based on the needs of the body

    Regulation of Fluid Volume, cont.


    Antidiuretic hormone (ADH)
    Produced by the hypothalamus
    Stored in the pituitary gland
    Restores blood volume by increasing or decreasing
    excretion of water
    Increased osmolality or decreased blood volume
    stimulates the release of ADH
    Then the kidneys reabsorb water
    Also may be released by stress, pain, surgery, and
    some meds

    Regulation of Fluid Volume, cont.


    Renin-angiotensin-aldosterone system
    Renin secreted in kidney
    Amount of renin produced depends on blood flow
    and amount of Na in the blood

    Produces angiotensin II (vasoconstrictor)


    Angiotensin causes peripheral vasoconstriction
    Angiotensin II stimulates the production of
    aldosterone

    Regulation of Fluid Volume, cont.


    Aldosterone
    Secreted by the adrenal gland response to
    angiotensin II
    The adrenal gland may also be stimulated by the
    amount of Na and K + in the blood
    Causes the kidneys to retain Na and H2O
    Leads to increases in fluid volume and Na levels
    Decreases the reabsorption of K+
    Maintains B/P and fluid balance

    Regulation of Fluid Volume, cont


    Atrial natriuretic peptide or factor (ANP) (ANF)
    Cardiac hormone
    Released in response to increased pressure in the
    atria (increased blood volume)
    Opposes the renin-angiotensin-aldosterone system
    Stimulates excretion of Na and H2O
    Suppresses renin level
    Decreases the release of aldosterone
    Decreases ADH release
    Reduces vascular resistance by causing vasodilation

    REGULATION OF FLUID
    VOLUME

    Result:
    increased water consumption
    increased water conservation
    Increased water in body, increased
    volume and decreased Na+ concentration

    35

    Dysfunction or trauma can cause:


    Decreased amount of water in body
    Increased amount of Na+ in the body
    Increased blood osmolality
    Decreased circulating blood volume

    36

    Edema is the accumulation of fluid within the


    interstitial spaces.
    Causes:
    increased hydrostatic pressure
    lowered plasma osmotic pressure
    increased capillary membrane
    permeability lymphatic channel obstruction

    37

    Hydrostatic pressure increases due to:


    Venous obstruction:
    thrombophlebitis (inflammation of veins)
    hepatic obstruction
    tight clothing on extremities
    prolonged standing
    Salt or water retention
    congestive heart failure
    renal failure
    38

    Decreased plasma osmotic pressure:


    plasma albumin (liver disease or
    protein malnutrition)
    plasma proteins lost in :
    glomerular diseases of kidney
    hemorrhage, burns, open wounds
    and cirrhosis of liver

    39

    Increased capillary permeability:


    Inflammation
    immune responses

    Lymphatic channels blocked:


    surgical removal
    infection involving lymphatics
    lymphedema
    40

    Volume Abnormalities
    Edema
    the accumulation of fluid within the interstitial
    space
    Causes:
    increased hydrostatic pressure
    venous obstruction, lymphedema, CHF, renal failure
    lowered plasma osmotic pressure (protein loss)
    liver failure, malnutrition, burns
    increased capillary membrane permeability
    Inflammation, SIRS, sepsis

    41

    Volume Abnormalities
    Edema
    the accumulation of fluid within the interstitial space
    Results in:

    increased distance for diffusion


    impaired blood flow
    slower healing
    increased risk of infection
    pressure sores over bony prominences
    impaired organ function (brain, liver, gut, kidney)
    42

    Edema of specific organs can be life


    threatening (larynx, brain, lung)

    Water is trapped, unavailable for metabolic


    processes. Can result in dehydration and shock.
    (severe burns)

    43

    Electrolytes

    44

    Electrolyte balance
    Na + (Sodium)
    90 % of total ECF cations
    136 -145 mEq / L
    Pairs with Cl- , HCO3- to neutralize charge
    Low in ICF
    Most important ion in regulating water
    balance
    Important in nerve and muscle function
    45

    Regulation of Sodium
    Renal tubule reabsorption affected by
    hormones:
    Aldosterone
    Renin/angiotensin
    Atrial Natriuretic Peptide (ANP)

    46

    Potassium
    Major intracellular cation
    ICF conc. = 150- 160 mEq/ L
    Resting membrane potential
    Regulates fluid, ion balance inside cell
    pH balance

    47

    Regulation of Potassium
    Through kidney
    Aldosterone
    Insulin

    48

    Isotonic alterations in water


    balance
    Occur when TBW changes are
    accompanied by = changes in electrolytes
    Loses plasma or ECF
    Isotonic fluid loss
    ECF volume, weight loss, dry skin and
    mucous membranes, urine output, and
    hypovolemia ( rapid heart rate, flattened
    neck veins, and normal or B.P. shock)
    49

    Isotonic fluid excess


    Excess IV fluids
    Hypersecretion of aldosterone
    Effect of drugs cortisone
    Get hypervolemia weight gain, decreased
    hematocrit, diluted plasma proteins, distended
    neck veins, B.P.
    Can lead to edema ( capillary hydrostatic
    pressure) pulmonary edema and heart failure

    50

    Electrolyte imbalances: Sodium


    Hypernatremia (high levels of
    sodium)
    Plasma Na+ > 145 mEq / L
    Due to Na + or water
    Water moves from ICF ECF
    Cells dehydrate
    51

    52

    Hypernatremia Due to:


    Hypertonic IV soln.
    Oversecretion of aldosterone
    Loss of pure water
    Long term sweating with chronic
    fever
    Respiratory infection water vapor
    loss
    Diabetes polyuria
    Insufficient intake of water (hypodipsia)
    53

    Clinical manifestations
    of Hypernatremia
    Thirst
    Lethargy
    Neurological dysfunction due to
    dehydration of brain cells
    Decreased vascular volume

    54

    Treatment of Hypernatremia
    Lower serum Na+
    Isotonic salt-free IV fluid
    Oral solutions preferable

    55

    Hyponatremia
    Overall decrease in Na+ in ECF
    Two types: depletional and dilutional
    Depletional Hyponatremia
    Na+ loss:
    diuretics, chronic vomiting
    Chronic diarrhea
    Decreased aldosterone
    Decreased Na+ intake

    56

    Dilutional Hyponatremia:
    Renal dysfunction with intake of hypotonic
    fluids
    Excessive sweating increased thirst
    intake of excessive amounts of pure water
    Syndrome of Inappropriate ADH (SIADH) or
    oliguric renal failure, severe congestive heart
    failure, cirrhosis all lead to:
    Impaired renal excretion of water

    Hyperglycemia attracts water

    57

    Clinical manifestations of
    Hyponatremia
    Neurological symptoms
    Lethargy, headache, confusion, apprehension,
    depressed reflexes, seizures and coma

    Muscle symptoms
    Cramps, weakness, fatigue

    Gastrointestinal symptoms
    Nausea, vomiting, abdominal cramps, and
    diarrhea

    Tx limit water intake or discontinue meds


    58

    Hypokalemia
    Serum K+ < 3.5 mEq /L
    Beware if diabetic
    Insulin gets K+ into cell
    Ketoacidosis H+ replaces K+, which
    is lost in urine

    adrenergic drugs or epinephrine


    59

    Causes of Hypokalemia
    Decreased intake of K+
    Increased K+ loss
    Chronic diuretics
    Acid/base imbalance
    Trauma and stress
    Increased aldosterone
    Redistribution between ICF and ECF
    60

    Clinical manifestations of Hypokalemia


    Neuromuscular disorders
    Weakness, flaccid paralysis, respiratory
    arrest, constipation
    Dysrhythmias, appearance of U wave
    Postural hypotension
    Cardiac arrest
    Others table 6-5
    TreatmentIncrease K+ intake, but slowly, preferably by foods
    61

    Hyperkalemia
    Serum K+ > 5.5 mEq / L
    Check for renal disease
    Massive cellular trauma
    Insulin deficiency
    Addisons disease
    Potassium sparing diuretics
    Decreased blood pH
    Exercise causes K+ to move out of cells
    62

    Clinical manifestations of
    Hyperkalemia
    Early hyperactive muscles , paresthesia
    Late - Muscle weakness, flaccid paralysis
    Change in ECG pattern
    Dysrhythmias
    Bradycardia , heart block, cardiac arrest

    63

    Treatment of Hyperkalemia
    If time, decrease intake and increase
    renal excretion
    Insulin + glucose
    Bicarbonate
    Ca++ counters effect on heart

    64

    Calcium Imbalances
    Most in ECF
    Regulated by:
    Parathyroid hormone
    Blood Ca++ by stimulating osteoclasts
    GI absorption and renal retention
    Calcitonin from the thyroid gland
    Promotes bone formation
    renal excretion
    65

    Hypercalcemia
    Results from:
    Hyperparathyroidism
    Hypothyroid states
    Renal disease
    Excessive intake of vitamin D
    Milk-alkali syndrome
    Certain drugs
    Malignant tumors hypercalcemia of malignancy
    Tumor products promote bone breakdown
    Tumor growth in bone causing Ca++ release
    66

    Hypercalcemia
    Usually also see hypophosphatemia
    Effects:
    Many nonspecific fatigue, weakness, lethargy
    Increases formation of kidney stones and
    pancreatic stones
    Muscle cramps
    Bradycardia, cardiac arrest
    Pain
    GI activity also common
    Nausea, abdominal cramps
    Diarrhea / constipation

    Metastatic calcification

    67

    Hypocalcemia
    Hyperactive neuromuscular reflexes and
    tetany differentiate it from hypercalcemia
    Convulsions in severe cases
    Caused by:
    Renal failure
    Lack of vitamin D
    Suppression of parathyroid function
    Hypersecretion of calcitonin
    Malabsorption states
    Abnormal intestinal acidity and acid/ base bal.
    Widespread infection or peritoneal inflammation
    68

    Hypocalcemia
    Diagnosis:
    Chvosteks sign
    Trousseaus sign

    Treatment
    IV calcium for acute
    Oral calcium and vitamin D for chronic

    69

    Hypochloremia
    Most commonly from gastric losses
    Emesis, gastric suctioning, EC fistula

    Often presents as a contraction alkalosis


    with paradoxical aciduria (Na+ retained
    and H+ wasted in the kidney)
    Rx: resuscitation with normal saline

    Hyperchloremia
    Most commonly from over-resuscitation
    with normal saline
    Often presents as a hyperchloremic
    acidemia with paradoxical alkaluria (H+
    retained and Na+ wasted in the kidney)
    Rx: stop normal saline and replace with
    hypotonic crystalloid

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