MEDICAL-SURGICAL

NURSING 1
by: Ms. Jenneth E. Dela
Cerna, R.N.

FLUIDS &
ELECTROLYTES

BODY FLUIDS
FUNCTIONS:
1. Facilitate the transport of nutrients, hormones,
proteins, and other molecules into cells
2. Aid in the removal of cellular metabolic waste
products
3. Regulates body temperature
4. Provide lubrication of musculoskeletal joints
5. Act as a component in all body cavities
( eg. Pericardial fluid, pleural, spinal & peritoneal
fluid )

FACTORS: AMOUNT OF
BODY FLUID
1. Age
2. Gender
3. Body fat

Compartments of Body Fluids

1.1 Intracellular Fluid ( ICF )

All fluids inside the cell ( 60 %)

It is essential for fluid and electrolyte balance and
metabolism.

1.2 Extracellular Fluid ( ECF )

All fluids outside the cell

It carries nutrients to and waste products from the

cell.
a.
b.
c.

Interstitial Fluid
(25%)
Intravascular Fluid (10%)
Transcellular Fluid (5%)

Third Space Fluid Shift

Is the accumulation & sequestration of

trapped extracellular fluid in an actual or
potential body space as a result of disease
or injury.
Clinical Manifestations:
1. urine output (early sign)
2. heart rate
3. body weight
4. Edema
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Third Space Fluid Shift

Etiology:
1. Liver cirrhosis
2. Burns
3. Peritonitis
4. Bowel Obstruction

RISK FACTORS AFFECTING FLUID-ELECTROLYTE, ACID-BASE

BALANCE

1. Age
2. Acute Illness
a. Surgery
b. Burns
c. Respiratory Disorders
d. Head Injury
3. Chronic Illness
a. Cardiovascular Diseases
b. Renal Disorders
c. GIT Disturbances
4. Environment
5. Lifestyle
6. Medications
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REGULATION OF BODY FLUID COMPARTMENT

PASSIVE TRANSPORT
no energy is expended to
move the substances.
a. Diffusion
is a natural tendency of a
substance to move from an
area of higher
concentration to an area of
lower concentration.

b. Osmosis
shifting of fluid from an area of low
solute concentration to an area of high
solute concentration.

before

after
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c. Filtration

is the movement of
both water & smaller
molecules through a
semipermeable
membrane.
is promoted by
hydrostatic pressure
differences
between areas.

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ACTIVE TRANSPORT
depends on the presence of
adequate cellular ATPadenosine triphosphate for
energy.

ex. Na-K pump (located in

the cell membranes, cause Na
to move out of the cells & K
to move into the cells when
needed)

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Forces Involved in Movement of Fluid Between

Capillaries and Interstitial Spaces:
a. Hydrostatic pressure

pressure created by the weight of

fluid against the wall that contains
it.
Physical force on vessel pushing
fluid out to the interstitial space.
b. Osmotic Pressure
is the ability of a solution to draw
water across a semipermeable
membrane to affect the
concentration.
a concentrated solution has a high
osmotic pressure.

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c. Oncotic pressure

is a special type of
osmotic pressure that is
exerted by the proteins.
it pulls the fluid out of
the interstitial space
into the intravascular
space to maintain fluid
balance.

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ELECTROLYTES

are chemicals that conduct electricity

when dissolved in water. (mEq/L)
cations
* Na, K, Ca, Mg, Hydrogen
ions
anions
* chloride, bicarbonate,
phosphate, sulfate
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Major electrolytes in ECF:

Na+ and Cl Sodium level is the primary determinant of ECF

concentration.
Major electrolytes in ICF

K+ and PO4 98% K+ of the body is inside the cells, 2%

is in the ECF.

NON ELECTROLYTES
- do not conduct electricity
- ex. Glucose, protein & urea

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Serum electrolytes values:

Potassium
Sodium
Magnesium
Chloride
108meq/L
Calcium
mg/dL
PO4

= 3.5-5 meq/L
= 135-145meq/L
= 1.3- 2.1 meq/L
= 95= 8.5-10.5
= 1.7-2.6 meq/L

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ROUTES OF LOSSES:
1. Kidney
- usual urine volume: 1-2L/day
2. Skin
- sensible losses through perspiration & fever
3. Lungs
- normally eliminate water vapor at a rate of
300-400 ml every day through respiration
4. GI tract
- usual loss: 100-200 ml/day

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LABORATORY TESTS FOR EVALUATING FLUID

STATUS:

1.

Osmolality (mOsm/kg)
measures the solute concentration per
kilogram in blood & urine.
serum osmolality reflects the concentration
of sodium & its anions
Normal serum osmolality: 280-300 mOsm/kg
Normal urine osmolality: 50-1,400 mOsm/kg

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2. Urine specific gravity

measure the kidneys ability to excrete or
conserve water.
normal: 1.01-1.025
varies inversely with urine volume
thus, the larger the volume of urine, the
lower the specific gravity.
3. Blood Urea Nitrogen (BUN)
is made up of urea
Normal: 10 to 20 mg/dL (3.5 to 7 mmol/L)
level varies with urine output
Increased: dehydration, increased protein

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4. Serum creatinine
end product of muscle metabolism
better indicator of renal function
than BUN
normal serum creatinine: 0.7-1.5 mg/dL
(60-130 mmol/L)
5. Hematocrit
measures the volume percentage of
RBC (erythrocytes) in whole blood.
males: 44%-52%

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6. Urine sodium
used to assess the fluid volume status
values changes depending on the
sodium intake & status of fluid
volume.
when sodium intake increases,
excretion increases;
when circulating fluid volume
decreases, sodium is conserved.
Normal: 50-220 mEq/24 hours

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HOMEOSTATIC MECHANISMS:
1.

KIDNEY FUNCTION

major regulator of fluid & electrolyte balance.

it normally filters 170L of plasma everyday; excretes 1.5 L
of urine
also contribute to the regulation of electrolyte level.
regulation of acid-base balance
also affect the calcium balance

2. HEART & BLOOD VESSEL FUNCTION

the pumping action of the heart propels blood through the
vascular system then to the kidneys under sufficient
pressure to allow for urine formation.
anything that diminishes the cardiac output, reduces GFR
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3. LUNG FUNCTION
the lungs remove approximately 300ml
of
water daily.
it also play a role in acid-base balance
by regulating the excretion of carbon
dioxide.

4. PITUITARY FUNCTION
ADH (Vasopressin)
water-conserving hormone
it maintains osmotic pressure of the

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5. ADRENAL FUNCTION
Aldosterone
opposite effect on Na-K excretion &
retention
Increased secretion = Na retention
(water retention) & potassium loss
decreased secretion = Na loss &
retention of K
Cortisol
causes Na & fluid retention &

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6.

PARATHYROID FUNCTIONS
PTG embedded in the thyroid gland
- regulates the calcium & phosphate balance by means of
PTH
- Ca & PO4 are inversely proportional

7.

OTHER MECHANISMS:

a.

Baroreceptors
are small nerve receptors located in the arch of the aorta
detect changes in pressure generated in the arteries by
the pumping action of the heart & send this info to CNS.
Decreased BP
few signals will be sent to the control
centers of the brain (decreased impulses)
stimulates
the activation of SNS & inhibits the PNS
BP &
HR.

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b. RAAS
Factors that reduce the BP stimulate both the SNS &
RAAS response to increase the blood volume & the BP.
When excess blood volume is present, both the SNS &
the RAAS are inhibited to reduce blood volume & BP.
c. Release of Atrial Natriuretic Peptide (ANP)
is released by the cardiac atria in response to increased
atrial pressure.
direct opposite of RAAS & decreases blood pressure &
volume.

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ATRIAL NATRIURETIC PEPTIDE

Blood volume
Blood pressure
Stretch of atria
ANP release from cardiac cells in atria
Vascular resistance by
filtration
causing vasodilation

ADH release by PPG

Glomerular
rate w/c urinary
excretion of Na

Blood pressure
Suppression of renin
Inhibits action angiotensin
aldosterone

Vascular volume
Blood pressure
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