FLUIDS

AND
ELECTROLYTES
Adopted/Revised Slides

Theresa Linda C. Narreto RN.,MSN

Central Mindanao University
College of Nursing
S.Y. 2017- 2018
 Water Content of the Body
60% to 70% of body weight in adult
45% to 55% in older adult
70% to 80% in infants

Varies with age, gender, body mass (weight),

Water comprises
about
60% -70% of the
total body
weight
Normal Composition in Average Man

When a person loses more than 10% of his

total body fluids,he can DIE!!!
Functions of Water in the Body
Transporting nutrients to cells and
wastes from cells
Transporting hormones, enzymes, blood
platelets, and red and white blood cells
Facilitating cellular metabolism and proper
cellular chemical functioning
Facilitating digestion and promoting elimination
Acting as a solvent for electrolytes and
non-electrolytes
Acting as a tissue lubricant and cushion
Helping maintain normal body temperature
 THE CELL
- The smallest autonomous
functional unit of the body

THE CELL MEMBRANE

- Semi permeability: allowing for the
exchange of materials through the
membrane, in order to:
to obtain energy,
synthesize complex molecules,
participate in electrical events
replicate
 The Cell Membrane COMPOSITION:

1. Phospolipids lipid composition that

determines the cell membranes degree of
fluidity.
- Hydrophilic end and Hydrophobic end

2. Proteins transport lipid-soluble particles

3. Cell coat long chain of complex

carbohydrates contains antigen that label the
cell as of self/nonself (ABO blood group antigens
in RBC)
Body Fluid Distribution
Fluid Compartments of the Body
 Two Compartments of Fluid in the Body

Intracellular fluid (ICF) (70%)

fluid within cells
- large amounts of K+, PO4--, Mg++
Extracellular fluid (ECF) (30%)
fluid outside cells
- large amounts of Na+, Ca+, Cl-, HCO3--
- Includes intravascular(15%) and
interstitial fluids(5%)
Interstitial Component
Fluid between cells
Surrounds cells
Transport medium for nutrients, gases,
waste products and other substances
between blood and body cells
Also acts as a back up fluid reservoir
Extracellular Fluid (ECF)
One third of body fluid
3 major components
1) Interstitial fluid
2) Intravascular
3) Transcellular fluid
over or across the cells
Homeostasis
Stateof equilibrium in body
Naturally maintained by adaptive
responses
Body fluids and electrolytes are
maintained within narrow limits
FLUID BALANCE
 Water Loss

ROUTES OF WATER LOSS

-SENSIBLE -INSENSIBLE
Urine Lungs
Feces Sweat
 Causes of Increased Causes of Increased
Water Loss Water Gain

Fever Increased sodium intake

Diarrhea Increased sodium retention
Diaphoresis Excessive intake of water
Vomiting Excess secretion of ADH
Gastric suctioning
Tachypnea
 Regulation of Body Fluid Compartments
Tonicity is the ability of solutes to cause osmotic
driving forces
Hydro static pressure - the pressure created by the
weight of fluid against the wall that contains it. In
the body, hydrostatic pressure in blood vessels
results from the weight of fluid itself and the force
resulting from cardiac contraction.
Osmolality reflects the concentration of fluid that
affects the movement of water between fluid
compartments by osmosis
Normal Value: 280-295 mOsm/Kg
Osmotic pressure amount of dissolved substances
 Factors Affecting Distribution
Filtration

Hydrostatic
Pressure

Osmotic
Pressure
 Movement of Fluids
Passive Transport
Osmosis
Diffusion
Active transport
Primary and Secondary
Sodium- Potassium Pump
Filtration
 Regulation of Body Fluid Compartments

Osmosis
is the movement of water from an area of
lower solute concentration to an area of higher
solute concentration.
Semi-permeable membrane
membrane must be more permeable to
water
a greater concentration of solutes on one
side of the membrane
Osmosis
Diffusion
Movement of solutes from an area of
higher concentration to an area of
lower concentration in a solution and or
across a permeable membrane

Thismovement occurs until near equal

state
Diffusion
Regulation of Body Fluid Compartments
Active Transport
movement of a substance across the cell membrane from
an area of lower concentration to an area of higher
concentration.
ATP is expended.
The sodium-potassium pump is an example of active
transport.
Active Transport
Filtration
- is the movement of water and solutes
from an area of high hydrostatic
pressure to an area of low hydrostatic
pressure

- Water pushing against the

confining walls of a space
Filtration
Osmosis VS. Diffusion
Osmosis

Lowto high
Water potential

Diffusion
High
to low
Movement of particles
 Hypertonic

Isotonic

Hypotonic
 Types of IV Solutions
ISOTONIC
-solution has the same osmolality as the extracellular fluid.
Examples: D5W ; Normal Saline
Hypertonic solutions have a higher concentration of
solute and are more concentrated than extracellular
fluids. Net movement intracellular to extracellular
Examples : 3% saline; 5% saline
Hypotonic solutions have a lower concentration of
solutes and is more dilute than extracellular fluid .Net
movement extracellular to intracellular
Examples : 1/2 Normal Saline; 1/3 Normal Saline
 Regulating Body Fluids
Fluid intake Maintaining homeostasis
Thirst Kidneys
Fluid output ADH
Urine Renin-angiotensin-
Insensible loss aldosterone system
Feces Atrial natriuretic system
Fig 52-8
Antidiuretic hormone (ADH) regulates water excretion from the
kidneys
Fluid Balance
Volume imbalance:
Net volume gain
hypervolemia

Net volume loss

- hypovolemia

Water intoxication
overhydration
 Fluid Volume Excess (FVE)
Intake Exceeds Output
Weight gain Cardiac palpitations
Surgery Decreased urinary

Pitting edema output

Cough Mental status changes

Dyspnea
 Fluid Volume Excess
Hypervolemia excessive retention of water
and sodium in ECF

Overhydration above normal amounts of

water in extracellular spaces

Edema excessive ECF accumulates in tissue

spaces

Interstitial-to-plasma shift movement of fluid

from space surrounding cells to blood
 Fluid Volume Deficit (FVD)
Output exceeds intake
Diarrhea Fever
Diuretics Excess urine output
Vomiting Change in mental
Gastric suction status
Anorexia Traumatic injury (burn)
Increasing fatigue Blood loss
and weakness
Weight loss
 Fluid Volume Deficit
Involves either volume or distribution of water or
electrolytes

Hypovolemia deficiency in amount of water

and electrolytes in ECF with near normal
water/electrolyte proportions

Dehydration decreased volume of water and

electrolyte change

Third-space fluid shift distributional shift of

body fluids into potential body spaces
 Electrolytes
Ions
Cations positive charge
Anions negative charge

-An electrolyte is a substance, that when dissolved in

water, gives a solution that can conduct electricity
(Electrochemistry Dictionary)
-Simple inorganic salts
-Electrolytes dissociate when dissolved in water to form
positively and negatively charged ions
(Dissociation and electrolytes)
-All inorganic acids, bases, salts, are electrolytes
-Also known as Ionic solutes
 Importance of electrolytes
-Maintain voltages across cell membranes
-Carry electrical impulses to other cells
-Found in blood or the human body in the form of
acids, bases or salts (Sodium, calcium, potasium,
chlorine, magnesium, bicarbonate)
-Conduct an electric current that transports
energy thoughout the body
Normal Composition in Average Man
Plasma/
Intravascular Interstitial Fluid Intracellular fluid

Cations (mmol per

litre)
Sodium 140 144 10
Potassium 4 4 155
Calcium 2.5 2 1
Magnesium 1 1 15
Anions (mmol per litre)

Chloride 102 114 5

Bicarbonate 27 30 10
Phosphate 1 1 50
Sulphate 0.5 0.5 10
Protein 2 0.1 8
Organic Anions 3 6 2
 Effects of Electrolytes

The loss of electrolytes in the body can lead to

an unbalance of fluids in the body and the pH,
and a damage of the electric potential between
the nerve cells that transmit the nerve signals
(Encarta)
Regulating Electrolytes
Sodium
Potassium
Calcium
Magnesium
Chloride
Phosphate
Bicarbonate
 Major Electrolytes/Chief Function
Sodium controls and regulates volume of body
fluids
Potassium chief regulator of cellular enzyme activity
and water content
Calcium nerve impulse, blood clotting, muscle
contraction, B12 absorption
Magnesium metabolism of carbohydrates and
proteins, vital actions involving enzymes
Chloride maintains osmotic pressure in blood,
produces hydrochloric acid
Bicarbonate bodys primary buffer system
Phosphate involved in important chemical reactions
in body, cell division and hereditary traits
Composition of Body Fluids
Regulating Acid-Base
Balance
Regulating Acid-Base
Balance
Low pH = acidic
High pH = alkalinic
Body fluids maintained between pH of
7.35 and 7.45 by
Buffers
Respiratory system
Renal system
Figure 52-10 Carbonic acidbicarbonate ratio and pH.

Prevent excessive
changes in pH
Major buffer in ECF
is HCO3 and
H2CO3
Other buffers
include:
Plasma proteins
Hemoglobin
Phosphates
 Electrolyte Imbalances
SODIUM (Na+) 135-145 mEq/L
Functions
Maintains osmolality
Participates in active transport
Helps regulate body fluids
Participates in the action potential
Hyponatremia:serum sodium level falls below 130
mEq/L.Cells become swollen.
Neurological Disturbances :cerebral edema,headache,
lethargy,depression, confusion,convulsions,coma
Cardiovascular Disturbances: postural hypotension,shock
Hypernatremia: Serum sodium is more than 150
mEq/L.Cells shrink.
Complications:Osmotic Diuresis,cellular dehydration,
circulation decreases
 Electrolyte Imbalances
POTASSIUM (K+): 3.5-5.0 mEq/L
Functions
Transmission of nerve impulses
Resting membrane potential
Acid-base balance
Promotes myocardial, skeletal, and smooth muscle
contractility
Hypokalemia: <3 mEq/L
Cardiovascular: dysrhythmias, hypotension, digitalis toxicity, myocardial
damage, cardiac arrest
Neurological: lethargy, confusion, depression
Gastrointestinal : paralytic ileus
Skeletal Muscle: weakness, flaccid paralysis, weakness of respiratory
muscles, respiratory arrest
Renal System: decreased ability to concentrate urine, water loss, kidney
damage
Acid-Base Balance: metabolic alkalosis
Hyperkalemia: serum value of >6 mEq/L
Nervous System : Paraesthesia
Neuromuscular: Muscle twitching, muscle weakness, paralysis
Cardiovascular : Bradycardia, Cardiac arrest
 Electrolyte Imbalances
CALCIUM :8.5-10.5 mg/dl or 4.5-5.8 mEq/L
Functions
Formation of bone and teeth
Contraction of muscle
Blood coagulation
Blocks sodium transport into the cell
Transmission of nervous impulses
 Hypocalcemia Hypercalcemia
<0.9 mmo/L ionized Calcium >12 mg/dL total Calcium or
>1.5 mmol/L ionized Calcium

-Nervous System -Neurological Manifestation

Paraesthesia lethargy, confusion, coma
-Muscular System -Skeletal Manifestations
Tetany, Laryngeal deep bone pain; fractures
spasms -Renal Manifestations:stones
-Cardiovascular System
congestive heart failure -Gastrointestinal Manifestations
decreased cardiac Constipation;anorexia
output Nausea and Vomiting
cardiac dysrhythmias -Cardiovascular Manifestations
Shortened QT interval,
Bradycardia
Cardiac arrest

end