FLUID AND ELECTROLYTES

(pdf file)

A. BODY FLUIDS
1. Adults
 Women- 50-55% body weight is water
 Men- 60-70% body weight is water
 Elderly- 47% body weight is water
2. Infant- 75-80% body weight is water
3. Intracellular- 80% of total body water
4. Extracellular- 20% of total body water
a. Interstitial
b. Intravascular (plasma)
c. Others: CSF, intraocular fluid, bone water,
GIT secretions

B. ELECTROLYTES
Extra
Normal Values General Functions
cellular
Na+ 135-145 mEq/l Promote
neuromuscular
Ca+ 8-10mg/dl
excitability
Maintain fluid
CI- 85-115 mEq/l
volume
Distribute water
HCO3- 22-29 mEq/l between fluid
Compartments
Intra cellular
K+ 3.5-5.5 mEq/l Regulate acid-base
PO4 2.5-4.5mg/dl balance
Mg+ 1.3-2.0 mEq/l

C. MOVEMENT OF FLUID AND ELECTROLYTES

1. Diffusion: molecules move form an area of
BODY FLUIDS COMPOSITION IN THE BODY:
higher concentration to an area of lower
1.Water – 60% of the body weight
concentration
2.Proteins – 18% of the body weight
2. Osmosis: water moves from an area of lower
3.Fats – 18% of the body weight
concentration of particles to an area of higher
4.Minerals – 4% of the body weight
concentration
3. Filtration: water and dissolved substances
move from an area of greater hydrostatic
pressure to an area of lower hydrostatic
pressure
 4. Types of solution Nursing Intervention
a. Isotonic 0.9% NaCl 1. Administer diuretics: Furosemide (Lasix) as
 Same osmolarity as plasma per order (K+ sparring diuretics): increases
 D5W; to replace fluid volume or diuresis (urination) without the loss of
increase ADH activity potassium
b. Hypertonic 3.0% NaCl 2. Restrict fluids, monitor intake and output
c. Hypotonic 0.45% NaCl 3. Weigh daily
5. Types of Pressure 4. Provide skin care
a. Osmotic 5. Use semi-fowler’s position
b. Hydrostatic 6. Maintain low-sodium diet

F. REGULATION OF BODY PH
D. MECHANISM OF FLUID BALANCE
1. Kidneys: regulates F&E, secretes renin
2. Lungs: regulate CO2 levels, water vapor
3. Skin: regulate fluid losses (sweat)
4. Hormonal control
a. ADH
b. Aldosterone

E. ASSESSMENT OF F&E BALANCE/IMBALANCE

1. Fluid volume deficit: water and electrolytes lost METABOLIC / RESPIRATORY
in same proportion (blood and urine become IMBALANCE – ACIDOSIS / ALKALOSIS
concentrated) 1. ACID-BASE IMBALANCE
- definition: base bicarbonate deficit; increase in
hydrogen ion concentration

Nursing Intervention
1. Weigh daily
2. Monitor intake and output
3. Replace fluid- P.O. or IV (Lactated Ringers,
0.9% NS) per order
4. Measure urine specific gravity (N: 1.002 -
1.035) 2. METABOLIC ALKALOSIS
- base HCO3 excess; decrease in hydrogen ion
2. Fluid Volume loss concentration
 Nursing Intervention 2. Components
1. Restore fluid volume
2. Prevent metabolic alkalosis
a. Monitor K+ level
b. Evaluate need for K+ replacement for
clients on gastric suction
c. Promote intake of K+ rich foods or oral
replacement for clients on long term
diuretic therapy

3. RESPIRATORY ACIDOSIS
- excess carbonic acid; increase in hydrogen
concentration

POINTS TO REMEMBER
1. Regardless of the pO2, delivery of O2 to the
tissues is affected by the pH and temperature
2. Ratio which dictates pH level: HCO3:HCO3 1:20
3. Remember: pCO2 is inversely associated to pH
in respiratory origin; HCO3 is directly
associated to pH in metabolic origin

EXAMPLES

4. RESPIRATORY ALKALOSIS
- carbonic acid deficit; decrease in hydrogen ion
concentration

BLOOD GASES
1. Arterial Blood Gases (ABG’s)
a. Most accurate means of assessing respiratory
function
b. Must be sterile, anaerobic
c. Drawn into heparinized syringe
d. Keep on ice and transport to lab immediately
e. Document amount of oxygen delivered
f. Document client’s body temperature
g. Apply pressure to site from 5-10 minutes
POINTS TO REMEMBER B. HYPONATREMIA
1. Clients with low sodium will present an onset S/S
of confusion. 1. Depressed and deflated
2. Never give K+ to a client who is not voiding, No 2. NEURO= Seizures & Coma
“P”, No “K” 3. HEART= Tachycardia & weak THREADY
3. When a client has a high calcium level, pulse
phosphorus levels will be low and vice versa. 4. RESPIRATORY ARREST

Thready Pulse
FLUIDS AND ELECTROLYTE DISORDERS - On such a scale zero would mean that
1. POTASSIUM (K) the pulse cannot be felt;
1. HYPERKALEMIA - +1 would indicate a thready, weak
S/S: pulse that is difficult to palpate, fades in
HEART: tight and contracted and out, and is easily obliterated with
1. St elevation and peaked T waves slight pressure;
2. Severe= V fib or cardiac standstill - +2 would be a pulse that requires light
3. Hypotension, bradycardia GIT- tight and palpation but once located would be
contracted stronger than a +1;
4. Diarrhea - +3 would be considered normal;
5. Hyperactive bowel sounds - +4 pulse would be one that is strong,
NEUROMUSCULAR – tight and contracted bounding, easily palpated, and perhaps
hyperactive, and could indicate a
Paralysis in Extremities
pathological condition such as aortic
Increased DTR (deep tendon reflex)
regurgitation.
Profound muscle weakness (General feeling
of heaviness) PROFOUND and & SEVERE:
LATE Serious Signs Pulses palpated during assessment of the
arterial system
2. HYPOKALEMIA
S/S:
HEART: Low & Slow
1. Flat Y=T waves, ST depression, & prominent
U wave MUSCULAR: Low & Slow
2. Decreased DTR
3. Muscle cramping
4. Flaccid paralysis (paralyzed limbs)
GI- Low & Slow
Decreased motility, hypoactive to absent
bowel sounds
Constipation
Abdominal distention
Paralytic ileus: paralyzed intestines
*PRIORITY* for SBO (small bowel
obstruction)
3. CHLORIDE
2. SODIUM (Na) - 3 Major functions
- 3 functions: 1) Blood volume
1) Blood pressure 2) Blood pressure
2) Blood volume 3) pH balance
3) pH balance
A. HYPERNATREMIA A. HYPERCHLOREMIA
S/S: S/S:
1. SKIN - Nearly same as high sodium
Flush “red and rosy” Edema “waterbed 1. NAUSEA AND VOMITING
skin” Low grade fever 2. SWOLLEN DRY TONGUE
2. POLYDIPSIA: EXCESS thirst 3. CONFUSION
3. LATE Serious Signs SWOLLEN dry tongue B. HYPOCHLOREMIA
GI nausea & vomiting S/S:
INCREASED muscle tone 1. Excessive diarrhea, vomiting , sweating
Severe Signs: 2. Fever: ONLY difference
 Nausea
 Vomiting 4. MAGNESSIUM (Mg)
 Increased muscle tone Main functions:
1. Law and order in the muscles
2. Required for
 a. Calcium 1. Bone and teeth formation
b. Vitamin D absorption 2. Helps regulate calcium
• Always works inversely
A. HYPERMAGNESSIUM • Calcium Phosphate
1. CARDIAC- calm & quiet
a. Heart block A. HYPERPHOSPHATEMIA
b. Prolonged PR intervals Note: “Low Calcium” S/S:
c. Vitals: bradycardia, hypotension 1. TROSSEAU’s Signs
2. DTR- calm & quiet 2. CHVOSTEK’s Signs
a. Hyporeflexia- decreased DTR 3. DIARRHEA
3. LUNGS- calm & quiet 4. WEAK B’s
a. Depressed shallow respirations a. Strong bones?- WEAK (fractures)
4. GIT- calm & quiet b. Strong blood clotting? WEAK (bleeding)
a. Hypoactive bowel sounds c. Strong heart beats?- WEAK (cardiac
dysrhythmias
B. HYPOMAGNESSIUM
1. CARDIAC- Buck wild
EKG: ST depression, T wave inversion
Torsades de pointes SEVERE: V fib
Vitals: tachycardia
2. DTR- Buck wild
Hyporeflexia- increased DTR (tremors,
twitching)
3. EYES: Buck wild
Abnormal eye movements (Nystagmus)
4. GIT- Buck wild
Diarrhea
5. DRUGS: Give MgSO4 (stop preterm
contractions)

Magnesium toxicity- same as

hypermagnesemia

BOTH:
 NEURO- confusion and irritability
 LUNGS- shallow respiration

5. CALCIUM (Ca)
Main functions:
a. Bones
b. Blood (clotting factors)
c. Beats (heart beats)

A. HYPERCALCEMIA
1. CONSTIPATION
2. BONE PAIN
3. STONES Renal Calculi (kidney stones)
4. DEEP TENDON REFLEXES
Decreased DTR
Severe muscle weakness
B. HYPOCALCEMIA
1. TROUSSEAU’s Signs
2. CHVOSTEK’s Signs
3. DIARRHEA
4. CIRCUMORAL TINGLING

WEAK B’s:
1. BONES- risk for fractures
2. BLOOD- risk for bleeding
3. BEATS- cardiac dysrthymias
6. PHOSPHATE
Note: Does the opposite of what Calcium does

Main functions: