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FLUID Imbalance

Fluid imbalance is a condition where the body's fluid levels are either excessive or deficient, affecting normal physiological functions. It involves understanding body fluid composition, regulation mechanisms, and conditions like hypovolemia and hypervolemia, which can arise from various causes and require specific management strategies. Nursing management includes monitoring fluid balance, vital signs, and patient education to address the underlying causes and maintain homeostasis.

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Ankita Dawn
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6 views

FLUID Imbalance

Fluid imbalance is a condition where the body's fluid levels are either excessive or deficient, affecting normal physiological functions. It involves understanding body fluid composition, regulation mechanisms, and conditions like hypovolemia and hypervolemia, which can arise from various causes and require specific management strategies. Nursing management includes monitoring fluid balance, vital signs, and patient education to address the underlying causes and maintain homeostasis.

Uploaded by

Ankita Dawn
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PPTX, PDF, TXT or read online on Scribd
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FLUID IMBALANCE

ANKITA DAWN
B.Sc.(H)
Nursing
II year
Content
• Definition
• Body Fluid composition and
compartments
• Regulation of body fluid
• Systemic Routes of Fluid Gains and
losses
• Homeostasis
• Hypovolemia
• Hypervolemia
Definition
Fluid imbalance refers to a condition in which the body's fluid levels are
either excessive or deficient, disrupting normal physiological functions.
It can occur due to various factors such as illness, dehydration,
excessive fluid intake, kidney disease, or hormonal imbalances.
Body Fluid Composition & Compartments

Total Body Water (TBW):


~60% of body weight in adults.

Factors Influencing TBW:


• Age
• Gender
• Body fat
Fluid
Compartments
Intracellular Fluid (ICF) Extracellular Fluid (ECF):
~40% of body weight ~20% of body weight
inside cells, mainly in skeletal outside cells.
muscle.

Intravascular: Interstitial Fluid: Trans cellular


~3L of total blood ~10–12L Fluid: ~1L
volume surrounds the cell cerebrospinal,
In plasma synovial, and
pleural fluids.
Regulation of Body Fluid
• Osmosis: Movement of water from low to high solute concentration through a
semipermeable membrane.
• Osmolality: Concentration of dissolved particles in body fluids, influencing water
movement.
• Diffusion: Movement of solutes from an area of higher concentration to lower
concentration (e.g., gas exchange in lungs).
• Filtration: Fluid movement due to hydrostatic pressure differences (e.g., kidney
filtration).
• Sodium-Potassium Pump: Active transport mechanism maintaining high Na⁺ in ECF and
high K⁺ in ICF.
Systemic Routes of Fluid Gains & Losses
Fluid Balance & Homeostasis

1. Kidneys
Regulate fluid volume by filtering ~180L of plasma/day.
Retain or excrete water & electrolytes (Na⁺, K⁺) based on body needs.

2. Heart & Blood Vessels


Pumping action maintains blood pressure & renal perfusion.
Heart failure can lead to fluid retention.

3. Lungs
Remove ~300mL of water daily via exhalation.
Regulate acid-base balance by controlling CO₂ levels.
Fluid Balance & Homeostasis (contd.)
4. Hormonal Control

• Antidiuretic Hormone (ADH): Retains water, regulates blood volume.

• Aldosterone: Increases Na⁺ & water retention, controls BP.

• Parathyroid Hormone (PTH): Regulates calcium & phosphate balance.

• Renin-Angiotensin-Aldosterone System (RAAS): Adjusts blood pressure & fluid


levels.

• Natriuretic Peptides (ANP, BNP): Promote sodium & water excretion to reduce
blood volume.
Hypovolemia (Fluid Volume Deficient)
It occurs when fluid loss exceeds intake, leading to a decrease in ECF.
It involves the loss of both water and electrolytes in the same proportion.

CAUSES:
• Abnormal Fluid Losses: Vomiting, diarrhea, GI suctioning, excessive sweating.
• Decreased Fluid Intake: Nausea, difficulty accessing fluids, lack of thirst response.
• Third Space Fluid Shifts: Fluid moves into spaces like peritoneal or pleural cavities.
(e.g., burns, ascites).
• Other Causes: Diabetes insipidus, adrenal insufficiency, osmotic diuresis, haemorrhage,
coma.
Clinical Manifestation

• Acute weight loss


• Poor skin turgor
• Oliguria (low urine output)
• Dry mucous membranes
• Increased heart rate (tachycardia)
• Decreased blood pressure (hypotension)
• Weakness, dizziness, confusion
• Sunken eyes
• Cool, clammy skin
Diagnostic Findings

• Elevated BUN-to-Creatinine Ratio (>20:1): Indicates dehydration.


• Elevated Hematocrit(>40-50%): Due to plasma volume loss.
• Electrolyte Imbalances:
Hypokalemia (low K⁺) from GI & renal losses.
Hyperkalemia (high K⁺) from adrenal insufficiency.
Hyponatremia (low Na⁺) due to excess thirst & ADH release.
Hypernatremia (high Na⁺) from diabetes insipidus & insensible losses.
Medical Management

• Oral Fluids:
Preferred for mild cases, if the patient can drink.
• IV Fluid Therapy:
1. Isotonic Fluids (e.g., Normal Saline, Lactated Ringer’s):
Used initially to expand plasma volume.
2. Hypotonic Fluids (e.g., 0.45% NaCl): Given once BP stabilizes to provide free water.
Nursing Management

• Monitoring & Assessment: Measure Intake & Output (I&O) every 8 hours.
• Daily weight monitoring. (1 kg weight loss ≈ 1 L fluid loss).
• Vital Signs: Watch for rapid pulse, hypotension, and temperature changes.
• Skin & Tongue Turgor: Pinch test (sternum or forehead), furrowed tongue.
• Urine Output: Less than 1 mL/kg/h indicates dehydration.
• Mental Status: Watch for confusion or delirium.
Hypervolemia (Fluid Volume Excess)
It is an excess of extracellular fluid (ECF) due to abnormal retention of sodium and water.
Often linked to impaired regulatory mechanisms affecting fluid balance.

Causes:
Heart failure (reduced cardiac output leads to fluid retention).
Kidney disease (impaired excretion of sodium and water).
• Liver cirrhosis (fluid shifts and decreased protein synthesis).
• Corticosteroid therapy (promotes sodium retention).
• Hormonal imbalances (excess aldosterone).
Diagnostic Findings

Low hematocrit & BUN (due to plasma dilution).


Low serum osmolality & sodium levels (if due to water retention).
• Urine sodium increased (if kidneys try to excrete excess fluid).
• Chest X-ray – may show pulmonary congestion.
Medical Management

• Identify & treat the underlying cause.


• Diuretics (e.g., Furosemide, Thiazides):Increase sodium & water excretion
• Monitor for electrolyte imbalances (hypokalemia, hyponatremia).
• Dialysis: Used if kidney function is severely impaired.
• Fluid & Sodium Restriction: Prevent further retention of fluids.
Nursing Management
• Monitor Fluid Balance: Measure intake & output (I&O) regularly.
• Monitor daily weight: 1 kg = ~1L fluid retained.
• Assess Respiratory Status: Check for dyspnoea, lung sounds, and O₂ saturation.
• Positioning: Semi-Fowler’s position to ease breathing.
• Patient Education: Dietary sodium restriction
• Medication adherence (diuretics, fluid control)
• Educate patient about edema.
Edema
Edema is the abnormal accumulation of fluid in the interstitial space due to imbalances in
fluid distribution.
• It results from increased capillary pressure, decreased oncotic pressure, or lymphatic
obstruction.
• Types of Edema
1. Peripheral Edema: Swelling in the feet, ankles, and legs due to gravity.
2. Pulmonary Edema: Fluid accumulates in lungs, making breathing difficult.
3. Ascites: Fluid build-up in the abdominal cavity.
4. Anasarca (Generalized Edema): Widespread swelling across the entire body.
• Management: Diuretics; Elevate legs; compression stockings

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