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Fluid & Electrolyte Basics ©2013 by Pocket Prof Apps Disclaimer - Pocket Prof Apps has used reasonable efforts to ensure that.

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Presentation on theme: "Fluid & Electrolyte Basics ©2013 by Pocket Prof Apps Disclaimer - Pocket Prof Apps has used reasonable efforts to ensure that."— Presentation transcript:

1 Fluid & Electrolyte Basics ©2013 by Pocket Prof Apps Disclaimer - Pocket Prof Apps has used reasonable efforts to ensure that the information provided is both accurate and current. However, your education is ultimately your responsibility, and Pocket Prof Apps makes no guarantee to the accuracy or applicability of any information provided, and assumes no liability for your reliance on any information we provide. Further, the information provided in resources published by Pocket Prof Apps represents the understanding and opinions of the presenters and authors, and may or may not be consistent with the opinions or preferences of your own professors. We therefore recommend that you use information provided by Pocket Prof Apps to supplement your other education resources, and not replace your own study, group discussions, and class lectures.

2 Homeostasis Body fluids are in constant motion transporting nutrients, electrolytes, and oxygen to cells while carrying away waste products Many disease and treatments affect this balance

3 Water More important to life than any other nutrient – Carries nutrients and waste products – Participates in metabolic reactions, food digestion – Solvent for minerals, vitamins, glucose – Lubricant and cushion for the joints, eyes, spinal cord – Aids in regulation of body temp – Maintains blood volume 60% of an adult’s body weight (more in a child, less in the elderly) Found in foods (but not in alcohol) Daily need is about 2000 mL 1 liter of water weighs 1 kg

4 Fluid Intake and Loss Intake sources – Liquids (1500 mL/day) – Solid foods (800 mL/day) – Metabolism (300 mL/day) Fluid loss routes – Kidney (1200-1500 mL/day) – Skin (500-600 mL/day) – Lungs (400 mL/day) – GI tract (100-200 mL/day) – Drainage from fistulas/drains, GI suction, salivation IntakeOutput Measurable Oral fluid, tube feedings Urine Parenteral fluid Emesis Enemas Feces Retained irrigation fluid Drainage from body cavities Not Measurable Solid foods Sweating Metabolism Vaporization through lungs

5 Electrolytes Chemicals dissolved in the body fluid, distribution affects fluid balance Regulated by intake, output, acid-base balance, hormones, and cell integrity Sodium – Major extracellular electrolyte – Controls and regulate water balance Potassium – Major intracellular electrolyte – Helps maintain intracellular water balance – Transmit nerve impulses to muscles and contract skeletal and smooth muscles

6 F&E Labs Sodium (Na) 135-145 – Determines whether water is retained, excreted, or moved – Imbalances cause neuro problems Potassium (K) 3.5-5.0 – Increased with poor kidney function – Decreased with excessive urination, diarrhea, vomiting – Imbalances cause cardiac problems Chloride (Cl) 96-106 – Works with sodium to maintain osmotic pressure – Increased with poor kidney function – Decreased with excessive vomiting or diarrhea

7 F&E Labs Calcium (Ca) 9.0-10.5 – Transmission of nerve impulses, heart and muscle contractions, blood clotting, formation of teeth and bone – Requires Vit D for absorption Phosphate (PO4) 3.0-4.5 – Balance is intertwined with calcium Other tests – BUN 6-20 – Creatinine 0.6-1.3 – Hematocrit 42-52% (males), 37-47% (females) – Total protein, albumin

8 Lab Normals – Magic 4 ElectrolyteRangeMagic 4 Potassium3.5 – 5.54 Chloride98 – 106104 Sodium135 - 145140 pH7.35 – 7.457.4 pCO235 – 4540 HCO322 – 2624 FYI – Hematocrit normal is 3 times the hemoglobin (10-14 is normal)

9 Osmolarity and Osmolality Indicates the water balance of the body Serum osmo is 285 - 295 mOsm/kg – High is water deficit (concentrated) – Low is water excess (dilute) Urine osmo is 50-1200 mOsm/kg (avg - 500- 800 mOsm/kg) Together are used to determine what is causing a sodium imbalance

10 Distribution of body fluids & Electrolytes Intracellular (2/3) – K+, PO4- Extracellular (1/3) – Na+, Cl- – Interstitial (lymph) and transcellular (cerebrospinal, pleural, peritoneal, synovial fluids) – Intravascular (blood plasma)

11 Regulation of Fluid & Electrolyte Movement Diffusion Filtration Osmosis Active Transport

12 Regulation of Water Balance Kidneys (JG cells) Sense low Na, low volume Release renin Converts angiotensinogen to angiotensin I which converts to angiotensin II Stimulates release of aldosterone (RAAS) Kidneys (adrenal cortex) Senses low serum osmo or low Na Releases aldosterone Reabsorbs Na into the blood, increases K excretion in the urine Increases serum osmo Hypothalamus Senses high serum osmo or high Na Stimulates thirst Triggers release of ADH (vasopressin) from posterior pituitary Retains water in the blood Concentrates urine Mildly constricts blood vessels Decreases serum osmo Heart Senses high volume through stretch receptors in the right atrium Secretes ANP, BNP Inhibits ADH Stops the RAAS Increases Na excretion through the urine Dilates blood vessels Decreases serum osmo

13 Fluid Spacing First spacing – Normal Second spacing – Edema Third spacing – Ascites – Burn edema

14 IV Fluids Isotonic – NS – D5W – LR Hypertonic – 3% NS – D51/2NS – D10W Hypotonic – 1/2NS Plasma Expanders

15 Gerontologic considerations Percent of body weight of water is decreased Structural changes in the kidney and decreased renal blood flow – Decreased GFR – Decreased creatinine clearance – Loss of ability to concentrate urine and thus conserve water – Decrease in renin and aldosterone – Increase in ADH and ANP Loss of subcutaneous tissue Decrease in thirst mechanism Musculoskeletal changes Mental status changes Incontinence

16 Assessment Considerations History – nutrition, I/Os, insensible losses, use of diuretics/laxatives, weight changes, kidney or endocrine disorders, LOC, mental status, depression, eating disorders, alcohol intake Physical – hydration status, skin turgor, mucous membranes, I/Os Dx tests – electrolyte levels, BUN, glucose, creatinine, pH, bicarb, osmolality, Hgb, Hct, urine dipstick, urine pH, urine specific gravity

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19 Image Attribution Slide 1 – Flickr by Randy Le'Moine Photography,, no attribution required Slide 2 – Flickr by TipsTimes, By Anna Frodesiak (Own work) [Public domain or CC0], via Wikimedia Commons Slide 3 – no attribution required Slide 10 - Slide 13 – By James Heilman, MD (Own work) [CC-BY-SA-3.0 ( or GFDL (], via Wikimedia Commons Slide 14 - This-sign-What-is-your-Differential-Diagnosis, Slide 15 - "Photo by Chalmers Butterfield"." [CC-BY-2.5 (, GFDL ( or CC-BY-SA-3.0 (], from Wikimedia Commons

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