Alyssa, Amanda, Heather, Lynn, Sarah, Tamara, & Tracy

60% of a person’s weight consists of fluid (water and electrolytes) Located in two compartments: o Intracellular space o Extracellular space Intracellular space: o Intracellular fluid (ICF) – fluid in the cells Extracellular space: o Extracellular fluid (ECF) – fluid outside the cells o Intravascular, interstitial and  transcellular

 Electrolytes in body fluids are active cells that consist of positively charged chemicals, cations, and negatively charged chemicals, anions.  Major cations in the body are Na, K, Ca, Mg, and H.  Major anions in the body are Cl, HCO3, PO3-4, SO2-4, and Proteinate.

 Each major cation and anion are present in varying degrees in the extracellular fluid of the cells.  In the intracellular fluid, K, Mg, and Na are the only cations present, and all of the major anions are accounted for.

 Electrolyte concentration in the body :  mmol/L (millimole per litre) – 1/1000 of a mole dissolved in one litre of solution  mEq/L (milliequivalent per litre) - one thousandth of 1 equivalent of a specific substance dissolved in 1 L of solution or plasma.  mOsm/L (milliosmoles per litre) – 1/1000 milliosmoles dissolved in one litre of solution

 Intracellular fluid o Potassium – 150 mmol/L o Magnesium – 40 mmol/L o Sodium – 10 mmol/L o Phosphates – 150 mmol/L  Extracellular fluids o Sodium – 142 mmol/L o Potassium – 5 mmol/L o Calcium – 5 mmol/L o Magnesium – 2 mmol/L o Chloride – 103 mmol/L o Bicarbonate – 26 mmol/L

 Electrolyte solution  Moves freely between the intravascular compartment and interstitial spaces  Sterile water with added electrolytes  Approximate the mineral content of human plasma  Isotonic, hypertonic and hypotonic  Long shelf life  Ex: 0.9%NaCl (Normal Saline) & Lactated Ringer’s

 Plasma proteins  Molecules are too large to pass through the capillary membranes  Expand intravascular volume, by pulling fluid into the intravascular space  Sterile water and electrolytes but a component of a colloidal substance  Does not freely pass the semipermeable membrane  Ex: dextran & Albumin

 Colloids have a longer duration of action  Molecules remain within the intravascular compartment longer  Colloids are more expensive  Some organizations have restrictions on the use of colloids  There is no difference in life or death  Crystalloids reduce serum protein concentrations and packed red cell volume  increased risk of tissue edema.

 Solutions that have between 250 – 350 mOsm/L  Total osmolality close to ECF – therefore cells do not shrink or swell  Expand the ECF volume – 1L fluid expands ECF by 1 L

 Only expands plasma by 0.25 L  Need 3 L of isotonic fluid to replace 1 L of blood  Because fluid diffuses quickly into ECF compartment (w/in approx. 1 hr of admin)

 Na mEq/L + Cl mEq/L (308 mOsm/L)  Expands ECF……so?  Used for: hypovolemic states, resuscitative efforts, shock, diabetic ketoacidosis, metabolic alkalosis, hypercalcemia, mild Na + deficit  Supplies excess of Na + and Cl -

 Only solution to be administered with blood products  Can be mixed with 5% dextrose – BUT this is a hypertonic solution  Can cause FVE and hyperchloremic acidosis in excessive volumes ----more susceptible patients: those with compromised renal fxn, heart failure, or edema

 Composition is similar to plasma (274 mOsm/L)  Lacks Mg ++ …….Provides 170 calories/L  Used for: tx of hypovolemia, burns, fluid lost as bile or diarrhea  Lactate metabolized rapidly into HCO 3 -  Should not be used in lactic acidosis (inability to convert lactate to bicarb)or renal failure (K + will cause hyperkalemia)  Not to be given with a pH > 7.5 d/t HCO would result in alkalosis

 No electrolytes - (252 mOsm/L)  Provides 170 calories/L and free water – aid in renal excretion in solutes  Used for: tx of hypernatremia, fluid loss, dehydration  Contraindicated in: excessive amts in early postop period, tx of FVD (dilutes electrolytes), head injury, fluid resuscitation (can cause hyperglycemia),  Use with caution in pts with renal or cardiac disease b/c of risk of fluid overload  Converts to hypotonic solution as dextrose is metabolized. Over time can cause water intoxication d/t intracellular FVE

 Less than 250 mOsm/L  Less osmotic pressure than ECF – gives to cells  Purpose: replace cellular fluid, provide free water for excretion of body wastes  Used to: treat hypernatremia and other hyperosmolar conditions  Excessive infusions of hypo solutions leads to: intravascular fluid depletion, decreased BP, cellular edema, cell damage

 Na + 77 mEq/L + Cl - 77 mEq/L (154 mOsm/L)  Provides Na +,Cl - and free water  Free water aids kidneys in elimination of solute  Lacking in electrolytes other than Na + & Cl -  Used to: tx hypertonic dehydration, Na + & Cl - depletion and gastric fluid loss  Not indicated for third-space fluid shifts (burns, traumatic injuries, malnutrition, liver disease) and increased ICP  Administer cautiously – causes fluid shifts into cells – can result in CV collapse and increased ICP

 Greater than 350 mOsm/L  Greater osmotic pressure than ECF – takes from cells  Draws water from ICF to ECF and causes cells to shrink  Rapid admin or large volumes: may cause extracellular FVE = circulatory overload and dehydration  Cautious administration – ONLY when serum osmolality has decreased to dangerously low levels

 Na mEq/L + Cl mEq/L (1026 mEq/L)  Highly hypertonic solution  Used to: tx hyponatremia  **Admin slowly and cautiously – can cause intravascular volume overload & pulm edema  Assists in removing ICF excess  No calories supplied

 Hypertonic – 559 mOsm/L  Used to: tx fluid volume deficit, for daily maintenance of body fluids & nutrition  Temporary effect on ICF – takes from cells until dextrose metabolized  Supplies 170 calories/L  Becomes isotonic once dextrose metabolized  Acts the same as NS but provides calories

What is the difference between a Cation and an Anion? An Anion is negatively charged A Cation is positively charged

Is there more sodium in Intracellular or Extracellular fluid? Extracellular 142 mmol/L in the Extracellular 10mmol/l in the Intracellular

What is an example of a cystalloid? 0.9%NaCl (Normal Saline) Lactated Ringer’s

What is an example of a colloid? Dextran Albumi

Hypertonic: _______ mOsm/L Isotonic: _______ mOsm/L Hypotonic: ______ mOsm/L > – 350 < 250 What is the range of osmolality of each type of solution?

What kind of solution would be used to increase the ICF? Hypotonic

What kind of solution would be used to decrease the ICF? Hypertonic

What pH level is a contraindication to infusion of Lactated Ringer’s? Why? pH > 7.5 Rationale: because lactate is converted to bicarb and this would cause alkalosis

 David, K. (2007). IV fluids: Do you know what’s hanging and why?. Modern Medicine.  Day, R. A., Paul, P., Williams, B., Smeltzer, S. C., & Bare, B. (2007). Textbook of medical-surgical nursing: Concepts and challenges in patient management. Philadelphia : Lippincott-Raven.  Smeltzer, S.C, & Baie. (2004). Fluid and electrolytes: Balance and Distribution. IN Q. McDonald & D. McMahan (Eds.), Brunner & Suddarth’s Thextbook of Medical-Surgical Nursing (10 th ed., pp ). Philadelphia. PA: Lippincott Williams & Wilkins.  