1. Fluid and Electrolyte Imbalance Acid and Base Imbalance

2. Fluid and electrolyte Disturbance
Amount and Composition of Body Fluids:
- Approximately 60% of atypical adult’s weight consists of
fluid (water&electrolyte).
- Body fluid is located in tow fluid compartment:
1) Intracellular fluids (fluids in the cells) 2/3.
2) Extracelluler fluids :( fluids out side the cells) 1/3.
a-Intravascular space (fluids with in blood vessels)
contains plasma.(3L of the total blood).
b- Interstitial fluids: contain fluids that surround the cell
and total about 8L.eg. Lymph.
c- Trancellular space: contain approximately 1L.
eg. Cerebrospinal, Pericardial, Synovial.

3. Average daily intake and output in an adult:
Intake Output
Oral Liquids ml Urine ml
Water in foods ml Stool ml
Water produced Insensible lungs ml
by metabolism ml Skin ml
2600ml ml

4. Normal Lab Results: - Na→ 135−145mEq/L. - K+ → 3.5−5.5mEq/L.
- Ca++→ 8.5−10.5mEq/L.
- Cl → 96−106mEq/L.
- Mg→ 1.5−2.5mEq/L.

5. Fluid Volume Disturbance:
I-Hypovolemia (fluids volume deficit):
− Contributing Factors:
* Loss of water and electrolyte.
e.g.( vomiting, diarrhea, burns).
* Decrease intake. e.g. (anorexia, nausea, inability to gain access to fluids).
* Some disease. e.g (D.M, Diabetic Insipidus).
− Signs and symptoms:
Weight loss, general weakness, dizziness, increase pulse.

6. Fluid Volume Disturbance:
II- Hypervolemia (fluid volume excess):
− Contributing Factors:
* Compromised regulatory mechanism such as renal failure, congestive heart failure, and cirrhosis.
* Administration of Na+ containing fluids.
* Prolong corticosteroid therapy.
* Increase fluid intake.
− Sings and Symptoms:
Weight gain, increase blood pressure, edema, and shortness of breathing.

7. Electrolyte imbalance:
I- Sodium Deficit (Hyponatremia):
−Contributing Factors:
* Use of a diuretic.
* Loss of GI fluids.
* Gain of water.
− Sings and Symptoms:
Anorexia, nausea and vomiting, headache, lethargy, confusion, seizures.

8. Electrolyte imbalance:
II- Sodium Excess (Hypernatremia):
− Contributing Factors:
* Water deprivation in patient.
* Hypertonic tube feeding.
* Diabetes Insipidus.
− Sings and Symptoms:
Thirst, hallucination, lethargy, restless, pulmonary edema.

9. Electrolyte imbalance:
III- Potassium Deficit (Hypokalemia):
− Contributing factors:
* Diarrhea, vomiting, gastric suctions.
* Corticosteroid administration.
* Diuretics.
− Signs and symptoms:
Fatigue, anorexia, nausea, vomiting, muscle weakness, change in ECG.

10. Electrolyte imbalance:
IV- Potassium Excess (Hyperkalemia):
− Contributing Factors:
* Renal Failure.
* Crush injury, burns.
* Blood transfusion.
* Administration of IV K+.
− Signs and Symptoms:
Bradycardia, dysarrythmia, anxiety, irritable.

11. Acid−Base Disturbance:
Normal Values:
PH→
PCO2→ mmHg.
PO2→ mmHg.
HCO3→ mEq/L.
Respiratory Acidosis: → → → → ↑ PCO2.
Respiratory Alkalosis: → → → → ↓ PCO2.
Metabolic Acidosis: → → → → ↓ PH, ↓ HCO3.
Metabolic Alkalosis: → → → → ↑ PH, ↑ HCO3.

12. Types of IV solutions: * Serum plasma osmalarity (280-300 m osmol).
I- Isotonic Solutions:
A solution with the same osmalality as serum and other body
Fluids.
e.g. N/S 0.9%, Ringer Lactate, D5W.
II- Hypotonic Solutions:
A solution with an osmolality lower than that of serum
plasma.
e.g. half strength saline (0.45% sodium chloride).
III- Hypertonic Solution:
A solution with an osmalality higher than that of serum.
e.g. D/S 0.9%, D/S 0.18%, D/S 0.45%, D10W, D25W.

13. Types of IV solutions: *Hypotonic Solutions (0.45% saline)
Decreases intravascular osmolarity.
Results in intracellular expansion.
Used for cellular dehydration.
Complications include shock and increased ICP.
Contraindications include cerebral edema, and hypotension.

14. Types of IV solutions:
*Hypertonic Solutions (D5% .45% saline, D5% NS, D5%LR.)
Increases intravascular osmolarity.
Results in intracellular and interstitial dehydration.
Used for intravascular expansion by shifting intracellular and interstitial fluids.
Complications include circulatory overload.
Contraindications include intracellular dehydration and hyperosmolar states.

15. Types of IV solutions:
*Isotonic Solutions (NS, Lactated Ringers, D5%W.)
Does not change osmolarity.
Results in TBW expansion.
Used to increase intravascular space.
Complications include circulatory overload.
Contraindications include circulatory overload and LR in alkalosis and liver disease.