1. FLUIDS
AND
ELECTROLYTES
Nelia B. Perez RN, MSN
IV Preceptor

2. Water overview
*Water comprises about
60% -70% of the total
body weight
*Varies with
age
weight
gender

3. Water Loss
ROUTES OF WATER LOSS
-SENSIBLE -INSENSIBLE
Urine Lungs
Feces Sweat

4. Causes of Increased Causes of Increased
Water Loss Water Gain
•Fever •Increased sodium intake
•Diarrhea •Increased sodium
•Diaphoresis retention
•Vomiting •Excessive intake of water
•Gastric suctioning •Excess secretion of ADH
•Tachypnea

5. Two Compartments of Fluid in the Body
•Intracellular fluid (ICF) (70%)
— fluid within cells
- large amounts of K+, PO4--, Mg++
•Extracellular fluid (ECF) (30%)
— fluid outside cells
- large amounts of Na+,Ca+,Cl-,HCO3--
- Includes intravascular(15%) and
interstitial fluids(5%)

6. FLUIDS AND ELECTROLYTES
There is a continuous exchange of fluid between
the fluid compartment , of these spaces only the
plasma is directly influenced by the intake or
elimination of fluid from the body.
There is also the so called third space fluid shift
or “third spacing” where there is a loss of ECF
into a space that does not contribute to the
equilibrium between ICF & ECF.

7. FLUIDS AND ELECTROLYTES
“ Third spacing” occurs in:
Ascites Burns Peritonitis Bowel
obstruction Massive bleeding into
body cavity or joints

8. Electrolytes
-An electrolyte is a substance,
that when dissolved in water,
gives a solution that can conduct
electricity.

9. Importance of electrolytes
-Maintain voltages across cell membranes
-Carry electrical impulses to other cells
-Found in blood or the human body in the form of
acids, bases or salts (Sodium, calcium, potasium,
chlorine, magnesium, bicarbonate)
-Conduct an electric current that transports
energy thoughout the body

10. Major Electrolytes/Chief Function
Sodium — controls and regulates volume of body
fluids
Potassium — chief regulator of cellular enzyme
activity and water content
Calcium — nerve impulse, blood clotting, muscle
contraction, B12 absorption
Magnesium — metabolism of carbohydrates and
proteins, vital actions involving enzymes
Chloride — maintains osmotic pressure in blood,
produces hydrochloric acid
Bicarbonate — body’s primary buffer system
Phosphate — involved in important chemical
reactions in body, cell division and
hereditary traits

11. Regulation of Body Fluid Compartments
•Osmosis
- the movement of water from
an area of lower solute
concentration to an area of higher
solute concentration.
•Semi-permeable membrane
•membrane must be more
permeable to water
•a greater concentration of
solutes on one side of the
membrane

12. •Facilitated Diffusion
•Requires a carrier molecule.
•Lipid insoluble substances cannot cross the plasma
membrane (glucose).
•ATP is not expended.
•Movement of the particles is from an area of higher
concentration to an area of lower concentration.

13. •Active Transport
 movement of a substance across the cell membrane from
an area of lower concentration to an area of higher
concentration.
 ATP is expended.
 The sodium-potassium pump is an example of active
transport.

14. Fluid Volume Deficit
- Involves either volume or distribution of water or
electrolytes
•Hypovolemia — deficiency in amount of water and
electrolytes in ECF with near normal
water/electrolyte proportions
•Dehydration — decreased volume of water and
electrolyte change
•Third-space fluid shift — distributional shift of
body fluids into potential body spaces

15. Fluid Volume Excess
Hypervolemia — excessive retention of water
and sodium in ECF
Overhydration — above normal amounts of
water in extracellular spaces
Edema — excessive ECF accumulates in tissue
spaces
Interstitial-to-plasma shift — movement of fluid
from space surrounding cells to blood

16. Types of IV Solutions
ISOTONIC
-solution has the same osmolality as the extracellular
fluid.
Examples: D5W ; Normal Saline
Hypertonic solutions have a higher concentration of
solute and are more concentrated than extracellular
fluids. Net movement intracellular to extracellular
Examples : 3% saline; 5% saline
Hypotonic solutions have a lower concentration of
solutes and is more dilute than extracellular fluid .Net
movement extracellular to intracellular
Examples : 1/2 Normal Saline; 1/3 Normal Saline

17. Electrolyte Imbalances
SODIUM (Na+)  135-145 mEq/L
Functions
•Maintains osmolality
•Participates in active transport
•Helps regulate body fluids
•Participates in the action potential
Hyponatremia:serum sodium level falls below 130
mEq/L.Cells become swollen.
Neurological Disturbances :cerebral edema,headache,
lethargy,depression, confusion,convulsions,coma
Cardiovascular Disturbances: postural hypotension,shock
Hypernatremia: Serum sodium is more than 150
mEq/L.Cells shrink.
Complications:Osmotic Diuresis,cellular dehydration,
circulation decreases

19. Electrolyte
POTASSIUMImbalancesmEq/L
(K+): 3.5-5.0
Functions
•Transmission of nerve impulses
•Resting membrane potential
•Acid-base balance
•Promotes myocardial, skeletal, and smooth muscle
contractility
Hypokalemia: <3 mEq/L
Cardiovascular: dysrhythmias, hypotension, digitalis toxicity, myocardial
damage, cardiac arrest
Neurological: lethargy, confusion, depression
Gastrointestinal : paralytic ileus
Skeletal Muscle: weakness, flaccid paralysis, weakness of respiratory
muscles, respiratory arrest
Renal System: decreased ability to concentrate urine, water loss, kidney
damage
Acid-Base Balance: metabolic alkalosis

20. Hyperkalemia: serum value of >6 mEq/L
Nervous System : Paraesthesia
Neuromuscular: Muscle twitching, muscle weakness, paralysis
Cardiovascular : Bradycardia, Cardiac arrest

21. Electrolyte Imbalances
CALCIUM :8.5-10.5 mg/dl or 4.5-5.8 mEq/L
Functions
•Formation of bone and teeth
•Contraction of muscle
•Blood coagulation
•Blocks sodium transport into the cell
•Transmission of nervous impulses

22. •Hypocalcemia •Hypercalcemia
<0.9 mmo/L ionized Calcium >12 mg/dL total Calcium or
>1.5 mmol/L ionized Calcium
•-Nervous System •-Neurological Manifestation
• Paraesthesia • lethargy, confusion, coma
•-Muscular System •-Skeletal Manifestations
• Tetany, Laryngeal • deep bone pain; fractures
• spasms •-Renal Manifestations:stones
•-Cardiovascular System •-Gastrointestinal
• congestive heart Manifestations
failure • Constipation;anorexia
• decreased cardiac • Nausea and Vomiting
• output •-Cardiovascular Manifestations
• cardiac • Shortened QT interval,
dysrhythmias •Bradycardia
• Cardiac arrest

23.  "the excessive loss of water and electrolytes from
the body“
 can be caused by losing too much fluid, not
drinking enough water or fluids, or both.

24.  Infantsand children are more susceptible to
dehydration than adults because of their smaller
body weights and higher turnover of water and
electrolytes.
 So are the elderly and those with illnesses

25.  dehydration occurs when losses are not
replaced adequately and a deficit of water
and electrolytes develop.
 These may occur in Vomiting or diarrhea
 Presence of an acute illness where there is loss
of appetite and vomiting:
 Pneumonia
 DHF
 Other Acute Ilnesses
 Excessive urine output, such as with
uncontrolled diabetes or diuretic use
 Excessive sweating (sports)
 Burns

26.  Since diarrhea and vomiting are the most
common causes of dehydration in children,
the volume of fluid loss may vary from 5
ml/kg (normal) to 200 ml/kg
 Concentration of electrolytes lost also varies
 NaCl and K are the most common
electrolytes lost through stools

27.  In order to diagnose the type of dehydration, you need to
know the History and you must do a thorough physical
examination
 We classify type of dehydration depending on the amount
of water and electrolytes lost
 These are reflected by the signs and symptoms the child
will present

28.  Dehydration is classified as no dehydration,
some dehydration, or severe dehydration
based on how much of the body's fluid is lost
or not replenished.
 When severe, dehydration is a life-threatening
emergency

29. Assesment of Dehydration
 Graded according to the signs and symptoms that
reflect the amount of fluid lost.
 There are usually no signs or symptoms in the early
stages
 As dehydration increases, signs and symptoms develop.
Initially, thirst, restlessness, irritability, decreased skin
turgor, sunken eyes and sunken fontanelles.
 As more losses occur, these
 effects become more pronounced.

30. Signs of hypovolemic shock (SEQUELAE)
1. diminished sensorium (lethargy)
2. Lack of urine output
3. Cool moist extremities
4. A rapid and feeble pulse
5. Decreased BP
6. Peripheral cyanosis
7. DEATH.

31. MAINTENANCE REQUIREMENTS
HOLIDAY-SEGAR METHOD
BODY SURFACE AREA METHOD

32. HOLIDAY-SEGAR METHOD
Estimates caloric expenditure in
fixed weight categories
Assumption
 100 cal metabolized : 100 mL water
Not suitable for neonates < 14 days
 Overestimates fluid needs

33. HOLIDAY-SEGAR METHOD
BODY ml/kg/day ml/kg/hr Electrolytes
WEIGHT (mEq/100ml
fluid)
First 10 kg 100 4 Na+ 3
Second 10 kg 50 2 Cl- 2
Each additional 20 1 K+ 2
kg

34. BODY SURFACE AREA METHOD
Assumption: caloric expenditure
is related to BSA
Not used in children < 10 kg

35. BSA METHOD
STANDARD VALUES FOR USE IN BODY
SURFACE AREA METHOD
Component Values
Water 1500 ml/m2/24 hrs
Na+ 30-50 mEq/m2/24 hrs
K+ 20-40 mEq/m2/24 hrs

37. BSA Formula
Surface area (m2) = ht (cm) x wt (kg)
3600

38. ICF & ECF COMPARTMENTS
In dehydration, there are variable
losses from the extracellular and
intracellular compartments
Percentage of deficit is based on
total duration of illness

39. Sources:
 Fluids & Electrolytes, Lippincott Williams & Wilkins
 Fluids & Electrolytes, Walters Kluwer
 Nelson’s Texbook of Pediatrics
 WHO department of child and adolescent
development
 (Medline Plus)
http://www.nlm.nih.gov/MEDLINEPLUS/ency/articl
e/000982.htm