The blood electrolytes—sodium, potassium, chloride, and bicarbonate—help regulate nerve and muscle function and maintain acid-base balance and water balance. ... Thus, having electrolytes in the right concentrations (called electrolyte balance) is important in maintaining fluid balance among the compartments

1. Nursing Path
www.nursingpath.in

2. Water
 Is simple inorganic compound
 H2O
 50 to 60 % of Adult body weight
 Fluid Balance = Required amount of water is
present and proportioned normally among
the various compartments in body.
 Total body water is mainly determined by
total amount of salt in body
 Salt & Water Concentration is controlled by
Kidney.
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3. Distribution of Fluid
in The Body
Intracellular
Fluid
66% in Cells
Extracellular
Fluid
34% In Blood
& Intestinal
Fluid
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4. Extracellular Fluid (ECF)
Intravascular
(Present in Blood
As a Plasma)
Extra vascular
•Interstitial Fluid
(Between the Cell)
•Lymph
•Brain, Aqueous
humor of Eye
•Pericardium &
Pleural Cavities
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5. Fluid
 Plasma Membrane separate ICF & ECF
 Blood Vessel Wall separate Blood Plasma &
Interstitial Fluid (between the cells)
 The major component of Fluid include
Water & Solute
 Solute = Mostly Electrolytes –in organic Ions
 Cations – Positive Charged Atoms e.g. Na,
K, Ca, Mg, Co3
 Anions –Negative Charged Atoms e.g.
Chloride, Sulphide, Phosphate &
Bicarbonate
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6. Movement of Body Fluid
 Fluids & Electrolytes constantly move
from one compartment to another for
 Metabolism
 Tissue oxygen
 Acid-base Balance
 Movement of Fluids & Solutes By 4 Way
1 Osmosis
2 Diffusion
3 Filtration
4 Active Transport.
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7. Osmosis
Definition:
Osmosis is process by which the Solvent-
Water moves across a Semi permeable
Membrane from an area of lesser Solute
Concentration to an Higher Solute
Concentration. Thus the concentration of
both the side become Equal.
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8. Rate of Osmosis depend on
 Concentration of Solutes
 Temperature
 Electrical Charges of Solutes
 Osmotic Pressures of Solution.
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9. Diffusion
Definition:
Diffusion refers to movement of a solute in a
Solution across Semi permeable membrane
from higher concentration to Lower
concentration
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10. Filtration
Definition:
Filtration is the process by which Water &
Substances that move across Semi
permeable membrane from an area of higher
Pressure to Lower Pressure
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11. Active Transport
Active Transport require energy to move
Substances across Semi permeable
membrane. By this process move molecules
from Lower Concentration to Higher
Concentration.
 Na -> Pump Out from cell
 K -> Pump in to cell
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12. Functions of Water
 Essential for cell & Body environment
 Serve as a Transport media of Nutrient &
Excretory Product
 Act as media of Biochemical reaction
 Act as a Solvent
 It play a vital role in Maintenance of body
Temperature
 Work as Protector e.g. Amniotic Fluid
 Help in Swallowing e.g. Saliva
 Help in Maintaining Texture of Tissue
 Help in Maintenance of Acid-base & Electrolyte
Balance
 Good source of Minerals e.g. Ca, Mg, F, I3/30/2020 www.nursingpath.in 12

13. Water Requirement
 The body has no Water storage Facility so we
maintain its requirement in every 24 hrs.
Factors Affecting on Water Requirement
 Surrounding Temperature
 High Temp. Water losses is High
 Activity Level
 High Physical Activity High Water requirement
 Functional Losses
 E.g. Diarrhea
 Metabolic Need
 1000 ml Water needed / 1000 kcal
 Age
 Infant 150ml / kg wt./day
 Adult 8 – 10 glass / day
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14. Water Requirement
 Climate
 Dietary Constituents
 Surface Area of Body
Daily Input of Water
2400 – 3000 ml / Day
By Food, Drink & Metabolism
 1500-1750 ml Drink
 600-900 ml Solid Food
 300-350 ml Oxidation of Car., Fat &
Proteins.
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15. Daily Output of Water
By Urine, Sweat, Breathing,
Faeces
Total output=2400 to 3000 ml / day
 1200-1500 ml Urine => Kidney
 700 – 900 ml Perspiration => Skin
 400 ml Respiration => Lungs
 100- 200 ml Faeces => Intestine
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16. Regulation of Fluid Gain
 Normal condition
Water loss = Water Gain
 The body regulate water intake by Thirst
Reflex
Thirst Reflex by Three Way
1. Level of Saliva Drops resulting in a Dry Mucosa
in Mouth & Pharynx
2. Increase blood Osmotic Pressure which
stimulates osmoreceptors in the Hypothalamus
3. Drop in Blood Volume which stimulate thirst
centre in the Hypothalamus
 Drinking of Water Inhibit Thirst Centre by
Stretching Stomach & Intestines.3/30/2020 www.nursingpath.in 16

17. Regulation of Fluid Loss
Three Hormones play
important role in
maintenance of Fluid volume
• Antidiuretic Hormone (ADH)
• Aldosterone
• Atrial Natriuretic Peptide (ANP)
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18. Regulation of Fluid Loss
A drop in
body
Fluid
•Increase Body tonicity
•Decrease Blood Volume
Release
of Renin
in Kidney
•Stimulate osmoreceptors of
Hypothalamus
Release
ADH from
Pituitary
Gland
•ADH Targets Kidney Gland
Reducing
Fluid Loss
•Arterioles constrict
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19. Regulation of Fluid Loss
 Aldosterone :
 Increase retention of Na & Cl ions as well as
Water by the Kidney
 Increase body Fluid & Blood Pressure
 Atrial Natriuretic Peptide (ANP):
 Increase in body Fluid results in increases
Blood Volume =>
-Which Stimulates the release of ANP Hormone
- That increases the loss of Fluid in Urine
- At the same time the level of ADH & Ranin
Decreases
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20. Other Factors
that Regulate Fluid Loss
Severe
Dehydration
Decrease
Blood
Pressure &
Glomerular
Filtration
Rate
Decreases
Loss of
Water in
Urine
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21.  Water overload will increase Blood
Pressure & Glomerular Filtration Rate =>
Which increase Loss of Water in Urine.
 Hyperventilation increase Fluid Loss Via
Vapour in lungs
 Vomiting & Diarrhea Increase Fluid Loss
via GIT.
 Fever, Heavy Perspiration & Skin Loss
(burns) increase Fluid Loss via skin.
Other Factors
that Regulate Fluid Loss
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22. Overhydration
 Overhydration = Excess of Water in
body
Overhydration occurs when
 High intake & Low output of Water
 Electrolytes Imbalances : Na Level is
diluted
 Intake more than 2 Gallon Water
(1 gallon = 3.78 L)
 Kidney Function is impaired
 Doctor / Nurses administer large amount
of fluid & Medications
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23. Overhydration
Causes & Symptoms
 People with Heart, Kidney or Liver
disease have high risk
 Change in behavior
 Patient may become confused,
Drowsy or Inattentive
 Burred vision
 Muscle Cramps & Twitching (jerky
motion)
 Paralysis on one side of the body
 Poor coordination
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24.  Nausea & Vomiting
 Rapid Breathing
 Sudden weight gain & weakness
 High blood Pressure
 Acidosis (High acidity in Blood & Tissue)
 Anemia
 Cyanosis (Decrease Oxygen level in Blood)
 Hemorrhage & shock
 Confusion & Seizures (A sudden occurrence
of a disease)
 coma
Overhydration
Causes & Symptoms
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25. Risk Factors of Overhydration
 Chronic illness
 Malnutrition
 Tendency to retain Water
 Kidney Diseases
 Infant due to over hydrated
 Mental disorder
 Alcoholics
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26.  Mild Overhydration => Limited
Fluid Intake
 Serious Overhydration =>
Diuretics may Prescribed
 Inpatient with sever Neurological
Symptoms => A powerful Diuretics
& Fluid to restore normal Na Level.
Treatment of Overhydration
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27. Dehydration
Dehydration
(Hypohydration) is the
removal of Water from
object.
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28. Causes of Dehydration
External/ Stress Related
Causes
• Prolonged Activity
• Prolonged exposure to Dry
Air
• Survival situation in Dessert
• Blood loss
• Diarrhea
• Hyperthermia
• Shock
• vomiting
Malnutrition
• Electrolyte Imbalance
• Hypernatremia
• Hyponatremia
• Excessive consumption of
Alcohol
• Fasting
• Recent Rapid Weight Loss
• Patient refusal of
Nutrition & Hydration
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29. Causes of Dehydration
Infectious Causes
• Cholera
• Gastroenteritis
• Shigellosis
• Yellow Fever
Other
Causes
• Sever Hyperglycemia
in Diabetes mellitus
• Glycosuria
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30. Symptoms of Dehydration
• Dehydration noticeable after 2 % Water loss than normal
• Thirst & Discomfort
• Loss of Appetite
• Dry Skin
• Low endurance (stamina)
• Rapid Heart Rate
• Elevated body Temperature
• Headache
• A sudden episode of visual snow
• Decreased Blood Pressure
• Dizziness
• Untreated Dehydration causes Delirium (restlessness), Unconsciousness
& Death.
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31. Symptoms of Mild Dehydration
• Thirst
• Decrease Urine Volume
• Urine that is darker than Usual
• Tiredness
• Lack of Tears when crying
• Headache
• Dry Mouth
• Dizziness (lacking boldness and courage)
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32. Symptoms of
Moderate to Sever Dehydration
• No Urine output
• Lethargy
• Extreme Sleepiness
• Seizures (A sudden occurrence of a disease)
• Sunken fontanel (Soft Spot) in infants
• Fainting & Sunken eyes.
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33. Symptoms of
Sever Dehydration
• Greater Water loss
• Hearts & Respiration Rate increase
• If 5-6 % water loss =>
 Become Sleepy
 Nausea
 Tingling sensation (Itching)
• If 10 -15% water Loss =>
 Fluid Loss
 Muscles may become spastic
 Skin may Shrivel & Wrinkle
 Vision may dim
 Urination greatly Reduced & Painful
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34. Treatment of Dehydration
• Replacement of Water & Electrolytes
– By Oral or Intravenous Rehydration
• Unnecessary Sweating should be Avoided
• Give Liquid Food
• Give ORS Drink
• Don’t give Dry Food
• Give Fluid rich of Electrolytes.
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35. Preventing of Dehydration
• Dehydration is best prevented by
replacement of Water & Electrolytes
• Drink water frequently
• Unnecessary Sweating should be
Avoided
• Give Fluid rich in Electrolytes
• High Liquid Food intake in summer.
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36. Water Intoxication
• Water Intoxication also known as
Hyperhydration or Water Poisoning
• Causes :
– Osmotic Pressure which affect passive transport
in the body is Upset
• Drinking excess water in absence of Na =>
– Hyponatremia =>
– Shift water from Blood to Brain Cells =>
– Cease Functions of cells.
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37. Symptoms of Water
Intoxication
• Light Headache
• Nausea
• Vomiting
• Plasma Na Below 2.3 g/L =>
– Cerebral edema
– Seizers
– Coma & Death
• Overdose of Alcohol => Body continuous
absorb water from Stomach.
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38. Persons At High Risk of
Water Intoxication
• Runners
– Marathon Runners if they drink only Water
– Sport Drink is given
• Diabetics
– Polydipsia (Excessive thirst)
• Ecstasy Users
– High dose of Ecstasy increase thirst
• Patient with Psychiatric Problems
– Psychogenic Polydipsia
– Drink large quantity of Water
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39. Prevention of Water
Intoxication
The Best way to Prevent water
Intoxication is
• To drink liquid in Moderate amount
• Diet include sufficient amount of
Electrolytes
• sport Drink for Athletes
• 2.5gm Na / 2000 kcal /24hrs.
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40. Electrolytes
• Definition: Substances dissolved in water as Ion
with positive or Negative Charged is known as
Electrolytes
• Fluid balance linked with Electrolytes
• Electrolytes established Osmotic Pressure
• ICF & ECF is Maintained by Electrolytes
• Electrolytes help to balance pH & Acid-base
balance
• Electrolytes regulate functions of Neuromuscular,
Endocrine & Excretory system
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41. The Serum Electrolytes
• Sodium ( Na) + Ve
• Potassium (k) + Ve
• Calcium (Ca) + Ve
• Magnesium (mg)
• Chloride (Cl) - Ve
• Phosphate (PO4) - Ve
• Bicarbonate (HCO3) – Ve
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42. Sodium ( Na) + Ve
– Help in Water Balance
– Help in Neuromuscular Functions
– Normal Serum Na Level = 135 – 145
mEq/L
Hypernatremia
– Cause By inadequate intake of Water
– Excessive fluid loss
– Diuretic Drugs
– Disease of Kidney.
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43. Sodium ( Na) + Ve
Symptoms of Hypernatremia
• Thirst
• Orthostatic hypotension
• Dry mouth & mucosa membrane
• Dark, Concentrated Urine
• Loss of elasticity in the skin
• Irregular Heart beat
• Irritability
• Fatigue
• Lethargy
• Heavy, Labored Breathing
• Muscle twitching.
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44. Hyponatremia Causes
• Diuretics
• Certain Psychoactive Drug
• Ecstasy Drugs
• Inadequate intake of Na
• Impaired Adrenal Gland.
Sodium ( Na) + Ve
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45. Sodium ( Na) + Ve
Symptoms of Hyponatremia
• Nausea, Abdominal Cramp, Vomiting
• Headache
• Edema
• Muscle Weakness
• Paralysis
• Disorientation
• Slowed Breathing
• seizure
• Coma
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46. Potassium (K) + Ve
• Help in Neuromuscular Functions &
Osmotic Pressure
• Maintain body water Balance
(intracellular Fluid)
• Transmission of Nerves impulses
• Regulate Normal Heart beat
• Normal Serum K Level = 3.5 – 5.5
mEq/L
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47. Potassium (K) + Ve
Hyperkalamia Causes
 by Ketoacidosis (Diabetic coma)
 Myocardial Infraction ( Heart Attack)
 Sever Burns
 Kidney Failure
 Fasting
 Bulimia nervosa (excessive eating followed by periods of fasting )
 GI Bleeding
 Adrenal insufficiency
 Diuretics Drugs.
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48. Potassium (K) + Ve
Symptoms of Hyperkalemia
 Weakness
 Nausea & Abdominal Pain
 Irregular Breathing
 Diarrhea
 Muscle Pain.
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49. Potassium (K) + Ve
Hypokalemia : Causes
• Sever Dehydration
• Aldosteronism
• Kidney Disease
• Long term diuretic therapy
• Certain Penicillin
• Cognitive Heart Failure
• Adrenal Gland Impairment.
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50. Potassium (K) + Ve
Symptoms of Hypokalemia :
• Weakness
• Paralysis
• Increase Urination
• Irregular Heart beat
• Orthostatic Hypotension
• Muscle Pain
• Tetany.
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51. Calcium (Ca) + Ve
Functions
• Need for Growth & Strong Bone
• Needed for Muscle Contraction
• Essential for Blood Clotting
• Ca is needed for Functioning of Neuro
Transmitters
• Normal Ca Level is 9 – 11 mg/dl.
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52. Calcium (Ca) + Ve
Hypercalcemia : Causes
• Thyroid Disorder
• Multiple Myeloma (A tumor of the
bone marrow)
• Metastatic Cancer
• Multiple Bone Fractures
• Milky- alkali Syndrome
• Excessive use of Calcium.
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53. Calcium (Ca) + Ve
Symptoms Of Hypercalcemia :
 Fatigue
 Constipation
 Depression
 Confusion
 Muscle Pain
 Nausea & Vomiting
 Dehydration
 Increase Urination
 Irregular Heartbeat.
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54. Calcium (Ca) + Ve
Hypocalcaemia : Causes
 Thyroid Disorder
 Kidney Failure
 Sever Burns
 Sepsis
 Vitamin D Deficiency
 Medication such Heparin & Glucagon.
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55. Calcium (Ca) + Ve
Symptoms of Hypocalcaemia :
• Muscle Cramps & Spasms
• Tetany & Convulsions
• Mood Changes
• Dry Skin
• Brittle nails
• Facial Twitching.
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56. Essential for Transmission of Impulses
between Nerves & Muscles
Production of ATP
Involved in Enzymic Activity
Mg & Ca Act as Synergistically &
Antagonistically
Maintain Ca & P Level
 Normal Serum Mg Level is 1.4-2.1 mEq/L
Magnesium (mg)
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57. Causes :
• End Stage Renal Disease
• Addison’s Disease (A glandular disorder caused
by failure of function of the cortex of the
adrenal gland and marked by anemia and prostration
with brownish skin)
• Overdose of Magnesium Salts.
Hypermagnesemia
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58. • Lethargy
• Hypotension
• Decreased Heart & Respiratory
Rate
• Muscle Weakness
• Diminished tendon reflex.
Symptoms of Hypermagnesemia
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59. Causes :
• Inadequate intake of Mg
• Chronic Alcoholic
• Malnutrition
• Malabsorption Syndromes
• Pancreatitis
• Burns
• Hyper parathyroidism
• GIT Disorders
• Use of Diuretics.
Hypomagnesaemia
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60. • Leg & Foot Cramps
• Weight loss
• Vomiting
• Muscle spasm
• Seizures
• Muscle Weakness
• Arrhythmia (An abnormal rate of muscle contractions in
the heart)
Symptoms of Hypomagnesaemia
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61. Chloride (Cl) - Ve
Regulate Blood Pressure
Maintain body water Balance
(extracellular Fluid)
HCl Production in Stomach
Normal Serum Cl Level is 100-108
mEq/L
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62. Hyperchloremia
Causes:
• Sever Dehydration
• Kidney Failure
• Hemodialysis
• Brain Injury
• Aldosteronism
• Drugs : Boric acid, Ammonium Chloride
• IV infusion of NaCl.
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63. Symptoms of Hyperchloremia
Weakness
Headache
Nausea
Cardiac arrest.
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64. Hypochloremia
Causes:
 Due to Na & K depletion
 Hyponatremia
 Hypokelemia
 Sever depletion of serum Cl Level
 Metabolic Alcolosis.
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65. Symptoms of Hypochloremia
• Mental Confusion
• Slowed Breathing
• Paralysis
• Muscle Tension or Spasm.
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66. Phosphate
• Metabolism of Energy- ATP Production
• Chemical reaction in body
• As Phospholipids & Phosphoproteins in cell
membrane
• Acid-base Balance
• Mineralization of bone
• Absorption & Transport of nutrients
• Regulation of Protein activity
• Normal Serum P level is 2.5-4.5 mEq/L.
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67. Hyperphosphatemia
Causes :
• Skeletal Fractures
• Kidney Failure
• Hypoparathyroidism
• Diabetic Ketoacidosis
• Acromegaly (Enlargement of bones of hands and feet and face)
• Systemic Infection
• Intestinal Obstruction.
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68. Hyperphosphatemia
Symptoms :
• Tingling Sensation in Hand &
Fingers
• Muscle spasm and Cramp
• Convulsions
• Cardiac Arrest.
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69. Hypophosphatemia
Causes :
• Serum P below 2mg/dl
• Hypomagnesemia & Hypokelemia
• Sever Burns
• Alcoholism
• Hyperparathyroidism & Hypothyroidism
• Diabetic Ketoacidosis
• Kidney Disease
• Malnutrition
• Vitamin D Deficiency.
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70. Hypophosphatemia
Symptoms :
• Muscle Weakness
• Weight Loss
• Bone Deformities.
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71. Electrolytes in the body
Electrolytes Function Distribution
Sodium Na+ -Fluid & Electrolyte
Balance
-Maintain Osmotic
Pressure of ECF
90 % in ECF
Level in Blood
Controlled by ANP
& ADH
Potassium K+ -Essential for Nervous &
Muscle Tissue
-Maintain Fluid Volume
-Regulate pH
Abundant in ICF
- Controlled by
Aldosterone
Calcium Ca+ -Essential for Blood
Clotting
- Maintenance of Muscle
Tone & Nervous Tissue
-Abundant in Bone
- Controlled by
Parathyroid Hormone
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72. Electrolytes in the body
Electrolytes Function Distribution
Chloride Cl- -Help to balance
Anions in ICF & ECF
-Most prevalent
ECF Anions
-Controlled by
Aldosterone
Bicarbonate
(HCO3)-
Major Buffer of H+ In
Plasma
Maintain Anions &
Cations in ECF & ICF
Abundant in ICF
- Controlled by
Aldosterone
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73. Acid-base Balance
• Maintain pH at
level 7
– Above 7 pH =
Acidic
– Below 7 pH =
Alkaline
• Most body Fluid are
near Neutral
pH of Some Solution
0 - HCl
2 - Gastric Juice
3 – Orange Juice
4 – Grape Juice
5 – Coffee
6 – Urine
7 - Water , Blood
8 - Sea Water
14- NaoH
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