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Fluid and electrolyte balance

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

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Fluid and electrolyte balance

  1. 1. Nursing Path www.nursingpath.in
  2. 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. 3/30/2020 www.nursingpath.in 2
  3. 3. Distribution of Fluid in The Body Intracellular Fluid 66% in Cells Extracellular Fluid 34% In Blood & Intestinal Fluid 3/30/2020 www.nursingpath.in 3
  4. 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 3/30/2020 www.nursingpath.in 4
  5. 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 3/30/2020 www.nursingpath.in 5
  6. 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. 3/30/2020 www.nursingpath.in 6
  7. 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. 3/30/2020 www.nursingpath.in 7
  8. 8. Rate of Osmosis depend on  Concentration of Solutes  Temperature  Electrical Charges of Solutes  Osmotic Pressures of Solution. 3/30/2020 www.nursingpath.in 8
  9. 9. Diffusion Definition: Diffusion refers to movement of a solute in a Solution across Semi permeable membrane from higher concentration to Lower concentration 3/30/2020 www.nursingpath.in 9
  10. 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 3/30/2020 www.nursingpath.in 10
  11. 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 3/30/2020 www.nursingpath.in 11
  12. 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. 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 3/30/2020 www.nursingpath.in 13
  14. 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. 3/30/2020 www.nursingpath.in 14
  15. 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 3/30/2020 www.nursingpath.in 15
  16. 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. 17. Regulation of Fluid Loss Three Hormones play important role in maintenance of Fluid volume • Antidiuretic Hormone (ADH) • Aldosterone • Atrial Natriuretic Peptide (ANP) 3/30/2020 www.nursingpath.in 17
  18. 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 3/30/2020 www.nursingpath.in 18
  19. 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 3/30/2020 www.nursingpath.in 19
  20. 20. Other Factors that Regulate Fluid Loss Severe Dehydration Decrease Blood Pressure & Glomerular Filtration Rate Decreases Loss of Water in Urine 3/30/2020 www.nursingpath.in 20
  21. 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 3/30/2020 www.nursingpath.in 21
  22. 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 3/30/2020 www.nursingpath.in 22
  23. 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 3/30/2020 www.nursingpath.in 23
  24. 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 3/30/2020 www.nursingpath.in 24
  25. 25. Risk Factors of Overhydration  Chronic illness  Malnutrition  Tendency to retain Water  Kidney Diseases  Infant due to over hydrated  Mental disorder  Alcoholics 3/30/2020 www.nursingpath.in 25
  26. 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 3/30/2020 www.nursingpath.in 26
  27. 27. Dehydration Dehydration (Hypohydration) is the removal of Water from object. 3/30/2020 www.nursingpath.in 27
  28. 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 3/30/2020 www.nursingpath.in 28
  29. 29. Causes of Dehydration Infectious Causes • Cholera • Gastroenteritis • Shigellosis • Yellow Fever Other Causes • Sever Hyperglycemia in Diabetes mellitus • Glycosuria 3/30/2020 www.nursingpath.in 29
  30. 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. 3/30/2020 www.nursingpath.in 30
  31. 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) 3/30/2020 www.nursingpath.in 31
  32. 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. 3/30/2020 www.nursingpath.in 32
  33. 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 3/30/2020 www.nursingpath.in 33
  34. 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. 3/30/2020 www.nursingpath.in 34
  35. 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. 3/30/2020 www.nursingpath.in 35
  36. 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. 3/30/2020 www.nursingpath.in 36
  37. 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. 3/30/2020 www.nursingpath.in 37
  38. 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 3/30/2020 www.nursingpath.in 38
  39. 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. 3/30/2020 www.nursingpath.in 39
  40. 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 3/30/2020 www.nursingpath.in 40
  41. 41. The Serum Electrolytes • Sodium ( Na) + Ve • Potassium (k) + Ve • Calcium (Ca) + Ve • Magnesium (mg) • Chloride (Cl) - Ve • Phosphate (PO4) - Ve • Bicarbonate (HCO3) – Ve 3/30/2020 www.nursingpath.in 41
  42. 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. 3/30/2020 www.nursingpath.in 42
  43. 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. 3/30/2020 www.nursingpath.in 43
  44. 44. Hyponatremia Causes • Diuretics • Certain Psychoactive Drug • Ecstasy Drugs • Inadequate intake of Na • Impaired Adrenal Gland. Sodium ( Na) + Ve 3/30/2020 www.nursingpath.in 44
  45. 45. Sodium ( Na) + Ve Symptoms of Hyponatremia • Nausea, Abdominal Cramp, Vomiting • Headache • Edema • Muscle Weakness • Paralysis • Disorientation • Slowed Breathing • seizure • Coma 3/30/2020 www.nursingpath.in 45
  46. 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 3/30/2020 www.nursingpath.in 46
  47. 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. 3/30/2020 www.nursingpath.in 47
  48. 48. Potassium (K) + Ve Symptoms of Hyperkalemia  Weakness  Nausea & Abdominal Pain  Irregular Breathing  Diarrhea  Muscle Pain. 3/30/2020 www.nursingpath.in 48
  49. 49. Potassium (K) + Ve Hypokalemia : Causes • Sever Dehydration • Aldosteronism • Kidney Disease • Long term diuretic therapy • Certain Penicillin • Cognitive Heart Failure • Adrenal Gland Impairment. 3/30/2020 www.nursingpath.in 49
  50. 50. Potassium (K) + Ve Symptoms of Hypokalemia : • Weakness • Paralysis • Increase Urination • Irregular Heart beat • Orthostatic Hypotension • Muscle Pain • Tetany. 3/30/2020 www.nursingpath.in 50
  51. 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. 3/30/2020 www.nursingpath.in 51
  52. 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. 3/30/2020 www.nursingpath.in 52
  53. 53. Calcium (Ca) + Ve Symptoms Of Hypercalcemia :  Fatigue  Constipation  Depression  Confusion  Muscle Pain  Nausea & Vomiting  Dehydration  Increase Urination  Irregular Heartbeat. 3/30/2020 www.nursingpath.in 53
  54. 54. Calcium (Ca) + Ve Hypocalcaemia : Causes  Thyroid Disorder  Kidney Failure  Sever Burns  Sepsis  Vitamin D Deficiency  Medication such Heparin & Glucagon. 3/30/2020 www.nursingpath.in 54
  55. 55. Calcium (Ca) + Ve Symptoms of Hypocalcaemia : • Muscle Cramps & Spasms • Tetany & Convulsions • Mood Changes • Dry Skin • Brittle nails • Facial Twitching. 3/30/2020 www.nursingpath.in 55
  56. 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) 3/30/2020 www.nursingpath.in 56
  57. 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 3/30/2020 www.nursingpath.in 57
  58. 58. • Lethargy • Hypotension • Decreased Heart & Respiratory Rate • Muscle Weakness • Diminished tendon reflex. Symptoms of Hypermagnesemia 3/30/2020 www.nursingpath.in 58
  59. 59. Causes : • Inadequate intake of Mg • Chronic Alcoholic • Malnutrition • Malabsorption Syndromes • Pancreatitis • Burns • Hyper parathyroidism • GIT Disorders • Use of Diuretics. Hypomagnesaemia 3/30/2020 www.nursingpath.in 59
  60. 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 3/30/2020 www.nursingpath.in 60
  61. 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 3/30/2020 www.nursingpath.in 61
  62. 62. Hyperchloremia Causes: • Sever Dehydration • Kidney Failure • Hemodialysis • Brain Injury • Aldosteronism • Drugs : Boric acid, Ammonium Chloride • IV infusion of NaCl. 3/30/2020 www.nursingpath.in 62
  63. 63. Symptoms of Hyperchloremia Weakness Headache Nausea Cardiac arrest. 3/30/2020 www.nursingpath.in 63
  64. 64. Hypochloremia Causes:  Due to Na & K depletion  Hyponatremia  Hypokelemia  Sever depletion of serum Cl Level  Metabolic Alcolosis. 3/30/2020 www.nursingpath.in 64
  65. 65. Symptoms of Hypochloremia • Mental Confusion • Slowed Breathing • Paralysis • Muscle Tension or Spasm. 3/30/2020 www.nursingpath.in 65
  66. 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. 3/30/2020 www.nursingpath.in 66
  67. 67. Hyperphosphatemia Causes : • Skeletal Fractures • Kidney Failure • Hypoparathyroidism • Diabetic Ketoacidosis • Acromegaly (Enlargement of bones of hands and feet and face) • Systemic Infection • Intestinal Obstruction. 3/30/2020 www.nursingpath.in 67
  68. 68. Hyperphosphatemia Symptoms : • Tingling Sensation in Hand & Fingers • Muscle spasm and Cramp • Convulsions • Cardiac Arrest. 3/30/2020 www.nursingpath.in 68
  69. 69. Hypophosphatemia Causes : • Serum P below 2mg/dl • Hypomagnesemia & Hypokelemia • Sever Burns • Alcoholism • Hyperparathyroidism & Hypothyroidism • Diabetic Ketoacidosis • Kidney Disease • Malnutrition • Vitamin D Deficiency. 3/30/2020 www.nursingpath.in 69
  70. 70. Hypophosphatemia Symptoms : • Muscle Weakness • Weight Loss • Bone Deformities. 3/30/2020 www.nursingpath.in 70
  71. 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 3/30/2020 www.nursingpath.in 71
  72. 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 3/30/2020 www.nursingpath.in 72
  73. 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 3/30/2020 www.nursingpath.in 73
  74. 74. 3/30/2020 www.nursingpath.in 74

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