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FLUID, ELECTROLYTE,   AND ACID-BASE      BALANCE
Anatomy and Composition of    Fluid Compartments   Total Body Water (TBW) adult    •   45-70% of body weight    •   lowes...
Anatomy and Composition of    Fluid Compartments The composition of body fluid: Two compartments    •   Intracellular Sp...
Body fluids   Extracellular fluids (ECF)    • Interstitial fluid - fills the spaces      between most cells of the body  ...
Body fluids   Intracellular fluids (ICF)    • Liquids within cell membranes    • 40% of body weight
Amount and composition of         body fluidsActual amount of body water differs according to Age Sex Body composition
Physiology of Body Water         Balance Newborn   70% 0f WT water 1-year-old 60% of WT water Men: higher water content...
Physiology of Body Water         Balance Obese:  less water because fat cells have minimal ICF  • Use ideal body weight w...
Fluid Shifts               “Third Spacing Refers to loss of ECF into a space that does  not contribute to equilibrium bet...
Fluid Shifts             “Third Spacing” Etiology  • Caused by an increase in filtration   and/or decrease in reabsorptio...
Fluid Shifts        “Third Spacing”Mechanisms causing third spacing & edema • massive inflammation • venous obstruction • ...
Components in body fluids   Electrolyte    • an element that when dissolved can carry an        electrical current    •  ...
Components of body fluids   Minerals    • ingested compounds    • serve as catalysts in nerve response, muscle      contr...
Movement of body fluids   Diffusion    • Area of higher concentration to an area of      lower concentration till even di...
Osmotic pressure   Drawing power of water (dependent on    the number or molecules in solution)    • Isotonic    • Hypoto...
Movement of body fluids   Filtration    • Water and diffusible substances move      together in response to fluid pressur...
Fluid Intake   Hypothalamus - thirst control center   Oral fluid intake requires an alert state   Osmoreceptors - monit...
Fluid Output   Loss through the kidneys and GI tract   Insensible   Sensible
Cations   Sodium (Na+)    • Most abundant in the extracellular fluid    • Maintains water balance, transmits nerve       ...
Cation   Potassium (K+)    • Major intracellular cation    • Regulates neuromuscular excitability,        muscular contra...
Cation   Calcium (Ca2+)    • Cardiac conduction, blood   coagulation, bone        growth and formation, & muscular relaxa...
Cation   Magnesium (Mg2+)    • Second most important of intracellular fluids    • Enzyme activities, muscular excitabilit...
Electrolyte Imbalances   Hyponatremia    • GI losses, sweating, & diuretics    • S/S: N/V/D, abd cramps, personality chan...
Electrolyte imbalances   Hypokalemia   Causes: K+ wasting diuretics   N/V/D   polyuria   S/S: weak, irregular pulse  ...
Electrolyte imbalances   Hyperkalemia    • Causes: Renal failure    • S/S: irregular slow pulse, weakness, irritability
Electrolyte Imbalances   Hypocalcemia    • Causes: Vitamin D deficiency    • S/S: Numb and tingling fingers and circumora...
Electrolyte imbalances   Hypomagnesemia    • Causes: malnutrition and alcoholism polyuria    • S/S: muscular tremors, hyp...
Acid - Base Balance   Blood pH - 7.35 - 7.45   paCO2 - 35 - 45   Bicarbonate (HCO3) - 22-26 mEq/L
Respiratory Acidosis   pH < 7.35   paCO2 > 45 mm Hg   Causes: Respiratory failure   Hypoventilation    Resp muscles p...
Respiratory Alkalosis   pH > 7.45   paCO2 < 35 mm Hg   Causes: excessive exhalation of CO2    (hyperventilation)
Metabolic Acidosis   pH < 7.35   bicarbonate - < 22 mEq/L   Causes: Starvation, DKA, Diarrhea, drug    use
Metabolic Alkalosis   pH > 7.45   bicarbonate > 26 mEq/L   Causes: excessive vomiting, prolonged    gastric suctioning
Fluid & Electrolyte Imbalances   Burns - body fluid loss   Renal D/O - abnormal retention of Na,    Cl, K   GI Disturba...
S/S electrolyte imbalance   Head: irritability   Fontanels: depressed, bulging   Eyes: sunken           periorbital ede...
Imbalances   GI: abdomen, V/D   Renal: Oliguria or anuria (FVD, FE)   Diuresis (FVE)   Increased urine spec. gravity (...
Replacement of fluids andelectrolytes   Types of IV fluids   Isotonic   Hypertonic   Hypotonic
IV complications   Infiltration    • IVF enter SQ space   Phlebitis    • vein inflammation    • S/S: pain, redness, warm...
Discontinuing an IV   Stop infusion   Remove tape   1 - 2 minute pressure
Blood transfusions   Large bore catheter (18 ga or larger)   Give with normal saline   Baseline vital signs   Double c...
Transfusion Reactions   Caused by:    • blood incompatibility    • allergic sensitivity    • S/S: fever, chills, rash, hy...
Fluid elec (102)
Fluid elec (102)
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Transcript of "Fluid elec (102)"

  1. 1. FLUID, ELECTROLYTE, AND ACID-BASE BALANCE
  2. 2. Anatomy and Composition of Fluid Compartments Total Body Water (TBW) adult • 45-70% of body weight • lowest in aged & obese • highest in very lean & young TBW • 60% -- male 70kg • 50-55% female
  3. 3. Anatomy and Composition of Fluid Compartments The composition of body fluid: Two compartments • Intracellular Space -- 2/3 -- 40% • Extracellular Space -- 1/3 -- 20%
  4. 4. Body fluids Extracellular fluids (ECF) • Interstitial fluid - fills the spaces between most cells of the body • 15% of body weight • Intravascular fluid - plasma • (WBC, RBC and platelets in this fluid) 5% of body weight
  5. 5. Body fluids Intracellular fluids (ICF) • Liquids within cell membranes • 40% of body weight
  6. 6. Amount and composition of body fluidsActual amount of body water differs according to Age Sex Body composition
  7. 7. Physiology of Body Water Balance Newborn 70% 0f WT water 1-year-old 60% of WT water Men: higher water content due to greater muscle mass
  8. 8. Physiology of Body Water Balance Obese: less water because fat cells have minimal ICF • Use ideal body weight when estimating TBW for obese Elderly: less water due to less muscle mass
  9. 9. Fluid Shifts “Third Spacing Refers to loss of ECF into a space that does not contribute to equilibrium between ICF and ECF Excess fluid in interstitial spaces and connective tissues between cells [edema] or Excess fluid in potential spaces [effusion] • peritoneal cavity • pericardial sac • synovial cavities of joints • alveoli or intra-pleural space
  10. 10. Fluid Shifts “Third Spacing” Etiology • Caused by an increase in filtration and/or decrease in reabsorption due to altered capillary forces
  11. 11. Fluid Shifts “Third Spacing”Mechanisms causing third spacing & edema • massive inflammation • venous obstruction • increased blood volume • low serum albumin
  12. 12. Components in body fluids Electrolyte • an element that when dissolved can carry an electrical current • Cations - (+) ; Anions - (-) • neuromuscular function • acid-base balance
  13. 13. Components of body fluids Minerals • ingested compounds • serve as catalysts in nerve response, muscle contraction, and metabolism of nutrients in foods, regulate electrolyte balance
  14. 14. Movement of body fluids Diffusion • Area of higher concentration to an area of lower concentration till even distribution Osmosis • Movement of a pure solvent, e.g. water through a semipermeable membrane from a solution that has a lower solute concentration to one that has a higher solute concentration
  15. 15. Osmotic pressure Drawing power of water (dependent on the number or molecules in solution) • Isotonic • Hypotonic • Hypertonic
  16. 16. Movement of body fluids Filtration • Water and diffusible substances move together in response to fluid pressure Active transport • Requires energy • Able to move larger molecules and go from less to greater concentration
  17. 17. Fluid Intake Hypothalamus - thirst control center Oral fluid intake requires an alert state Osmoreceptors - monitor osmolality
  18. 18. Fluid Output Loss through the kidneys and GI tract Insensible Sensible
  19. 19. Cations Sodium (Na+) • Most abundant in the extracellular fluid • Maintains water balance, transmits nerve impulses, contracts muscles • Values - 135-145 mEq/L
  20. 20. Cation Potassium (K+) • Major intracellular cation • Regulates neuromuscular excitability, muscular contraction, and acid-base • Value - 3.5 -5.3 mEq/L
  21. 21. Cation Calcium (Ca2+) • Cardiac conduction, blood coagulation, bone growth and formation, & muscular relaxation • Value - 4 - 5 mEq/L
  22. 22. Cation Magnesium (Mg2+) • Second most important of intracellular fluids • Enzyme activities, muscular excitability • Value - 1.5 - 2.5 mEq/L
  23. 23. Electrolyte Imbalances Hyponatremia • GI losses, sweating, & diuretics • S/S: N/V/D, abd cramps, personality change Hypernatremia • Ingestion of large amounts • S/S: Dry tongue and mucous membranes, restlessness, convulsions, thirst, dry skin
  24. 24. Electrolyte imbalances Hypokalemia Causes: K+ wasting diuretics N/V/D polyuria S/S: weak, irregular pulse • hypotension • weakness
  25. 25. Electrolyte imbalances Hyperkalemia • Causes: Renal failure • S/S: irregular slow pulse, weakness, irritability
  26. 26. Electrolyte Imbalances Hypocalcemia • Causes: Vitamin D deficiency • S/S: Numb and tingling fingers and circumoral region, muscle cramps Hypercalcemia • Causes: osteoporosis, prolonged immobilization • S/S: decreased muscle tone, weakness, lethargy, kidney stones
  27. 27. Electrolyte imbalances Hypomagnesemia • Causes: malnutrition and alcoholism polyuria • S/S: muscular tremors, hyperactive deep tendon reflexes Hypermagnesemia • Causes: Renal failure • S/S: hypoactive deep tendon reflexes, shallow and slow respirations
  28. 28. Acid - Base Balance Blood pH - 7.35 - 7.45 paCO2 - 35 - 45 Bicarbonate (HCO3) - 22-26 mEq/L
  29. 29. Respiratory Acidosis pH < 7.35 paCO2 > 45 mm Hg Causes: Respiratory failure Hypoventilation Resp muscles paralysis Airway obstruction
  30. 30. Respiratory Alkalosis pH > 7.45 paCO2 < 35 mm Hg Causes: excessive exhalation of CO2 (hyperventilation)
  31. 31. Metabolic Acidosis pH < 7.35 bicarbonate - < 22 mEq/L Causes: Starvation, DKA, Diarrhea, drug use
  32. 32. Metabolic Alkalosis pH > 7.45 bicarbonate > 26 mEq/L Causes: excessive vomiting, prolonged gastric suctioning
  33. 33. Fluid & Electrolyte Imbalances Burns - body fluid loss Renal D/O - abnormal retention of Na, Cl, K GI Disturbances - Loss of fluid, potassium, and chloride Exercise
  34. 34. S/S electrolyte imbalance Head: irritability Fontanels: depressed, bulging Eyes: sunken periorbital edema Mouth: mucous membranes CV: neck veins, edema, blood pressure
  35. 35. Imbalances GI: abdomen, V/D Renal: Oliguria or anuria (FVD, FE) Diuresis (FVE) Increased urine spec. gravity (FVD) Skin (Temp) • increased - met acidosis, hypernatremia • decreased - FVD
  36. 36. Replacement of fluids andelectrolytes Types of IV fluids Isotonic Hypertonic Hypotonic
  37. 37. IV complications Infiltration • IVF enter SQ space Phlebitis • vein inflammation • S/S: pain, redness, warmth Fluid overload • Fluids given too rapidly Bleeding
  38. 38. Discontinuing an IV Stop infusion Remove tape 1 - 2 minute pressure
  39. 39. Blood transfusions Large bore catheter (18 ga or larger) Give with normal saline Baseline vital signs Double check with two RNs Begin transfusion slowly Observe closely for first 15 min
  40. 40. Transfusion Reactions Caused by: • blood incompatibility • allergic sensitivity • S/S: fever, chills, rash, hypotension, shock Treatment: stop transfusion, give NS, save tubing, prepare for emergency drugs
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