Fluids and electrolytes (1)

FLUIDS and ELECTROLYTES

BODY FLUIDS

Functions of Fluids

 Body fluids:
 Facilitate in the transport [nutrients,
hormones, proteins, & others…]
 Aid in removal of cellular metabolic wastes
 Provide medium for cellular metabolism
 Regulate body temperature
 Provide lubrication of musculoskeletal jts.
 Component in all body cavities [parietal,
pleural… fluids]

 Water is the principal body fluid & essential for life.


BODY FLUIDS

Distribution of Body Fluids – 50-70% of total body weight;
infant [70-80%], elderly [45-50%]

ICF ECF
60-kg man
TBW = 0.6 x 60 kg = 3.6 L

ICF = 0.4 x 60 kg ECF
P IS
= 24 L = 12 L

3L 9L

40% TBW 20% TBW


BODY FLUIDS

Factors that Dictate Body Water Requirement

1) Amount needed to give the proper osmotic
concentration
2) Amount needed to replace water lost excretion
Normal Routes of water gain and loss
INTAKE ml/day OUTPUT ml/day

Fluid intake 1,200 Insensible loss 700
Food 1,000 Sweat 100
Metabolic water 300 Feces 200
Urine 1,500
TOTAL 2,500 TOTAL 2,500


FLUID EXCHANGE BETWEEN BODY FLUID
COMPARTMENTS

ICF ECF

Osmotic Pressure Gradient

Oncotic P (Colloid osmotic P)

Capillary P (Hydrostatic P)

P ISF


Control of Osmotic Pressure, Volume & Electrolyte
Concentration

OBLIGATORY Reabsorption
 occurs in the proximal tubules
 178 L/day of glomerular filtrate (80%
reabsorbed)
 2° to solute reabsorption
 independent of the water requirement

FACULTATIVE Reabsorption
 occurs in the distal & collecting tubules
 independent of the active solute transport
 dependent of body’s need of water
 under the control of ADH


DISTURBANCES IN FLUID BALANCE

EDEMA (Dropsy)

 ↑ in the interstitial fluid volume of about 2 L or
more due to increase transudation of fluid from
capillaries 2° to:

 Increased HP [pregnancy, CHF]
 Decreased OP [malnutrition, end-stage liver
dse, nephrotic syndrome]



CELL OVERHYDRATION

 excess of water in the ECC w/ a normal amount
of solute or a deficient amount of solute
 occurs in prolonged and excessive diuresis,
forcing hypotonic fluids to produce diuresis in
the presence of renal impairment
 fluid overload from ↑ production of adrenal
corticoid hormones [Cushing’s syndrome]



CELL OVERHYDRATION

 Symptoms
 Weight gain & edema
 Cough, moist rales, dyspnea [fluid congestion in
lungs]
 CVP, bounding pulse,neck vein engorgement
[fluid excess in the vascular system]
 Bulging fontanelles
 ↓ Hg and Hct
 Nausea & vomiting



CELL OVERHYDRATION

 Management
 Restrict fluids to lower fluid volume
 Diuretics or hypertonic saline
 Continuous assessments to prevent skin
breakdown
 Record daily weight to assess progress of
treatment



CELL DEHYDRATION (DHN)
 loss of body fluids, particularly from the
extracellular fluid compartment
 water loss > water intake

 Causes
 Fever
 Insufficient water intake
 Diarrhea, vomiting
 Excess urine output [Diabetes insipidus,
diuretics]
 Excessive perspiration, burns
 Hemorrhage, shock, metabolic acidosis



CELL DEHYDRATION (DHN)

 Symptoms
 Thirst, dry mucus membranes, sunken
eyeballs
 “Doughy“ abdomen, dry skin w/ poor turgor
 ↑ temp, weight loss
 ↑ HR, ↑ RR, ↓ BP
 Restlessness,irritability, disorientation,
convulsion, coma [22-30% body H20 loss]
 Management
 Fluid replacement therapy & continued fluid
maintenance


Volume Disorders 2° Alteration in Sodium Balance
Volume ECF ICF Water Conditions
Disorder Vol. Vol. Shift

Expansion
Isotonic Inc N No net change Isotonic fluid
ingestion
Hypertonic Inc Dec ICF → ECF Sea water
ingestion
Hypotonic Inc Inc ECF → ICF Hypotonic IVF

Contraction
Isotonic Dec N No net change Diarrhea
Hypertonic Dec Dec ICF → ECF Diabetes insipidus
Hypotonic Dec Inc ECF → ICF Addison’s dse


ELECTROLYTES

 salts or minerals in extracellular or intracellular
body fluids

 Sodium – major cation of ECF

 Potassium – major cation of ICF

 Chloride - major anion of ICF

 Protein – in ICF > ISF


ELECTROLYTE Composition

Electrolyte Conc Plasma (mEq/L) ISF ICF

Sodium, Na+ 142 141 10
Potassium, K+ 5 4.1 150
Calcium, Ca++ 5 4.1 -
Magnesium, Mg++ 3 3 40
(155)
Chloride, Cl- 103 115 15
Bicarbonate, HCO3- 27 29 10
Biphosphate, HPO4- 2 2 100
Sulfate, SO4-2 1 1 20
Protein 16 1 60
Organic foods 6 3.4 -
(155)


ELECTROLYTES

Functions of Electrolytes

 Contribute most of the osmotically active
particles in body fluids

 Provide buffer systems for pH regulation

 Provide the proper ionic environment for
normal neuromuscular irritability & tissue
function


ELECTROLYTES
Hyponatremia [Na+ < 135 mEq/L; Normal = 135-145 mEq/L]

 Causes
 ↓ Na+ intake
 ↑ Na+ excretion [diaphoresis, GI suctioning]
 Adrenal insufficiency

 Assessment
 N & V, abdominal cramps, weight loss
 Cold, clammy skin, ↓ skin turgor
 Apprehension, HA, convulsions, focal
neurologic deficit, coma [cerebral edema]
 Fatigue, postural hypotension
 Rapid thready pulse


ELECTROLYTES

Hyponatremia [Na+ < 135 mEq/L; Normal = 135-145 mEq/L]

 Management
 Provide foods high in sodium
 Administer NSS IV
 Assess blood pressure frequently
[measure lying down, sitting & standing]


ELECTROLYTES

Hypernatremia [Na+ >145 mEq/L; Normal = 135-145 mEq/L]

 Causes
 Excessive, rapid IV adm’n of NSS
 Inadequate water intake
 Kidney disease

 Assessment
 Dry, sticky mucus membranes
 Flushed skin
 Rough dry tongue, firm skin turgor
 Intense thirst
 Edema, oliguria to anuria
 Restlessness, irritability [cerebral DHN]


ELECTROLYTES

Hypernatremia [Na+ >145 mEq/L; Normal = 135-145 mEq/L]

 Nursing Intervention
 Weigh daily
 Assess degree of edema frequently
 Measure I & O
 Assess skin frequently & institute nursing
measures to prevent breakdown
 Encourage sodium-restricted diet


ELECTROLYTES

Hyperkalemia [K+ > 5.5 mEq/L; Normal = 3.5-5.5 mEq/L]

 Causes
 Renal insufficiency
 Adrenocortical insufficiency
 Cellulose damage [burns]
 Infection
 Acidotic states
 Rapid infusion of IV sol’n w/ potassium-
conserving diuretics


ELECTROLYTES


 Assessment
 Thready, slow pulse
 Shallow breathing
 N & V, diarrhea, intestinal colic
 Irritability
 Muscle weakness, flaccid paralysis
 Numbness, tingling
 Difficulty w/ phonation, respiration


ELECTROLYTES


 Nursing Interventions
 Administer kayexalate as ordered
 Administer/monitor IV infusion of glucose
& insulin
 Control infection
 Provide adequate calories & carbohydrates
 Discontinue IV or oral sources of K+


ELECTROLYTES

Hypokalemia [K+ < 3.5 mEq/L; Normal = 3.5-5.5 mEq/L]

 Causes
 Renal insufficiency
 Adrenocortical insufficiency
 Cellulose damage [burns]
 Infection
 Acidotic states
 Rapid infusion of IV sol’n w/ potassium-
conserving diuretics


ELECTROLYTES


 Assessment
 Thready, rapid, weak pulse
 Faint heart sounds
 ↓ BP
 Skeletal muscle weakness
 ↓ or absent reflexes
 Shallow respirations
 Malaise, apathy, lethargy
 Loss of orientation
 Anorexia, vomiting, weight loss
 Gaseous intestinal distention


ELECTROLYTES


 Administer K+ supplements to replace
losses
 Be cautious in administering drugs that
are not potassium-sparing
 Monitor acid-base balance
 Monitor pulse, BP and ECG


ELECTROLYTES

Hypercalcemia [Ca > 5.8 mEq/L; Normal = 4.5-5.8 mEq/L]

 Causes
 Hyperparathyroidism
 Immobility
 Increased vitamin D intake
 Osteoporosis & osteomalacia [early stages]

 Assessment
 N & V, anorexia, constipation
 Headache, confusion
 Lethargy, stupor
 Decreased muscle tone
 Deep bone/flank pain


ELECTROLYTES

Hypercalcemia [Ca > 5.8 mEq/L; Normal = 4.5-5.8 mEq/L]

 Encourage mobilization
 Limit vitamin D intake
 Limit calcium intake
 Normal saline
 Administer diuretics
 Calcitonin


ELECTROLYTES

Hypocalcemia [Ca < 4.5 mEq/L; Normal = 4.5-5.8 mEq/L]

 Causes
 Acute pancreatitis
 Diarrhea
 Hypoparathyroidism
 Lack of vitamin D I the diet
 Long-term steroid therapy

 Assessment
 Painful tonic muscle & facial spasms
 Fatigue, dyspnea
 Laryngospasm, convulsions
 (+) Trousseau’s and Chvostek’s signs


ELECTROLYTES

Hypocalcemia [Ca < 4.5 mEq/L; Normal = 4.5-5.8 mEq/L]

 Administer oral Ca lactate or IV CaCl2 or
gluconate
 Providing safety by padding side rails
 Administer dietary sources of calcium
 Vitamin D
 Provide quiet environment


ELECTROLYTES

Hyermagnesemia [Mg > 3.0 mEq/L; Normal = 1.5-3.0 mEq/L]

 Causes
 Renal insufficiency, dehydration
 Excessive use of Mg-containing antacids or
laxatives
 Assessment
 Lethargy, somnolence, confusion
 N&V
 Muscle weakness, depressed reflexes
 ↓ pulse and respirations
 Withhold Mg-cont’g drugs/foods; Ca adm’n
 ↑ fluid intake, unless CI


ELECTROLYTES

Hypomagnesemia [Mg < 1.50 mEq/L; Normal = 1.5-3.0 mEq/L]

 Causes
 Low intake of Mg in the diet
 Prolonged diarrhea
 Massive diuresis
 Hypoparathyroidism
 Assessment
 Paresthesias, muscle spasm
 Confusion, hallucination, convulsions
 Ataxia, tremors, hyperactive deep reflexes
 Flushing of the face, diaphoresis
 Provide good dietary sources of Mg


IV FLUID REPLACEMENT THERAPY

Indications

 Replacement of abnormal fluid & electrolyte
losses [surgery, trauma, burns, GI bleeding]

 Maintenance of daily fluid & electrolyte needs

 Correction of fluid disorders

 Correction of electrolyte disorders


IV FLUID REPLACEMENT THERAPY

Types of Solutions

 Isotonic
 0.9% sodium chloride (NSS)
 Lactated Ringer’s sol’n
 Hypotonic
 5% dextrose and water (D5W)
 0.45% sodium chloride
 0.33% sodium chloride
 Hypertonic
 3% NaCl
 Protein sol’ns
 Colloids
 Salt pour albumin Plasmanate, Dextran

BURNS

BURNS
 wounds caused by excessive exposure to the
following agents or causes:

Causes of Burns:

 Thermal [moist or dry heat]
 Electrical
 Chemical [strong acids and strong alkali
 Radiation [UV, x-rays, radium, sunburns]

BURNS

CLASSIFICATION OF BURNS

 Superficial Partial thickness (1st degree)
 Outer layer of dermis
 Erythema, pain up to 48 hrs
 Healing 1-2 wks [sunburn]
 Deep Partial thickness (2nd degree)
 Epidermis & dermis
 Blisters & edema, frequently quite painful
 Healing 14-21 days
 Full thickness (3rd degree)
 Epidermis, dermis, subcutaneous fat
 Dry, pearly white or charred in appearance
 Not painful
 Eschar must be removed; may need grafting

BURNS

STAGES OF BURNS

1st: Shock/Fluid Accumulation Phase

 1st 48 hrs
 IVC → ISC
 Generalized DHN [fluid shifting]
 Hypovolemia [plasma loss], ↓ BP, ↓ C.O.
 Hemoconcentration, ↑ Hct [liquid blood
component → ISC]
 Oliguria [↓ renal perfusion], ADH release &
aldosterone
 HyperK, hypoNa
 Metabolic acidosis

BURNS

STAGES OF BURNS

2nd: Diuretic/Fluid Remobilization Phase

 After 48 hrs
 ISC → IVC
 Hypervolemia,
 Hemodilution, ↓ Hct
 Diuresis [↑ renal perfusion], ↓ ADH &
aldosterone secretion
 HypoK, hypoNa [K moves back into the cells,
Na+ still trapped in the edema fluids
 Metabolic acidosis

BURNS

STAGES OF BURNS

3rd: Recovery Phase

 5th day onwards
 Hypocalcemia
 Ca is lost on the exudates
 Ca is utilized in the granulation tissue
formation
 Negative nitrogen balance
 Due to stress response
 ↑ protein catabolism
 Protein intake is lesser than the demand
 HypoK

BURNS

ASSESSMENT

1. Assess extent of body surface burned
 Greater morbidity & mortality for burns
affecting face, hands & perineum
 Assess for dyspnea, stridor, hoarseness

2. Assess extent of burn injury
 Rule of nine – immediate appraisal
 Lund-Browder chart – more accurate
 Berkow’s method – based on client’s age &
changes that occur in proportion of head & legs
to the rest of the body as one grows

BURNS

ASSESSMENT
9%

Front=18%
9% Back=18% 9%

1%
Burn Evaluation
18% 18% Chart

BURNS

ASSESSMENT

3. Assess depth of burn
 Major burns – 2nd degree over 30% of body
 Hospitalization - eyes, face, neck, hands,
perineum, genitalia

4. Assess unique contributing factors
 Age of client
 Health history
 Diabetes, preexisting ulcers
 Tetanus immunization

BURNS

EMERGENCY MANAGEMENT

Stop the burning process
 Remove patient from source of injury
 Advise client to roll on the ground if clothing is
in flame [STOP-DROP-ROLL]
 Throw a blanket over the client to smother the
flame
 Remove clothing only if hot or for scald burn
 Immerse affected part in cold water [10 min]
 Irrigate copiuosly w/ large amount of running
water w/ chemical burns [except w/
phosphorus]
 Interrupt power source w/ electrical burn

BURNS

MANAGEMENT

 Maintenance of adequate airway

 Promoting comfort: relieve pain

 Promoting fluid-electrolyte, acid-base balance

 Preventing infection

 Maintaining adequate nutrition

 Wound care

BURNS

METHODS OF TREATING BURNS

 Open method or Exposure method
 Face, neck, perineum, trunk
 Allowing exudate to dry in 3 days

 Occlusive
 Less pain, absorption of secretion, comfort,
transportability, accelerated debridement
 Aesthetic considerations

 Semi-open method
 Covering of wound w/ topical antimicrobials:
 Silver sulfadiazine 1% (Flamazine)
 Silver nitrate 0.5% sol’n
 Mafenide acetate (sulfamylon acetate)

BURNS

BIOLOGIC DRESSING (Skin Graft)

 Allograft
 Skin taken from other person [cadaver]

 Autograft
 Same person

 Heterograft
 Different species
 Xenograft [segment of skin from animal
such as pig or dog]

BURNS

FLUID REPLACEMENT

Types of fluids:

 Colloids
 Blood
 Plasma & plasma expanders
 Electrolytes
 Lactated Ringers
 Non-electrolyte
 D5W

BURNS

FLUID REPLACEMENT

EVAN’S Formula:

 C – 1ml x % burns x kgBW
 E - 1ml x % burns x kgBW
 Glucose 5% for insensible loss – 2,000ml D5W

 Administer sol’n 1st 24 hrs – ½ [1st 8hrs], ½ [16hrs]

BROOKE Formula: [Administer as in Evan’s]

 C – 0.5ml x % burn x kgBW
 E - 1.5ml x % burns x kgBW
 Water – 1000ml D5W

BURNS

FLUID REPLACEMENT

MOORES BURN BUDGET:

 75 ml of plasma, 75 ml of electrolyte-cont’g
fluid for q 1%TBSA plus 2000 D5W

HYPERTONIC RESUSCITATION Formula:

 Hypertonic salt containing 300mEq of Na+,
100mEq of Cl-, 200mEq lactate
 Administered to maintain urinary output of
30-40 ml/hr

Fluids and electrolytes (1)

Recommended

Recommended

More Related Content

What's hot

What's hot (20)

Viewers also liked

Viewers also liked (12)

Similar to Fluids and electrolytes (1)

Similar to Fluids and electrolytes (1) (20)

Recently uploaded

Recently uploaded (20)

Fluids and electrolytes (1)