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Fluid & Electrolytes  Balance
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Fluid & Electrolytes Balance

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  • 1. Overview of Fluids, Electrolytes Balance MOHAMMED ALHABSI INDANAN,RN Clinical Instructor King Abdul Aziz Specialist Hospital-Taif
  • 2. sketch out of my talks
    • Concept of Fluid & Electrolyte Balance:
    • Properties & components of Electrolytes
    • Description & Measurement of Electrolytes
    • Body Fluid Compartments
    • Third Spacing
    • Edema
    • Description & Constituent of Body Fluids
    • Body Fluid Transport
    • Movement of Body Fluid
    • Body Fluid Excretion
  • 3. Surah AL- MURSALAT (Those Sent Forth)
    • ” ألم نخلقكم من ماء مهين“
    • سورة المرسلات آيه 20
    • “ Have We not created You from a fluid (Held) despicable?” Holy Qur’an
  • 4. Body Fluids Body Water = 60% of a patient’s body weight 16% 4% 40% Figure 1-1
  • 5. Fluid Compartments
    • Intracellular space
    • Extracellular space
        • Interstitial
        • Intravascular
  • 6.
    • Solute
    • the substance that dissolved
    • Solvent
    • substance in which solute is dissolved
    • Osmolality
    • concentration of solute per kg of water
    • Osmolarity
    • concentration of solute per L of solution
    • Solution - substance that dissolve in other substances
  • 7. Composition of the Body Fluids
    • The fluids circulating throughout the body in ECF & ICF spaces contain:
    • Electrolytes
    • Minerals
    • Cells
  • 8. Movement of BODY FLUIDS
    • Diffusion
    • Osmosis
    • Active Transport
    • Filtration
  • 9. Definition:
    • Diffusion is the natural tendency of a substance to move from an area of higher concentration to one of lower concentration.
    • Osmosis fluid shift to the membrane from the region of low concentration to the region of high concentration.
    • Active Transport this is movement of molecules against a concentration as they move from an area of lower concentration to an area of higher concentration and requires an energy.
    • Filtration movement of water & solutes occurs from an area of high hydrostatic pressure to an area of low.
  • 10. Osmosis Figure 2. Fluid High Solution Concentration, Low Fluid Concentration Low Solute Concentration, High Fluid Concentration
  • 11. Diffusion High Solute Concentration Low Solute Concentration Fluid Solutes Figure 3.
  • 12. Active transport K + K + K + K + K + K + K + K + K + K + K + K + K + K + K + K + K + ATP ATP ATP ATP Na + Na + Na + Na + Na + Na + Na + Na + Na + Na + Na + Na + Na + Na + Na + Na + Na + Na + Na + Na + Figure 4. INTRACELLULAR FLUID EXTRACELLULAR FLUID
  • 13. BLOOD VESSEL NORMAL CELL ISOTONIC
  • 14. BLOOD VESSEL SHRUNKEN CELL HYPERTONIC
  • 15. HYPOTONIC BLOOD VESSEL SWOLLEN CELL
  • 16. Electrolytes
    • Chemically, electrolytes are substances that become ions in solution & acquire the capacity to conduct electricity.
    • Essential for normal function of the cells & our organs.
    • Sodium, Potassium, chloride, & Bicarbonate
  • 17. Sodium (Na)
    • 135 to 145 mEq/L (135-145 mmol/L)
    • Major positive ion in fluid outside the cells.
    • Regulates the total amount of water in the body & the transmission of into & out of cells.
  • 18. Potassium (K+)
    • 3.5 to 5.0 mEq/L (3.5 to 5.0 mmol/L)
    • Major positive ion found inside the cells.
    • Regulation of the heartbeat & function of the muscles.
  • 19. Chloride (Cl-)
    • 98 to 108 mmol/L
    • Major anion (negatively charged ion) found outside the cells & in the blood.
    • Helping the body maintain a normal balance of fluids
  • 20. Bicarbonate (HCO3)
    • 22 to 30 mmol/L
    • Acts a buffer to maintain the normal level of pH in the blood & other fluids in the body.
    • Measured to monitor the acidity of the blood & body fluids.
  • 21. Third Spacing
    • Occurs when the fluid is “trapped” in the interstitial spaces.
    • Fluids shifts from the vascular space into an area where it is not readily accessible as extracellular fluid.
    • This fluid is remains in the body but is essentially unavailable for use, causing an isotonic fluid volume deficit.
    • Pt. may not manifest fluid loss or weight loss.
  • 22. Decreased Oncotic Pressure
    • Loss of albumin or protein leads to decreased oncotic pressure, causing fluid to “leak” from the intravascular space to the interstitial space
    • Due to the loss in circulating fluid volume, cardiac output decreases
  • 23. Causes of Fluid Shifts
    • Albumin losses can occur in liver failure, liver dysfunction, and malnutrition
    • Albumin losses can lead to fluid shifting into the peritoneum, causing ascites
    • Destruction of endothelial cells, such as in bowel surgery, can cause fluid to move and be trapped in the interstitial spaces
    • Fluid trapped in the lungs can lead to pulmonary edema
  • 24. Inside the Cells
    • Interstitial fluid trapping can cause compression of the microvasculature, resulting in hypoperfusion and ischemia
    • Inflammatory “mediators” are released into the bloodstream, which can lead to systemic inflammatory response syndrome (SIRS)
    • Multiple organ dysfunction syndrome (MODS) occurs, leading to organ failure and death
  • 25. What Happens When Fluids Shift?
    • With decreased circulating volume, baroreceptors in the aorta are activated
    • Sympathetic nervous system releases epinephrine and norepinephrine, causing vasoconstriction and an increased heart rate
    • Kidneys launch the renin-angiotensin-aldosterone system in response to a lower glomerular filtration rate
    • All this happens with the goal of increasing circulating volume, blood pressure, and cardiac output
  • 26. Fluid Shift in the Bowel
    • Causes abdominal distention
    • Measure bladder pressure and abdominal girth at least every 4 to 8 hours while signs are abnormal.
  • 27. Monitoring the Patient
    • Fluid shift will either resolve over the next several hours (up to 48 hours) or the patient will continue to develop bowel edema and, eventually, ischemia
    • Closely monitor vital signs, urine output, peripheral perfusion, mental status, ventilation/perfusion status, hematocrit/hemoglobin, serum electrolytes (elevated lactate may indicate bowel ischemia)
  • 28. Fluid Resuscitation
    • Administer maintenance I.V. isotonic fluid plus intermittent colloids (i.e., albumin); pulls fluid from the interstitial spaces into the intravascular space
    • Small dose of a loop diuretic, such as furosemide (Lasix) may be ordered if kidneys can’t get rid of the excess fluid
    • If hemoglobin is low, infuse blood products, such as packed red blood cells, as ordered to help increase oxygen and pull fluid from the interstitial space
  • 29. EDEMA
    • In fluid volume excess, both intravascular & interstitial spaces have an increased water & Na content.
    • Excess interstitial fluid
    • Most apparent areas where the tissue pressure is low like around the eye.
    • Dependent tissues known as dependent edema , where hydrostatic capillary pressure is high.
  • 30. 3 MAIN MACHANISM OF EDEMA
    • Increase capillary hydrostatic pressure
    • Decrease plasma oncotic pressure
    • Increase capillary permeability
  • 31.
    • Due to FVE that increase capillary hydrostatic pressure, pushing fluids into the interstitial tissues. This type of edema seen in dependent tissue such as feet, ankles, & sacrum.
    • Low level of plasma proteins from malnutrition or liver or kidney disease can reduce the plasma oncotic pressure.
    • With tissue trauma & some disorders like allergic reactions, capillaries becomes more permeable, allowing fluid to escape into interstitial tissues.
  • 32. Pitting Edema
    • That leaves a small depression or pit after finger pressure is applied to the swollen area.
    • The pit is caused by movement of fluid to adjacent tissue, away from the point of pressure.
    • Within 10 to 30 seconds the pit normally disappears.
  • 33.
    • Magsukul