Fluid balance

1. Electrolyte Functions
• Regulate water distribution
• Muscle contraction
• Nerve impulse transmission
• Blood clotting
• Regulate enzyme reactions (ATP)
• Regulate acid-base balance

2. Sodium (Na++)
Functions
• Regulates volume of body fluids
• Maintains water balance
• Regulates ECF
• Maintain blood pressure
• Generation and transmission of nerve
impulses , muscles contruction.
• Sodium-Potassium pump

3. Hyponatremia
Definition
• Hyponatremia represents a decrease in
plasma sodium concentration below 135
mmol/L.

4. Hyponatremia (<135mEq/L)
Contributing Factors
Excessive diaphoresis
NPO,burns,
Low salt diet
Diarrhea,vomiting
CHF
Renal , liver Disease
Diuretics

5. Hyponatremia (<135mEq/L)
Symptoms:
• Cerebral edema
• Nausea, vomiting, lethargy, confusion,
seizures, coma.

6. Hyponatremia (<135mEq/L)
Assessment findings:
• Neuro - Generalized skeletal muscle weakness.
Headache / personality changes.
CV - Cardiac changes depend on fluid volume
• GI – Increased GI motility, Nausea, Diarrhea
(explosive)
• GU - Increased urine output

7. Hyponatremia (<135mEq/L)
Interventions/Treatment
• Restore Na levels to normal and prevent further
decreases in Na.
• Drug Therapy –
• (FVD) - IV therapy to restore both fluid and Na. If
severe may see 2-3% saline.
• (FVE) – Administer osmotic diuretic (Mannitol) to
excrete the water rather than the sodium.
• Increase oral sodium intake and restrict oral fluid
intake.

8. Hypernatremia
• Definition
Hypernatremia implies a plasma sodium
level above 145 mmol /L.

9. Causes of hypernatremia
• Excessive Water Losses
• Decreased Water Intake
• Excessive Sodium Intake

10. Hypernatremia (>145mEq/L)
Contributing Factors
• Hyperaldosteronism
• Renal failure
• Corticosteroids
• Increase in oral Na intake
• Na containing IV fluids(hypertonic)
• Decreased urine output with increased urine
concentration

11. Manifestations of hypernatremia
• Thirst and signs of increased ADH levels
• Oliguria or anuria
• Intracellular dehydration
• Dry skin and mucous membranes
• tongue rough
• decreased salivation
• Signs related to hyperosmolality of ECF and movement of
water out of brain cells
• Headache, agitation and restlessness, seizure and
coma

12. Hypernatremia (>145mEq/L)
• Contributing factors (cont’d):
• Watery Diarrhea
• Dehydration
• Fever

13. Hypernatremia (>145mEq/L)
• Assessment findings:
• Neuro - Spontaneous muscle twitches.
Irregular contractions. Skeletal muscle
weakness.
• Resp. – Pulmonary edema
• CV – Diminished HR and BP depend on
vascular volume.

14. Hypernatremia (>145mEq/L)
• GU – Dec. urine output.
• Skin – Dry, flaky skin. Edema r/t fluid
volume changes.

15. Hypernatremia (>145mEq/L)
Interventions/Treatment
• Drug therapy
• (FVD) .45% NSS. If caused by both Na and
fluid loss, will administer NaCL. If inadequate
renal excretion of sodium, will administer
diuretics.
• Diet therapy
• Mild – Ensure water intake