Fluid and electrolyte imbalance and Factors affecting fluid and electrolyte imbalance. Disturbance in fluid volume.

1. BODY FLUID AND ELECTROLYTE
BALANCE
Presented By:-
Ms. Saroj Kamboj
Associate Professor
Dept. of CHN
PDMNC Subharti University

2. INTRODUCTION
 Fluid balance is a term used to describe the balance of input and output of
fluids in the body, to allow metabolic processes to function properly.
 Fluid and electrolyte balance is one of the key issues in maintaining
homeostasis in the body, and it also plays important roles in protecting
cellular function, tissue perfusion and acid-base balance. Fluid and
electrolyte balance must also be maintained for the management of many
clinical conditions.

4. FUNCTION OF WATER
 APPROXIMATELY 60% OF THE HEALTHY ADULT’S WEIGHT IS WATER.,THE PRIMARY BODY
FLUID. IN GOOD HEALTH THIS VOLUME REMAINS RELATIVELY CONSTANT AND PERSON
WEIGHT VARIES BY LESS THAN 0.2KG IN 24 HOURS. REGARDLESS OF THE AMOUNT OF
FLUID INGESTED.
WATER IS VITAL TO HEALTH AND NORMAL CELLULAR FUNCTION SERVING AS :-
 A MEDIUM OF METABOLIC REACTIONS WITHIN CELL.
 A TRANSPORT FOR NUTRIENT, AND WASTE PRODUCTS AND OTHER SUBSTANCES.
 A LUBRICANT
 REGULATING AND MAINTANING BODY TEMPERATUE.

6. DITRIBUTION OF BODY FLUID
 THE BODY’S FLUID IS DIVIDED INTO TWO MAJOR COMPARTMENT:-
 INTRACELLULAR FLUID:-
 IS FOUND WITHIN CELLS IN THE BODY. IT CONSTITUTES APPROXIMATELY TWO THIRDS OF BODY FLUID IN
ADULT.
 EXTARCELLULAR FLUID:-
 IT IS FOUND OUTSIDE THE CELLS IN BLOOD, LYMPH, IN BODY CAVITIES, MUSCULAR AND OTHER BODY
TISSUES. IT IS APPROXIMATE ONE THIRD OF THE BODY FLUID.
 IT IS SUBDIVIDED INTO TWO COMPARTMENTS , INTRAVASCULAR AND INTERSTITIAL.
 INTRAVASCULAR FLUID IS WHOLE BLOOD BLOOD VOLUME AND ALSO INCLUDES RBC, WBC, PLASMA AND
PLATELETS . APPROXIMATE 20%.
 INTERSTITIAL FLUID :- FLUID FOUND IN THE SPACES AROUND CELLS. IT HELPS BRING OXYGEN AND
NUTRIENTS TO CELLS AND TO REMOVE WASTE PRODUCTS FROM THEM.

8. REGULATING BODY FLUID
 NORMALLY FLUID INTAKE AND FLUID LOSS ARE BALANCED. ILLNESS CAN
UPSET THIS BALANCE SO THAT THE BODY HAS TOO LITTLE OR TOO
MUCH FLUID.
 FLUID INTAKE:- DURING PERIOD OF MODERATE ACTIVITY AT MODERATE
TEMPERATURE THE AVERAGE ADULT DRINKS ABOUT 1500 ML PER DAY
BUT NEEDS 2500 ML, AN ADDITIONAL 1000ML, THIS ADDED VOLUME
ACQUIRED FROM FOOD. THE WATER CONTENT FROM FRESH FRUIT AND
VEGETABLE APPROXIMATE 750 ML PER DAY.

9.  FLUID OUTPUT:-
 URINE:- NORMAL URINE OUTPUT FOR AN ADULT IS 1400 -1500 ML PER
DAY
 THROUGH THE SKIN AS PERSPIRATION ;- 300 TO 400 ML PPER DAY
 LOSS THROUGH THE INTESTINE IN FECES;- 100 TO 200 ML

11. ELECTROLYTE IMBALENCE
Electrolytes are minerals that carry an electric charge.
They're found in our blood, urine and sweat and are vital to
specific processes that keep our body functioning as it
should.
Electrolytes are essential for basic life functioning, such as
maintaining electrical neutrality in cells, generating and
conducting action potentials in the nerves and
muscles. Sodium, potassium, and chloride are the
significant electrolytes along with magnesium, calcium,
phosphate, and bicarbonates.

12. THE REGULATORY MECHANISM AND FUNCTIONS
OF THE MAJOR ELECTROLYTE ARE:-
 SODIUM (+)
 Sodium plays a critical role in helping your cells maintain the right balance
of fluid. It’s also used to help cells absorb nutrients. It’s the most abundant
electrolyte ion found in the body.
 Hypernatremia (too much sodium): Can cause confusion or behaviour
changes, unusually strong reflexes and loss of muscle control, seizures and
coma.
 Hyponatremia (not enough sodium): Confusion, irritability, weakened
reflexes, nausea and vomiting, seizures and coma.

13. MAGNESIUM (+)
 Magnesium helps your cells as they turn nutrients into energy. Your brain and muscles
rely heavily on magnesium to do their job.
 Hypomagnesemia (too much magnesium): Heart rhythm changes and arrhythmias,
weakened reflexes, decreased ability to breathe and cardiac arrest (your heart stops).
 Hypomagnesemia (not enough magnesium): Muscle weakness, twitching and loss of
control, heart arrhythmias. This commonly happens in connection with calcium and
potassium deficiencies.

14. POTASSIUM (+)
 Your cells use potassium alongside sodium. When a sodium ion enters a cell, a potassium
ion leaves, and vice versa. Potassium is also especially critical to your heart function. Too
much or too little can cause serious heart problems.
 Hyperkalemia (too much potassium): Weakness, inability to move muscles, confusion,
irregular heart rhythms (arrhythmias).
 Hypokalemia (not enough potassium): Muscle weakness and cramps, feeling unusually
thirsty and needing to pee frequently, dizziness or passing out when standing up too
quickly. At higher levels, muscle tissue begins to break down (a condition called
rhabdomyolysis, which can severely damage your kidneys) and heart arrhythmias become
a serious threat.

15. CALCIUM (+)
 Calcium is a key element in your body, but it does more than just build strong bones and teeth. It’s
also used to control your muscles, transmit signals in your nerves, manage your heart rhythm and
more. Having too much or too little calcium in your blood can cause a wide range of symptoms
across different systems in your body.
 Hypercalcemia (too much calcium)
 Brain: Headache, fatigue, apathy and confusion.
 Digestive tract: Constipation, abdominal pain and vomiting.
 Kidneys: Frequent need to pee, kidney stones and kidney failure.
 Heart: Arrhythmias, some of which can be severe.
 Skeletal: Pain in the bones and joints.

16. Hypocalcemia (not enough calcium)
Brain: Confusion and behavior changes.
Muscles: Unusually strong reflexes and loss of muscle control,
muscle twitching, spasms in the throat muscles making it hard
to speak or breathe.

17.  Chloride (the name for a chlorine ion) is the second-most abundant ion in the body. It’s
also a key part of how your cells maintain their internal and external balance of fluid. It
also plays a role in maintaining the body’s natural pH balance.
 Hyperchloremia (too much chloride)
 This can cause acidosis, which is when your blood’s acidity is too high. It results in
nausea, vomiting and fatigue, as well as rapid, deeper breathing and confusion. This
usually happens in connection with too much or too little potassium.
 When related to hyperkalemia: When associated with too much potassium, it can cause
severe kidney problems or kidney failure.
 When related to hypokalemia: When connected with too little potassium, it can cause
diarrhea, fluid leakage from the pancreas, and other serious urinary tract problems.
CHLORIDE (-)

18. Hypochloremia (not enough chloride)
This causes your blood to become more alkaline, a
condition called alkalosis. It usually happens with
hyponatremia or vomiting. Symptoms of alkalosis are
apathy, confusion, arrhythmias and muscle twitching or
loss of control.

19. PHOSPHATE (-)
 Hyperphosphatemia (too much phosphate): This typically causes you to experience
hypocalcemia because your body tries to use calcium as a substitute for phosphorus. It
usually doesn’t cause symptoms until it becomes severe, and symptoms of hypocalcemia
also often happen with this. It can also be associated with excessive itching.
 Hypophosphatemia (not enough phosphate): The early symptom of this condition is
usually muscle weakness. As it gets worse, more severe symptoms occur. They include
rhabdomyolysis (breakdown of muscle tissue, which can cause severe kidney damage),
seizures, reduced heart function and trouble breathing (caused by muscle weakness).

20. BICARBONATE (-)
Acidosis. Too little bicarbonate causes acidosis, where your
blood is too acidic. This causes fatigue, nausea and vomiting,
and you will breathe faster and deeper. It can also cause
confusion.
Alkalosis. Too much bicarbonate causes alkalosis, where your
blood becomes too alkaline. Symptoms include confusion,
apathy, arrhythmias and muscle twitching.

23. FACTORS AFFECING FLUID AND ELECTROLYTE
IMBALANCE
AGE :-
infant and growing children have much greater fluid
turnover than adults because their higher metabolic
rate increases fluid loses. infants lose more fluid
through the kidney because immature kidneys.

24. GENDER AND BODY SIZE
Fat Cells Contain Little Or No Water And Lean Tissue Has High
Water Content. People With A Higher Percentage Of Body Fat
Have Less Body Fluid. Women Have Proportionately More Body
Fat And Less Body Water Than Men. In Obese Individuals This
This May Be Even Less.

25. ENVIRONMENTAL TEMPERATURE
People with an illness and those participating in strenuous
activity are at risk for fluid and electrolyte imbalances when the
environmental temperature is high. Both salt and water are lost
through sweating. When only water is replaced, salt deletion is
a risk, may experience fatigue, weakness, headache, and
gastrointestinal symptoms such as anorexia, and nausea, at risk
of heat stroke.

26. LIFESTYLE
Other Factors Such As Diet, Exercise, And Stress Affect Fluid,
Electrolyte, And Acid Base Balance.
Diet: - People With Anorexia Nervosa Or Bulimia Are At Risk For
Severe Fluid And Electrolyte Imbalances Because Of Inadecuate
Intake Or Purging Regimens.

27. DISTURBANCE IN FLUID VOLUME
Fluid and electrolyte disorders are among the most
common clinical problems encountered in the setting
of intensive care. Critical disorders such as severe burns,
trauma, sepsis, brain damage, and heart failure lead to
disturbances in fluid and electrolyte homeostasis.

28. HYPOVOLEMIA
 Fluid Volume Deficit (Hypovolemia) The body loses water all the time. A person responds to the thirst reflex by
drinking fluids and eating foods that contain water. However, if water isn’t adequately replaced, the body’s cells
can lose water. This causes dehydration, or fluid volume deficit. Dehydration refers to a fluid loss of 1% or more
of body weight.
Etiology/Cause
1. Hemorrhage
2. Vomiting
3. Diarrhea
4. Burns
5. Diuretic therapy
6. Fever
7. Impaired thirst

29. SIGNS/SYMPTOMS
; MILD FLUID LOSS:
ORTHOSTATIC HYPOTENSION, INCREASED HEART RATE
RESTLESSNESS, ANXIETY
WEIGHT LOSS MODERATE FLUID LOSS:
CONFUSION, DIZZINESS, IRRITABILITY
EXTREME THIRST,NAUSEA -COOL, CLAMMY SKIN
RAPID PULSE
DECREASED URINE OUTPUT (10-30 ML/HR) SEVERE FLUID LOSS:
DECREASED CARDIAC OUTPUT
UNCONSCIOUSNESS
HYPOTENSION WEAK OR ABSENT PERIPHERAL PULSE

30. HYPERVOLEMIA
Hypervolemia Refers To An Excess Of Fluid
(Water And Sodium) In ECF. The Body Has
Compensatory Mechanisms To Deal With
Hypervolemia. However, If These Fail Signs And
Symptoms May Develop

31. SIGNS AND SYMPTOMS
 Tachypnea ,Dyspnea, crackles
 Rapid or bounding pulse
 Hypertension (unless in heart failure)
 Distended neck and hand veins
 Acute weight gain
 Edema
 Pulmonary edema –
 Dyspnea

32. ACID–BASE IMBALANCE
Acid–base imbalance is an abnormality of
the human body's normal balance of acids
and bases that causes the plasma pH to
deviate out of the normal range (7.35 to
7.45).

33. Respiratory Acidosis
 Respiratory Acidosis
 When You Breathe, Your Lungs Remove Excess Carbon Dioxide From Your
Body. When They Cannot Do So, Your Blood And Other Fluids Become Too
Acidic.
 Symptoms Of Respiratory Acidosis
 Symptoms May Include Fatigue, Shortness Of Breath, And Confusion.

34. METABOLIC ACIDOSIS
Metabolic acidosis occurs either when your body produces too
much acid, or when your kidneys are unable to remove it
properly.
Symptoms of metabolic acidosis
Symptoms can include rapid breathing, fatigue, and confusion.

35. ALKALOSIS
 Alkalosis is when alkaline levels are too high due to decreased carbon dioxide or increased bicarbonate.
 Symptoms of alkalosis
 Symptoms of alkalosis may include:
 Muscle twitching, hand tremor, muscle spasms
 Numbness and tingling
 Nausea
 Vomiting
 Lightheadedness
 Confusion