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Prof. Utham Murali. M.S.,M.B.A.

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 Fluids – Importance & Composition.
 Fluid – Types of Transport.
 Fluid Imbalances – You See & You Do.

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 Between 50% and 60% of the human body by
weight is water.
 Water provides a medium for transporting
nutrients to cells and wastes from cells and for
transporting substances such as hormones,
enzymes, platelets, RBC’s & WBC’s.
 Helps maintain normal body temperature
 Facilitates digestion and promotes elimination
 Acts as a tissue lubricant

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 Because fat cells contain
little water and lean
tissue is rich in water, the
more obese the person,
the smaller the
percentage of total body
water compared with
body weight.
 This is also true between
sexes because females
tend to have
proportionally more body
fat than males.

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AGEAGE

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60% composed of water
70 kg person= 42 L
2/3 ICF = 28L
1/3 ECF = 14L
TBW= ECF + ICF

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 Fluids and solutes constantly move within the
body, which allows the body to maintain
homeostasis.
 Fluids along with nutrients and waste products
constantly shift within the body’s compartments
from the cell to the interstitial spaces, to the blood
vessels and back again.

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 A. Active transport
 B. Passive transport
- Diffusion
- Osmosis
- Filtration

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 Solutes / Molecules can be moved against a
concentration gradient as they move from an
area of lower concentration to an area of higher
concentration and requires an energy.
 Also called “pumping”
 Dependent on the presence of ATP

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ATPATP
ATPATP
ATPATP
ATPATP Na +Na +
Na +Na +
Na +Na +
Na +Na + Na +Na +
Na +Na +
Na +Na +
Na +Na +
Na +Na +
Na +Na +
Na +Na +
Na +Na +
Na +Na +
Na +Na +
Na +Na +
Na +Na +
Na +Na +
Na +Na +
Na +Na +
Na +Na +
INTRACELLULAINTRACELLULA
R FLUIDR FLUID
EXTRACELLULAEXTRACELLULA
R FLUIDR FLUID

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 Molecules move across a biological membrane
from an area of higher to an area of lower
concentration
 Membrane types
◦ Permeable
◦ Semi-permeable
◦ Impermeable

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High Solute ConcentrationHigh Solute Concentration Low Solute ConcentrationLow Solute Concentration
FluidFluid
SolutesSolutes

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 Movement of solute and solvent across a
membrane caused by hydrostatic (water pushing)
pressure
 Occurs at the capillary level
 If normal pressure gradient changes (as occurs
with right-sided heart failure) edema results from
“third spacing”

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 Movement of solvent from an area of lower
solute concentration to one of higher
concentration
 Occurs through a semipermeable membrane
using osmotic (water pulling) pressure

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FluidFluid
High SolutionHigh Solution
Concentration,Concentration,
Low FluidLow Fluid
ConcentrationConcentration
Low SoluteLow Solute
Concentration,Concentration,
High FluidHigh Fluid
ConcentrationConcentration

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 Fluids in the body generally aren’t found in pure
forms.
 Isotonic, hypotonic, and hypertonic types.
 Defined in terms of the amount of solute or
dissolve substances in the solution.
 Balancing these fluids involves the shifting of fluid
not the solute involved.

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 No net fluid shifts
occur between
isotonic solutions
because the solution
are equally
concentrated
 Eg - NSS or 0.9SS

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 Has a lower solute
concentration than
another solution
 Fluid from the
hypotonic solution
would shift into the
second solution until
the two solutions had
equal concentrations
 Eg - Half normal or
0.45%SS

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 Has a higher solute
concentration than
another solution
 Fluid from the second
solution would shift
into the hypertonic
solution until the two
solutions had equal
concentrations
 Eg - D5 / NSS

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 Isotonic loss of water and electrolytes (fluid
volume deficit) – “Hypovolaemia”
 Isotonic gain of water and electrolytes (fluid
volume excess) – “Hypervolaemia / Edema”
 Hyperosmolar loss of only water (Dehydration)
 Hypo-osmolar gain of only water (Overhydration) –
“Water Intoxication”

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 Loss of body fluids ⇒ increased concentration
of solutes in the blood and a rise in serum Na+
levels.
 Fluid shifts out of cells into the blood to restore
balance.
 Cells shrink from fluid loss and can no longer
function properly.

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 Mild = Weight loss – 5%
 Moderate = Weight loss – 10%
 Severe = Weight loss – 15%

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 Irritability
 Confusion
 Dizziness
 Weakness
 Extreme thirst
 ⇓ urine output
 Fever
 Dry skin/mucous
membranes
 Sunken eyes
 Poor skin turgor
 Tachycardia

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 Fluid Replacement - Oral or IV over 48 hrs.
 Monitor symptoms and vital signs
 Maintain I & O
 Maintain IV access
 Daily weights
 Skin and mouth care

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 Isotonic fluid loss
from the
extracellular
space
 Can progress to
hypovolemic
shock
 Caused by:
◦ Excessive fluid loss
(hemorrhage)
◦ Decreased fluid
intake
◦ Third space fluid
shifting

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 Mild = < 2 L fluid loss
 Moderate = 2 – 3 L fluid loss
 Severe = > 3 L fluid loss

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 Mental status
deterioration
 Thirst
 Tachycardia
 Delayed capillary
refill
 Orthostatic
hypotension
 Urine output < 30
ml/hr
 Cool, pale
extremities
 Weight loss

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 Fluid replacement
 Albumin
replacement
 Blood transfusions
for hemorrhage
 Dopamine to
maintain BP
 Assess for fluid
overload with
treatment

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 Excess fluid in the extracellular compartment
as a result of fluid or sodium retention,
excessive intake, or renal failure.
 Occurs when compensatory mechanisms fail to
restore fluid balance.
 Leads to CHF and pulmonary edema.

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 Tachypnea
 Dyspnea
 Crackles
 Rapid, bounding pulse
 Hypertension
 S3 gallop
 Increased CVP,
pulmonary artery
pressure and
pulmonary artery
wedge pressure
 Acute weight gain
 Edema

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 Fluid is forced into
tissues by the
hydrostatic
pressure
 First seen in
dependent areas
 Anasarca
 Pitting edema
 Pulmonary edema

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 Fluid and Na+
restriction
 Diuretics
 Monitor vital signs
 Hourly I&O
 Breath sounds
 Monitor ABGs and
labs
 Elevate HOB and give
O2 as ordered
 Maintain IV access
 Skin & mouth care
 Daily weights

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 Hypotonic
extracellular fluid
shifts into cells to
attempt to restore
balance
 Cells swell
 Causes:
◦ SIADH
◦ Rapid infusion of
hypotonic solution
◦ Excessive tap water NG
irrigation or enemas
◦ Psychogenic polydipsia
◦ TURP

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 Signs and symptoms of increased intracranial
pressure
◦ Early: change in LOC, N/V, muscle weakness,
twitching, cramping
◦ Late: bradycardia, widened pulse pressure,
seizures, coma

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 Prevention is the best
treatment
 Assess neuro status
 Monitor I&O and vital
signs - ICU
 Fluid restrictions
 IV access
 Daily weights
 Monitor serum Na+
 Seizure precautions

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