common sign symptoms , causes, management & nursing management of fluid & eletrolyte imbalance.

1. FLUID & ELETROLYTE
IMBALANCE
Mr.Veerabhadra.B.Badiger
Asst Professor
Dept Of Medical Surgical Nsg.

2. FLUID VOLUME
DEFICIT.

3. FLUID
 Approximately 60% of a typical adult’s weight consists of
fluid.
 Factors that influence the amount of body fluid are age,
gender, and body fat.
 Body fluid is located in two fluid compartments:
Intracellular space (fluid in the cells) Extracellular
space (fluid outside the cells).
 Approximately two thirds of body fluid is in the
Intracellular fluid (ICF) compartment and is located
primarily in the skeletal muscle mass.

4. CONTINUED..
The Extracellular fluid (ECF) compartment is further
divided into the intravascular, interstitial, and
transcellular fluid spaces.
 The intravascular space: plasma.
 The interstitial space contains the fluid that surrounds
the cell in an adult. Example :Lymph
 Transcellular space fluid are cerebrospinal, pericardial,
synovial, intraocular, and pleural fluids; sweat; and
digestive secretions.

5. FLUID IMBALANCES
 Fluid imbalances occur when the body’s compensatory
mechanisms are unable to maintain a homeostatic state.
FLUID VOLUME DEFICIT (HYPOVOLEMIA)
Fluid volume deficit (FVD) occurs when loss of
extracellular fluid volume exceeds the intake of fluid.
Causes of FVD include
 Vomiting, Diarrhea, GI suctioning, and sweating, and
 Decreased intake, as in nausea.

6. RISK FACTORS
Diabetes insipidus,
Adrenal insufficiency,
Osmotic diuresis,
Hemorrhage
Coma.
Cardiac problems.

7. CLINICAL MANISFESTATION OF FVD INCLUDE Acute weight loss
 Decreased skin turgor
 Oliguria
 Concentrated urine
 Postural hypotension
 A weak, rapid heart rate
 Flattened neck veins
 Increased temperature
 Decreased central venous pressure
 Cool, clammy skin related to peripheral vasoconstriction;
 Thirst; anorexia; nausea; lassitude
 Muscle weakness; and cramps.

8. DIAGNISTIC STUDIES
 Compelete health history
 Physical examination.
 BUN (elevated due to dehydration or decreased
renal perfusion and function).
 Hematocrit level.
 Urine specific gravity .
 Urine osmolality
 Serum Osmolality.
 Serum eletrolytes level.

9. MANAGEMENT
 Treatment of underlying cause.
 Diarrhea- Antidiarrhea
 Vomiting-antiemetics.
 Symptomatic treatment.
 Isotonic electrolyte solutions
(Eg:- Lactated Ringer’s or 0.9% sodium chloride) are
frequently used to treat the hypotensive patient

10. NURSING MANAGEMENT FOR FVD
 Monitors and measures fluid intake & output.
 Close monitoring of vital signs.
 Skin and tongue turgor is monitored on a regular
basis.
 Measuring the urine specific gravity.
 Observe for cardiac & renal function by hemodynaic
monitoring.
 Observe for mental status & confusion.

11. FLUID VOLUME
EXCESS
(HYPERVOLEMIA)

12. FLUID VOLUME EXCESS (FVE)
(HYPERVOLEMIA)
 Fluid volume excess (FVE) refers to an isotonic
expansion of the ECF caused by the abnormal
retention of water and sodium in the ECF.
Contributing factors can include
 Heart failure
 Renal failure
 Cirrhosis of the liver.
 Consumption of excessive amounts salts.

13. CLINICAL MANISFESTATION OF FVE
 Edema
 Distended neck veins
 Crackles (abnormal lung sounds).
 Tachycardia
 Increased blood pressure, Pulse pressure, and
central venous pressure.
 Weight gain.
 Increased urine output
 Shortness of breath and wheezing.

14. DIAGNOSTIC STUDIES.
 History collection.
 Physical examination.
 BUN and Hematocrit levels
 Serum osmolality and the sodium level
 urine sodium level
 Renal function test
 ECG.
 Chest x-rays may reveal pulmonary
congestion

15. MANAGEMENT
Symptomatic treatment consists of
 Administering diuretics : Loop diuretics, such as
furosemide (Lasix), bumetanide (Bumex), or
torsemide
 Restricting fluids and sodium.
 HEMODIALYSIS:
 Used to remove nitrogenous wastes and
 Control potassium and acid–base balance, and to
remove sodium and fluid.
 NUTRITIONAL THERAPY: Salt restricted diet

16. NURSING MANAGEMENT.
 Measures fluid intake and output.
 Monitor vital signs closely.
 Monitor patient body weight daily.
 Measuring the circumference of the extremity with a
tape.
 Check for edema

17. ELETROLYTE
IMBALANCE

18. NORMAL LEVELS
sn Name Normal Hypo Hyper
1 Sodium 135-145m
Eq/lit
Less than
130
More than
145
2 Potassium 3.5-5.5mg/dl Less than
3
More than
5
3 Calcium 8.5-10.5mg/dl Less than
8.5
More than
11
4 Magnesium 1.5-2.5 mEq/L Less than
1
More than
3
5 chloride 98 and 107
meq/L

19. SODIUM DEFICIT (HYPONATREMIA)
Causes
 Use of diuretics
 Excessive diaphoresis
 Loss of GI fluids
 Cerebral salt-wasting syndrome
 Renal disease,
 Adrenal insufficiency.
 Hyperglycemia
 Heart failure cause a loss of sodium
 Low-salt diet
 Drug induced (oxytocin and certain tranquilizers)
Sodium level less than 130mEq/litre

20. CLINICAL FEATURES OF HYPONATREMIA
 Anorexia,
 Nausea and vomiting,
 Headache,
 Lethargy,
 Confusion,
 Muscle cramps and weakness,
 Muscular twitching,
 Seizures,
 Papilledema,
 Dry skin, ↑ pulse, ↓ BP

21. Diagnostic studies.
 Serum and urine sodium
 Urine specific gravity and osmolality
Treatment
 Nutritional therapy:-Increasing oral sodium intake
and restricting oral fluid intake.
 Avoiding drugs which causes low sodium.
 IV Sodium chloride 3% infusion

22. SODIUM EXCESS (HYPERNATREMIA)
Causes:
 Hyper-aldosteronism
 Kidney failure
 Corticosteroids
 Cushing’s syndrome or disease
 Excessive oral sodium ingestion
 Excessive administration of sodium-containing IV
fluids
 Watery diarrhea
 Dehydration
Sodium level more than 145mEq/lit

23. CLINICAL MANISFESTATION HYPERNATRENMIA
 Thirst
 Elevated body temperature
 Swollen dry tongue
 Sticky mucous membranes
 Hallucinations
 Lethargy,
 Restlessness, irritability,
 focal or grand mal seizures,
 pulmonary edema,
 Hyperreflexia, twitching,
 Nausea, vomiting,
 Anorexia, ↑ pulse, and ↑ BP.

24. Diagnostic studies.
 ↑ serum sodium, ↓ urine sodium,
 ↑ urine specific gravity and osmolality
Management
 Increase fluid intake.(Plain water)
 Salt restricted diet.
 Avoid drugs causing hypernatremia.
 In severe cases Dialysis can be done.

25. POTASSIUM DEFICIT (HYPOKALEMIA)
Causes
 Diarrhea,
 Vomiting,
 Gastric suction,
 Corticosteroid administration,
 Hyperaldosteronism,
 Carbenicillin, Amphotericin B, Diuretics, and digoxin
toxicity
 Alkalosis
 Starvation
Potassium level less than 3.5mg/dl

26. CLINICAL MANISFESTATION:
 Fatigue, anorexia, nausea and vomiting,
 Muscle weakness,
 Polyuria,
 Decreased bowel motility
 Ventricular tachycardia or fibrillation,
 Paresthesias,
 Leg camps, ↓ BP,
 Abdominal distention
 Hypoactive reflexes,

27. Diagnostic studies.
 Serum potassium level
 ECG: flattened T waves, prominent U waves, ST
depression, prolonged PR interval
Treatment for hypokalemia
 Nutritional therapy: High potassium diet banana,
tender coconut water,Vegetables.
 IV Potassium chloride infusion.
 Avoiding drug that causes potassium loss.

28. POTASSIUM EXCESS (HYPERKALEMIA)
Causes
 Pseudohyperkalemia, oliguric renal failure,
 Use of potassium-conserving diuretics.
 Angiotensin-converting enzyme inhibitors (ACEIs)
 metabolic acidosis
 Addison’s disease
 Crush injury
 Burns
 Stored blood transfusions,
 Rapid IV administration of potassium
Potassium level more than 5mg/dl.

29. CLINICAL MANISFESTATION
 Vague muscular weakness,
 Tachycardia → bradycardia,
 Dysrhythmias
 Flaccid paralysis
 Paresthesias
 Intestinal colic
 Cramps
 Irritability, anxiety

30. Diagnostic studies.
 Serum Potassium level.
 ECG: tall tented T waves, prolonged PR interval
and QRS duration, absent P waves, ST depression.

31. CLINICAL MANISFESTATION
 Numbness
 Tingling of fingers & toes
 Positive trousseau’s sign and chvostek’s sign
 Seizures,
 Hyperactive deep tendon reflexes
 Irritability,
 Bronchospasm,
 Anxiety
 Impaired clotting time

32. TREATMENT
 Administer IV calcium gluconate :
calcium antagonizes the action of hyperkalemia on
the heart, thereby reduces the adverse cardiac
conduction abnormalities.
 IV administration of regular insulin and a
hypertonic dextrose (25% dextrose) solution
causes a temporary shift of potassium into the cells.
 In severe cases Peritoneal dialysis,
Hemodialysis can be done.

33. CALCIUM DEFICIT (HYPOCALCEMIA)
Causes:
 Hypo-parathyroidism
 Malabsorption
 Pancreatitis,
 Alkalosis,
 Vitamin D deficiency,
 Massive subcutaneous infection
 Generalized peritonitis,
 Massive transfusion of citrated blood
 Chronic diarrhea,
 Renal failure
Calcium level less than 8.5mg/ dl

34. Diagnosis:-
 Sr calcium level
 ECG- prolonged QT interval and lengthened ST.
 Coagulation profile.
Treatment:-
 Vitamin D & Calcium replacement (oral and IV).
 Nutrition therapy involves a high-calcium diet

35. CALCIUM EXCESS (HYPERCALCEMIA)
Causes:-
 Hyperparathyroidism,
 malignant neoplastic disease,
 Prolonged immobilization,
 Overuse of calcium supplements,
 Vitamin D excess,
 Oliguric phase of renal failure,
 Acidosis
 Corticosteroid therapy,
 Thiazide diuretic use, increased parathyroid
hormone
 Digoxin toxicity.
Calcium level more than 10.5 mg/dl

36. CLINICAL MANISFESTATION
 Muscular weakness
 Constipation
 Anorexia
 Nausea and vomiting
 Polyuria and polydipsia
 hypoactive deep tendon reflexes
 Lethargy, deep bone pain, pathologic fractures,
 flank pain, and calcium stones

37. Diagnostic studies:
 Serum calcium level
 ECG: shortened QT interval, bradycardia, heart
blocks.
Treatment
 Avoid RL (Ringer’s lactate) iv fluids.
 Avoid calcium & vit-D Supplementation.
 IV normal saline 0.9%.(It increses the calcium
excretion by kidneys.)
 Dialysis is used when severe hypercalcemia
causes lifethreatening cardiac problems

38. HYPOMAGNESEMIA
Hypomagnesemia refers to a below-normal serum
magnesium concentration. (lower than 1.8 mg/dL)
Normal value is 1.5 to 2.5 mEq/L (or 1.8–3.0 mg/dL)
Role of magnesium
 Protein synthesis .
 Cellular energy production and storage
 Stabilization of cells
 DNA synthesis
 Nerve signal transmission muscles and nerves
 Bone metabolism
 Cardiac function & blood pressure

39. CAUSES FOR HYPOMAGNESEMIA
 GI diseases celiac disease, crohn’s
disease, and chronic diarrhea & vomiting
 Type-2 diabetes : (excrete mg+ in urine)
 Poor dietary intake of magnesium
 Increase in urination and fatty stools
 Liver disease
 Kidney impairment
 Pancreatitis
 Use of loop diurectics.
 Malbsorption (older adults)

40. CLINICAL FEATURES.
 Nausea & vomiting
 Weakness
 Decreased appetite
 Numbness
 Tingling
 Muscle cramps
 Seizures
 Muscle spasticity
 Personality changes
 Abnormal heart rhythms

41. Diagnostic studies.
 Blood magnesium level
Management
 Oral magnesium supplements and increased
intake of dietary magnesium.
Exam: Spinach , almonds ,cashews ,peanuts ,whole
grain cereal ,soymilk, black beans ,avocado
,banana ,salmon & baked potato with the skin
 Magnesium intravenously.

42. COMPLICATIONS OF HYPOMAGNESEMIA
Severe hypomagnesemia can have life-threatening
complications such as:
 Seizures
 Cardiac arrhythmias
 Coronary artery vasospasm
 Sudden death

43. HYPERMAGNESEMIA
 Hypermagnesemia refers to an excess amount of
magnesium in the bloodstream.( more then 2.8mg/dl/
Causes of Hypermagnesemia
 Kidney failure
 End-stage liver disease
 Lithium therapy
 Hypothyroidism
 Addison’s disease
 Milk-alkali syndrome
 Drugs containing magnesium, such as some laxatives
and antacids
 Familial hypocalciuric hypercalcemia

44. CLINICAL FEATURES.
 Nausea
 Vomiting
 Neurological impairment
 Abnormally low BP (Hypotension)
 Flushing
 Headache

45. Diagnostic studies
 Serum magnesium level
 LFT & RFT.
Management
 Intravenous calcium.
 loop diuretics ( Furosemide , Torasemide)
 Treatment of Low BP. ( IV fluids, inotropes)
 Treatment of cardiac arrhythmias.

46. NURSING CARE FOR ELETROLYTES
IMBALANCE
 Proper history collection
 Through physical examination
 Monitoring blood level.
 Administering drug as ordered & assess for side
effects.
 Monitoring cardiac & respiratory function.
 Monitoring kidney function ( I/O chart)
 Dietician consultation for balance diet.
 Monitoring mental status & cognitive function of
patient.

47. Thank you….