fluid and electrolyte imbalance

1. FLUID & ELECTROLYTE DISTURBANCE –
SODIUM & POTASSIUM
Presented By
Karana Ram
Msc.(n) 1st year

2. INTRODUCTION
•Fluid helps maintain body temperature and cell
shape and helps transport nutrient gases and
wastes.
•An electrolyte imbalance is present whenever
there is an excess or deficit in the plasma level
of a specific ion.
•The desirable amount of fluid intake and loss in
adult range from 1500 to 3500 ml each 24 hours
(average 2500 ml).
•Normally Intake = Output

3. Contd,,
• Body fluid is located in two fluid compartments: the intra-
cellular space and the extracellular space. Approximately two
thirds of body fluid is in the intracellular fluid (ICF
compartment)
•

4. FLUID VOLUME DISTURBANCE
•It is a normally decrease or increase fluid
volume or rapid shift from one
compartment of body fluid to another.

5. ELECTROLYTES
Electrolytes are charged particle (ions) that are
dissolved in body fluids.
•Major positive ions-
●Sodium ion (Na+)
●Potassium ion (K+)
●Calcium ion (Ca+)
●Magnesium ion (Mg+)
•Major negative ions-
●Chloride ion (Cl-)
●Bicarbonate ion (Hco3-)

6. Functions Of Electrolyte In The Body
Electrolyte helps in the following forms-
•Promote neuromuscular activity
•Maintain body fluid volume and
osmolarity
•Distribute body water between fluid
compartment
•Regulate acid base balance

7. SODIUM (Na+)
•Control and regulate volume of body fluid.
•Sodium is the most abundant electrolyte in ECF.
•Its concentration is the major determinant of
Extra Cellular Fluid volume.
•Participates in the generation and transmission
of the nerve impulse.
•Sodium is the conserve through the reabsorption
in the kidney a process stimulated by
aldosterone.

8. HYPONATREMIA-
•Sodium concentration in the serum is less
than 135 mEq/L.
•Therefore monitoring serum level is
critical and careful assessment for
symptoms of hyponatremia is important
for all postoperative patients.

9. CAUSE-
Decrease sodium intake
Excessive sodium loss from body-
• Vomiting
• Diarrhoea
• Polyuria
• Diaphoresis
• Gastric lavage
• Colostomy
• Wound drainage
• Adrenal insufficiency
• Thiazide diuretic
• Potassium-sparing diuretics

10. Dilutional of serum sodium
•Hypotonic I.V. therapy
•SIADH
•Oliguria
•Kidney disease
•Hyperglycaemia

11. Pathophysiology-

12. Clinical Manifestation-
• Blood pressure according to volume
• Tachycardia
• Poor skin turgor
• Dry mucosa
• Decreased saliva production
• Altered mental status (seizure)
• Headache
• Weight loss
• Decrease muscle tone
• Decrease activity
• Decrease DTR

13. Management
SODIUM REPLACEMENT-
•Increase oral sodium intake and restricts oral fluid
intake.
•Administered osmotic diuretics (mannitol), to
excrete the water rather than sodium.
•Isotonic saline (0 9% sodium chloride solution may
be prescribed
•In SIADS administer hypertonic normal saline with
diuretics.
•High sodium diet like-sea food, milk product, brade.

14. HYPERNATREMIA
•A serum sodium level above 145 mEq/L.
•May occur as a result of fluid deficit or
sodium excess.
•Develop when an excess of sodium occurs
without a proportional increase body fluid
when water loss occur without
proportional loss of sodium.

15. CAUSE-
Increase sodium intake
Increase use of sodium by iv therapy
Decrease Intake of water
Excessive water loss from Body
Decrease sodium excretion from the body-
•Cann syndrome
•Cushing disease
•Kidney disease

16. Pathophysiology
16

17. Clinical Manifestation
•Urine output decrease
•Excessive thirst
•Tachycardia
•Manic- excitement
•Increase muscle tone and activity
•Increase DTR
•Increase serum osmolality
•Increase urine specific gravity.
•Pulmonary edema.

18. Treatment
•Drug therapy- Loop diuretics (torsemide,
furosemide) use in oedematous condition.
•Lowering of serum sodium levels by
infusion of hypotonic solution (0.45%).

19. Nursing Management
•The nurse should obtain the medication
history, because some prescription of
medication have a high sodium content.
•Restricted salt diet.
•The nurse also note the patients thirst or
elevated body temperature, and evaluates it
in relation to other clinical sign and
symptoms.
•Monitor the patient seizures for activity.

20. POTASSIUM (K+)
• Potassium is major electrolyte in intracellular
electrolyte.
• K+ play a vital role in such process such as
transmission of electrical impulse, particularly heart,
skeletal, intestinal and lung tissue.
• Assist in regulation of acid base balance by cellular
exchange with H.
• To maintain potassium balance the renal system must
function because 80% of potassium excreted daily by
kidneys. Other 20% loss through bowel and in sweat.

21. HYPOKALEMIA
•Serum level below 3.5 mEq/L.
•Severe hypokalaemia can cause death
due to respiratory or cardiac arrest.

22. Cause
•Inadequate intake
•GI losses by- Diarrhoea and vomiting
•Nasogastric suctioning
•Enema or laxative uses
•Hyperaldosteronism
•Diuretics therapy
•Cushing disease
•SIADH
•Alkalosis
•Insuline therapy
•Salbutamol therapy

23. Clinical Manifestation
• A/N/V
• Decrease peristalsis movement.
• Abdominal distension
• Constipation(decrease bowel mobility)
• Decrease muscular activity
• Paresthesia
• Alkalosis (shallow respiration)
• Increase sensitivity to digitalis
• Potassium depletion depressed the release of insulin
and result in glucose intolerance.
• Dysrhythmias

24. 24
● ECG changes -

25. Treatment
•Administration of 40-80 mEq/day of potassium
is adequate in adult if there are no abnormal loss
of potassium.
•Dietary intake of potassium in average adult
50-100 meq/day.
•Potassium rich diet (banana, coconut water,
tomato, spinch, potato )
•When dietary intake is inadequate for any
reason, oral and IV potassium supplement may
be prescribed.

26. Contd,
•Give potassium
tablet .
•Give potassium syrup
(potklor).

27. Contd,,
•Give potassium I.V. injection (1 ampule
contain 20 meq- 10 ml)
•If patient taking diuretics than give k+
sparing diuretics.

28. HYPERKALEMIA
•Serum potassium level greater than 5
mEq/l.
•Less common than hypokalemia, but it is
usually dangerous.

29. Cause
•Retention of potassium by the body because
of decrease and inadequate urine output.
•Excessive release of potassium from the cell
during the first 24-72 hours of traumatic
injury or burns.
•Excessive infusion of IV solution that
content potassium or excessive intake of
potassium.
•By transfusion of old blood.

30. Contd,,
•Renal Failure
•K+ sparing diuretics.
•Addison disease
•Shift or K+ out of the cells (cell
damage, burn, cancer, radiation)
•Metabolic acidosis
•Cancer radiation therapy.

31. 31

32. Clinical Manifestation
•Increase peristalsis movement
•Increase bowel sound
•Abdominal cramp
•Increase bowel Sound
•Drowsiness
•Diarrhoea
•Palpitation

33. Treatment
•In non-acute situations, restriction of
dietary potassium and potassium containing
medications may correct the imbalance
•Emergency pharmacologic therapy
•If serum potassium level are dangerously
elevated, it may be necessary to anti-
diuretics medication IV with calcium
gluconate

34. Contd,,
•Give fresh blood
•Given insulin therapy with dextrose
•Given salbutamol therapy
•Given kayxelate anaemia
•Avoid multiple prick
•Dialysis
•Monitor blood pressure

35. SUMMARY-
So we have learn today about Fluid and
electrolyte imbalance about sodium and
potassium in sodium disturbance about
hyponatremia and hypernatremia and in
potassium hypokalaemia and
hyperkalemia and what are the cause,
sign and symptoms and management of
electrolyte imbalance.

36. Conclusion-
•New studies have been undertaken to fill the
multiple gaping knowledge and to clarify areas of
controversy. For nurses providing holistic
comprehensive care for patients, meeting
nutritional needs is a critical component in the
recovery process that requires an appropriate
knowledge base. It is also as a nurse very important
for us to know the fluid and electrolyte balances
and imbalances so that the minute changes can be
detected and early management could be done.

37. RESEARCH ARTICLES
Impact of Hot Environment on Fluid and Electrolyte
Imbalance, Renal Damage, Hemolysis, and Immune
Activation Postmarathon.
•Previous studies have demonstrated the physiological changes
induced by exercise exposure in hot environments. We
investigated the hematological and oxidative changes and tissue
damage induced by marathon race in different thermal
conditions. Twenty-six male runners completed the São Paulo
International Marathon both in hot environment (HE) and in
temperate environment (TE). Blood and urine samples were
collected 1 day before, immediately after, 1 day after, and 3 days
after the marathon to analyze the hematological parameters,
electrolytes, markers of tissue damage, and oxidative status.

38. Contd,,
•In both environments, the marathon race
promotes fluid and electrolyte imbalance,
hemolysis, oxidative stress, immune activation,
and tissue damage. The marathon runner’s
performance was approximately 13.5% lower in
hot environment compared to temperature
environment however, in HE, our results
demonstrated more pronounced fluid and
electrolyte imbalance, renal damage, hemolysis,
and immune activation.

39. REFRENCES-
• Janice L. Hinkle, Kerry H. Cheever. Brunner and Suddarth’s Textbook of
Medical Surgical Nursing. 2015. New Delhi. Wolters Kluwer.13th Edition.
Volume 2. Pg. no. 238-249.
• Lewis. Medical Surgical Nursing Assessment and Management of clinical
problems.2015. New Delhi. Elsevier. 2nd Edition. Volume I. Pg no. 301-312.
• Joyce M. Black, Jane Hokanson Hawks. Medical Surgical Nursing Clinical
Management of positive outcomes.2015. New Delhi. Reed Elsevier India
Private Limited. Volume II. Pg. no. 151-166.
• Assuncao Oliva R. Impact of hot environment on fluid and electrolyte
imbalance renal damage, hemolysis, and immune activation postmerathan.
2017. Article ID 9824192, Available from http // doi.org / 10. 1155 / 2017 /
9824192.
• Hickey JV. The Clinical Practice of Neurological and Neurosurgical
Nursing. New Delhi: Wolters Kluwer Pvt Ltd, 6th Edition 2014. p 251-261.