This document discusses fluid and electrolyte balance and disturbances. It covers the mechanisms of fluid and electrolyte movement including osmosis, diffusion, and filtration. It then discusses sodium, potassium, calcium, magnesium, chloride, bicarbonate, and phosphate levels and imbalances including causes, clinical manifestations, and nursing interventions for conditions like hyponatremia, hypernatremia, hypokalemia, hyperkalcemia, hypocalcemia, hypercalcemia, hypomagnesemia, and hypermagnesemia. Food sources of important electrolytes are also provided.

1. Fluid and Electrolytes,
Balance and Disturbances
By:
Ms. katherina

2. Mechanism for fluid and
electrolyte movement
osmosis filtration
diffusion
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3. osmosis
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4. diffusion
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5. diffusion
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6. filtration
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7. Fluid and electrolyte
balances
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8. cations
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9. sodium potassium
calcium magnesium
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10. Electrolytes are measured
milliequivalent per litre
of water
(mEq / L)
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11. Equivalent refers to the chemical
combining power of a substance or
the power of cations to unite with
anions to form molecules
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12. #

13.  most abundant cat ion in the
extracellular fluid
 sodium is regulated by
Salt intake Aldosterone
Urinary output
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14. functions
Maintain balance of extracellular fluid, thereby
it controls the movements of the water between
fluid compartments
Transmission of nerve impulses
Neuro muscular and myocardial impulse
transmission
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15. Normal concentration
of sodium
135 to 145
mEq/L
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16. #

17. Main intracellular cat ion
Helps in maintaining fluid balance of
the intracellular fluid
Potassium is regulated by
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18. functions
Regulates neuromuscular excitability and muscle
contraction
Needed for glycogen formation and protein
sunthesis
Correction of acid base imbalances. Potassium
ion can be exchanged with hydrogen ion (H+)
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19. Normal concentration
of potassium
3.5 to 5.3
mEq/L
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20. #

21. Calcium is the most abundant element
in the body
Calcium is extracellular fluid
Regulated by the action of
Thyroid gland parathyroid gland
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22. Parathyroid hormone (PTH) controls
the balance among bone calcium,
gastrointestinal absorption and
kidney excretion of calcium.
Thyrocalcitonin from the thyroid
gland inhibits the release of calcium
from bones, thus playing a minor
role in determining serum calcium
levels.
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23. functions
Maintenance of cell membrane, its integrity and
structure
Conduction of nerve impulses in the skeletal
muscle
Stimulation and depolarization and contraction
of cardiac muscles
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24. functions
Aids in blood coagulation
Growth and formation of bones
Muscle relaxation
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25. Normal concentration
of calcium
4 to 5
mEq/L
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26. #

27. Magnesium is the second most
important cat ion in the
intracellular fluid
It has an inhibitory effect on
skeletal muscles.
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28. functions
Precipitation of metabolic activities of cells
Enzyme activity
Neuro chemical activity
Muscular excitability
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29. Normal concentration
of magnesium
1.5 to 2.4
mEq/L
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30. anions
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31. chloride
phosphate
bicarbonate
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32. #

33. Phosphate is a buffer anion in
extracellular and intracellular fluid
Phosphate absorption is through
gastrointestinal tract in a range of 3 to
12 mg/100 ml
Calcium and phosphate are inversely
proportional.
When one rises the other falls
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34. Serum phosphate is regulated by
kidneys
Parathyroid hormone
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35. Activated vitamin D
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36. functions
Development and maintenance of bones and
teeth
Promotes normal neuromuscular action
Participates in carbohydrate metabolism
Assist in acid base regulation
Maintains levels of ATP ( Adenosine
Triphosphate) and thus energy levels #

37. Normal concentration
of phosphate
2.5 to 4.5
mEq/L
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38. #

39. Chlorides are found in extracellular and
intracellular fluids
The chloride ion balances the cations
within the extracellular fluid
The ion exchange helps to maintain the
electrical neutrality
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40. Chloride is regulated through
kidneys
The dietary intake of chloride and
the amount excreted in urine are
closely related
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41. Normal concentration
of chloride
100 to 106
mEq/L
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42. #

43. Bicarbonate is found in extracellular
and intracellular fluids
It is a major chemical buffer in the
body
Regulation is through kidneys
It is an essential component of the
carbonic acid-bicarbonate buffering
system essential to acid base balance
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44. Normal arterial
bicarbonate value
22 to 26
mEq/L
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45. Normal venous
bicarbonate value
24 to 30
mEq/L
In venous blood, bicarbonate
is measured as
carbondioxide content
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46. FLUID VOLUME
DISTURBANCES
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47. Fluid
volume deficit
hypovolemia
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48. Fluid Volume Deficit
Mild – 2% of body weight loss
Moderate – 5% of body weight loss
Severe – 8% or more of body
weight loss
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49. Pathophysiology
results from loss of
body fluids and occurs
more rapidly when coupled
with decreased fluid
intake
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50. Clinical manifestations
Acute Weight loss
Decreased skin turgor
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51. Concentrated urine
flattened neck veins
Postural hypotension
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52. Weak, rapid, heart rate
 Oliguria
Increased temperature
Decreased central venous pressure
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53. Nursing Diagnosis
Fluid volume Deficit r/t
Insufficient intake, vomiting, diarrhea,
hemorrage, m/b dry mucous membranes
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54. Nursing management
Restore fluids by oral or IV
Treat underlying cause
Monitor I & O at least every 8
hours
Daily weight
Vital signs
Skin turgor
Urine concentration
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55. Fluid
volume excess
hypervolemia
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56. Pathophysiology
may be related to
fluid overload or
diminished function of the
homeostatic mechanisms
responsible for regulating
fluid balance
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57. Contributing factors
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58. Clinical manifestations
Edema
Distended neck veins
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59. Tachycardia
Increased blood
Pressure
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60. Increased weight
crackles
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61. Nursing Diagnosis
Fluid volume excess r/t
CHF, excess sodium intake,
renal failure
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62. Nursing management
Preventing FVE
Detecting and Controlling FVE
Teaching patients about edema
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63. Electrolyte Imbalances
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64. SODIUM
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65. Sodium
Normal range – 135 to 145 mEq/L
Primary regulator of ECF
volume (a loss or gain of sodium is
usually accompanied by a loss or
gain of water)
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66. HYPONATREMIA
Sodium level less
than 135 mEq/L
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67. causes
Vomiting Diarrhea
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68. Sweating Diuretics
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69. Clinical manifestations
Poor skin
turgor Dry mucosa
Decreased
saliva production Anorexia
vomiting
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70. Clinical manifestations
Nausea/
Orthostatic
abdominal
hypotension
cramping
Confusion &
Altered mental lethargy
status
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71. Nursing interventions
 Assess clinical manifestations
 Monitor fluid intake and output, vital
signs and lab data.
 Encourage food and fluids high in Na
 Limit water intake.
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72. HYPERNATREMIA
Sodium level more
than 145 mEq/L
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73. CAUSES
Loss of fluids
Water deprivation
Excessive salt intake
Conditions like Diabetes insipidus,
heatstroke
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74. Pathophysiology
- Fluid deprivation in patients who
cannot perceive, respond to, or
communicate their thirst
- Most often affects very old, very
young, and cognitively impaired
patients
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75. Clinical manifestations
- Thirst
- Sticky mucous membranes
- Flushed skin
- Postural hypotension
- Dry, swollen tongue
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76. Nursing interventions
Monitor intake and output
Monitor behavioural changes
Monitor lab findings
Encourage fluids
Monitor diet as ordered(salt
restriction)
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77. POTASSIUM
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78. Normal serum potassium
concentration is 3.5 to 5.5 mEq/L
Major Intracellular electrolyte
and 98% of the body’s potassium is
inside the cells
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79. HYPOKALEMIA
Potassium level less
than 3.5 mEq/L
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80. CAUSES
Loss of K+ in the form of
vomittings ,GI suction
poor K intake
diuretics
steroid administration
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81. Clinical manifestations
 Muscle weakness
 Leg cramps
 Fatigue
 Lethargy
 Anorexia
 Nausea, vomitting
 Decreased bowel sounds
 Decreased bowel motility
 Cardiac dysrhythmias
 Depressed deep tendon reflex #

82. Nursing interventions
Monitor heart rate and rhythm
Monitor clients receiving DIGITALIS
Administer oral K+ as ordered with
food /fluids
Administer IV K+ as ordered ,flow
rate not more than 10-20 meq/hr
Teach patients about potassium rich
diet and to reduce potassium wastage
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83. HYPERKALEMIA
Potassium level more
than 5.5 mEq/L
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84. Causes
 Decreased renal potassium excretion as
seen with renal failure and oliguria
 High potassium intake
 Renal insufficiency
 Shift of potassium out of the cell as
seen in acidosis #

85. Clinical manifestations
Skeletal muscle weakness/paralysis
ECG changes – such as peaked T waves,
widened QRS complexes
Heart block
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86. Nursing interventions
Monitor ECG changes – telemetry
Administer Calcium solutions to
neutralize the potassium
Monitor muscle tone
Give Kayexelate
Give Insulin and D50W
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87. CALCIUM
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88. Normal serum calcium level is 4
to 5 mEq/L
More than 99% of the body’s
calcium is located in the skeletal
system
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89. HYPOCALCEMIA
Calcium level less
than 4 mEq/L
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90. Causes
- Vitamin D/Calcium deficiency
- Primary/surgical
hyperparathyroidism
- Pancreatitis
- Renal failure
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91. Clinical Manifestations
Tetany and cramps in muscles of
extremities
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92. Trousseau’s sign – carpal
spasms
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93. Chvostek’s sign – cheek
twitching
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94. Seizures, mental changes
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95. ECG shows prolonged QT
intervals
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96. Nursing interventions
- IV/PO Calcium Carbonate or Calcium
Gluconate
- Encourage increased dietary intake
of Calcium
- Monitor neurlogical status
- Establish seizure precautions
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97. HYPERCALCEMIA
Calcium level more
than 5 mEq/L
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98. Causes
- Hyperparathyroidism
- Prolonged immobilization
- Thiazide diuretics
- Large doses of Vitamin A and D
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99. Clinical manifestations
- Muscle weakness, nausea and
vomiting
- Lethargy and confusion
- Constipation
- Cardiac Arrest
(high level)
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100. Nursing interventions
- Eliminate Calcium from diet
- Monitor neurological status
- Increase fluids (IV or PO)
- Calcitonin
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101. MAGNESIUM
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102. Normal serum magnesium level
is 1.5 to 2.4 mEq/L
Thought to have a direct
effect on peripheral arteries
and arterioles
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103. HYPOMAGNESEMIA
magnesium level less
than 1.5 mEq/L
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104. Causes
- Chronic Alcoholism
- Diarrhea, or any disruption in small
bowel function
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105. - TPN
- Diabetic ketoacidosis
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106. #

107. Clinical manifestations
- Neuromuscular irritability
- Positive Chvostek’s and Trousseau’s
sign
- EKG changes with prolonged QRS,
depressed ST segment, and cardiac
dysrhythmias
- May occur with hypocalcemia and
hypokalemia
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108. • Starved – possible cause of
hypomagnesemia
• Seizures
• Tetany
• Anorexia and arrhythmias
• Rapid heart rate
• Vomiting
• Emotional lability
• Deep tendon reflexes increased
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109. Nursing interventions
- IV/PO Magnesium replacement,
including Magnesium Sulfate
- Give Calcium Gluconate if
accompanied by hypocalcemia
- Monitor for dysphagia, give soft
foods
- Measure vital signs closely
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110. Foods high in Magnesium:
Green leafy vegetables
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111. Nuts
Legumes
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112. Seafood
Chocolate
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113. HYPERMAGNESEMIA
magnesium level
more than 2.4 mEq/L
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114. Causes
- Renal failure
- Untreated diabetic ketoacidosis
- Excessive use of antacids and
laxatives
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115. Clinical manifestations
- Flushed face and skin warmth
- Mild hypotension
- Heart block and cardiac
arrest
- Muscle weakness and even paralysis
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116. RENAL
• Reflexes decreased (plus weakness
and paralysis)
• ECG changes (bradycardia and
hypotension)
• Nausea and vomiting
• Appearance flushed
• Lethargy (plus drowsiness and
coma)
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117. Nursing interventions
- Monitor Mg levels
- Monitor respiratory rate
- Monitor cardiac rhythm
- Increase fluids
- IV calcium for emergencies
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118. PHOSPHORUS
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119. Normal serum phosphorus
level is 2.5 to 4.5 mg/100 ml
- Phosphate levels vary inversely
to calcium levels
- High Calcium = Low Phosphate
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120. HYPO
PHOSPHOTEMIA
Phosphorus level
less than 2.5 mEq/L
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121. Causes
- Most likely to occurs with
overzealous intake or
administration of simple
carbohydrates
- Severe protein-calorie
malnutrition (anorexia
or alcoholism)
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122. Clinical manifestations
- Muscle weakness
- Seizures and coma
- Irritability
- Fatigue
- Confusion
- Numbness
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123. Nursing interventions
- Prevention is the goal
- IV Phosphorus for severe
- Prevention of infection
- Monitor phosphorus levels
- Increase oral intake of
phosphorus rich foods
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124. Foods rich in phosphorus
- Milk and milk products
- Poultry
- Whole grains
- Organ meats
- Nuts
- Fish
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125. HYPER
PHOSPHOTEMIA
Phosphorus level
more than 4.5 mEq/L
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126. Causes
- Renal failure
- Chemotherapy
- Hypoparathyroidism
- High phosphate intake
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127. Clinical manifestations
- Tetany
- Muscle weakness
- Similar to Hypocalcemia because
of reciprocal relationship
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128. Nursing interventions
- Treat underlying cause
- Avoid phosphorus rich foods
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129. #

130. #