Jays george Msc Nursing

1. FLUID AND
ELECTROLYTE
IMBALANCE
MRS. PRIYADARSINI
JOHN
ASSOCIATE PROFESSOR
DYPSON
MISS. JAYS
GEORGE
1ST YR MSC (N)
DYPSON

2. INTRODUCTION
Fluid And Electrolyte Plays Vital Role In Maintaining
Homeostasis With In The Body.
Our Body Consists Of Two Type Of Fluid Intracellular
And Extracellular Fluid.
Fluid Is A Major Component Of Our Body It Serves A
Vital Role In Our Health, And In Normal Cellular Function
By Serving As A Medium For Metabolic Reactions With In
The Cell.
It Also Is The Transporter And Waste Products , A
Lubricant , An Insulator And A Shock Absorber

3. TERMINOLOGIES
•HOMEOSTASIS : The ability or tendency
of an organism or cell to maintain
internal equilibrium by adjusting its
physiological process.

4. •HYDROSTATIC
PRESSURE: It is
pertaining to the liquid
in the state of
equilibrium or the
pressure exerted by
stationary fluid.

5. •OSMOSIS: Movement of
molecules through A
semipermeable membrane
from A solution with A lower
concentration to A higher
concentration until there is
an equal concentration of
fluid on both sides of the

6. •OSMOLARITY : The concentration of A
solution in terms of osmoles of
solutes per litre of solution.

7. •DIFFUSION : The
process by which
solutes move from an
area of higher
concentration to the
area of lower
concentration , without

8. •ISOTONIC : A solution with the same
osmolality as serum and other body
fluids.
•HYPOTONIC : A solution with an
osmolality lower than that of the serum.
•HYPERTONIC : A solution with an
osmolality higher than that of the

10. •OSMOLALITY : The
number of osmosis
(standard unit of
osmotic pressure)
per kilogram of
solution.

11. •ACTIVE TRANSPORT :
The physiologic pump
that moves fluid from an
area of lower
concentration to the area
of higher concentration :
active transport requires
ATP for energy.

12. •FILTRATION : Passage
through A filter or
through A material that
prevents passage of
certain molecules;
E.G.(Capillary wall ,blood
brain barrier,
radiographic grid.

13. •BODY FLUIDS : The Total Body Water In
Adults Of Average Built Is About 60%
Of Body Weight This Proportion Is
Higher In Young People And In Adults
Below Average Weight. It Is Lower In
The Elderly And Obese Of The All Age
Groups.

14. •FLUID
COMPARTMENTS :
Body water is located
in 2 major fluids
compartments the
intracellular fluid (ICF)
compartment and the
extracellular fluid(ecf)

15. REGULATORS OF FLUID
BALANCE

16. FLUID IMBALANCES

17. • EXTRACELLULAR FLUID VOLUME
DEFICIT(ECFVD)
An ECFVD is A decrease in
intravascular and interstitial fluids. It is A
common and serious fluid imbalance that
results in vascular fluid volume loss(
hypovolemia). ECFVD can lead to cellular
fluid loss owing to fluid shifting from the
cells to the vascular fluid to restore fluid

18. ETIOLOGY
Severe Vomiting
Diarrhoea
Traumatic Injuries With Excessive
Blood Loss
Third Space Fluid Shifts
Insufficient Water Or Fluid Intake

19. RISK FACTORS
•IN DIABETIC KETOACIDOSIS,
 Loosing Large Volume Of Blood
 Experiencing Severe Vomiting Or
Diarrhoea
 Having Difficult in Swallowing
 Elderly , confused Person

20. CLINICAL
MANIFESTATION

21. • Mild – 1 to 2 litres of water
and 2% of body weight is lost.
• Moderate – 3 to 5 litres of
water loss and 5% of weight
loss.
• Severe – 5 to 10liters of water
loss and 8% weight loss.
• Thirst
• Decreased skin turgor
• Dry mucous membrane
• Dry , cracked lips or tongue
• Eye balls sunken and soft
• Restlessness , coma in severe
deficit.
• Elevated temperature & pulse
• Systolic BP > 15 mm hg and
diastolic fall <10 mm hg.
• Weight loss
• Oliguria (<30ml/ hr)

22. LABORATORY FINDINGS
•Increased Osmolality
•Increased Or Normal Serum Sodium
Level
•BUN (> 25 Mg/Dl)
•Hyperglycaemia (> 120 Mg/Dl)
•Elevated Haematocrit Value (>55%)
•Increased specific gravity

23. MEDICAL MANAGEMENT
PHARMACOLOGICAL MANAGEMENT :
• An intravenous solution of 5% dextrose in 0.2% saline
may be prescribed.
• If haemorrhage is the cause blood replacement may be
necessary if blood loss is >1liter.
• If blood loss is <1liter , normal saline and ringer lactate
may be used.
DIETARY MANAGEMENT :
• Clients experiencing fluid loss from diarrhoea should
Fatty or fried foods and milk products

24. EXTRACELLULAR FLUID VOLUME
SHIFT(3RD SPACE FLUID SHIFT)
DEFINITION :
Basically A Change In The Location Of
ECF Between The Intravascular And
Interstitial Spaces.

25. ETIOLOGY
Simple Blister Or Sprain
Crushing Injuries
Extensive Burns
Perforated Peptic Ulcer
Intestinal Obstruction.
Large Venous Thrombosis
Lymphatic Obstruction

26. PATHOPHYSIOLOGY

27. CLINICAL MANIFESTATIONS :
•Skin Pallor , Cold Extremities
•Weak And Rapid Pulse , Hypotension
•Oliguria And Decreased Level Of
Consciousness.
LABORATORY FINDINGS :
•Elevated Haematocrit And BUN Level.

28. MEDICAL MANAGEMENT
PHARMACOLOGICAL :-
When Hypovolemia Results From
Tissue Injury Such As Burns Or Crush
Injury , Large Volume Of IV Fluids Need
To Be Administered
Amount Of Fluid Infusion May Be 3
Times Greater Than The Urinary Output.

29. If 3rd space fluid has occurred as A result of
other process such as pericarditis and bowel
obstruction , the fluid may have to be removed in
order for the organ to retain its function .
NURSING MANAGEMENT:-
Vital signs should assessed every 1-8 hrs.
Iv fluids replacement should be monitored. If
fluids are administered rapidly hypervolemia may
occur.
Frequent checks for chest crackles , difficulty in
breathing and neck vein engorgement (pulmonary

30. The Abdominal Girth Of Clients With Ascites
Should Measures Every 8 Hrs.
The Level Of Consciousness Should Be
Monitored (Seizures)
Frequent Skin Care To Oedematous Areas
During Fluid Shift Is Essential To Prevent
Skin Breakdown.
At Least 25ml/Hr Urine Output
Serum BUN Should Be Monitored In Clients

31. INTRACELLULAR FLUID
VOLUME EXCESS(ICFVE)
Water intoxication may occur in clients who
receive continuous D5% IV fluids , in those
with brain injury or disease that can cause
increased production of ADH , which
increases water reabsorption from renal
tubules. (Mainly due to sodium loss)

32. ETIOLOGY
•Administration Of Excessive Amount Of
Hypo-osmolar Fluids Such As 0.45% Saline
Or 5% Dextrose In Water.
•Client Who Receive Continuous D5% Iv
Fluids.
•Brain Injury Patients.
•Disease That Cause An Increased
Production Of ADH, Which Increases Water
Reabsorption From Renal Tubules.

33. CLINICAL MANIFESTATION
Headache , Nausea
Pupillary Changes
Behavioural Changes , Irritability
,Disorientation
Confusion , Drowsiness , Decreased Co-
ordination
Weight Gain
Bradycardia With Increased Systolic BP
Increased Respiration , Projectile Vomiting

34. LABORATORY FINDINGS
Serum Sodium Level<
125meq/Litre
Decreased Haematocrit Value

35. MANAGEMENT
Addition of solutes to IV fluids.
Use of d5 with 0.45% na cl will help to correct
ICFVE , when the cause is water excess.
Iv therapy should be monitored every hour.
Monitor vital signs and intake-output every 1
– 8 hrs.
Weight should be checked daily to measure
fluid gain or loss.

36. ELECTROLYTE IMBALANCE

37. HYPONATREMIA
•Hyponatremia Is A Serum Sodium
Level Below 135meq/L

38. ETIOLOGY
• Loss of sodium in GI fluids, renal disease .
• Use of diuretics
• Water intoxication
• Gain of water as in excessive
• Administration of D5%
• GI suction
• Excessive perspiration followed by increased
water intake.
• Kidneys inability to excrete sufficiently diluted

39. CLINICAL MANIFESTATION
• Anorexia, Nausea, Lethargy,
diarrhoea, headache
• Confusion., Muscular
Twitching
• Seizures, Coma, Saliva
Production, B.P.
• Cirrhosis
• Nephrotic Syndrome
• Congestive Heart Failure ,
tachycardia, orthostatic

40. MEDICAL MANAGEMENT
•Monitor Fluid Loss And Gain
•Monitor Serum Sodium Levels
•Encourage Fluids And Sodium With High
Sodium
•Take Seizure Precautions When
Hyponatremia Is Severe
•Monitor For GI And CNS Symptoms

41. PHARMACOLOGICAL
MANAGEMENT :
 Moderate Hyponatremia 125 Meq/L Iv
Saline (0.9% Nacl) Or Lactated Ringers
Solution May Be Ordered.
When The Sodium Level Is 115 Meq/ L Or
Less, A Concentrated Saline Solution Such
As 3% Nacl Is Indicated.

42. DIETARY MANAGEMENT:
A Balanced Diet Is Usually Adequate
For Mild Hyponatremia(126 To
135meq/L).
More Severe Hyponatremia May
Require Sodium Replacement.
Fluids May Be Restricted To 800 -

43. HYPERNATREMIA
Serum Sodium > 145 Meq/L)

44. ETIOLOGY
• Diabetes Insipidus
• Water Deprivation
• Ingestion Of Large Amount Of salt
• Excessive Administration Of nacl iv fluids
• Heat Stroke
• Hyperventilation
• Profuse Sweating, Dehydration
• Pulmonary Oedema

45. CLINICAL MANIFESTATION
• Thirst
• Dry Tongue
• Sticky Mucous Membrane
• Disorientation And Hallucination
• Lethargy, Agitation ,Irritability,
Tremor ,Seizures
• Dehydration
• Pulmonary Oedema
• Oliguria
• Anorexia, Nausea , Vomiting

46. MANAGEMENT
•Monitor Fluid Loss And Gain
•Monitor For Change In Behaviour Like
Restlessness, Lathery
• Look For Excessive Thirst , Increase
Temperature
•Administer Hypotonic Solution And

47. HYPOKALAEMIA
•SERUM POTASSIUM <
3.5 MEQ/L)

48. ETIOLOGY
• Diarrhoea , Vomiting
• Potassium spairing Diuretics
• Poor Intake
• Alcoholism
• Hyperaldosteronism
• Alkalosis
• Gastric Suction
• Recent Ileostomy

49. CLINICAL MANIFESTATION

50. MANAGEMENT
Intake of potassium
Administer oral supplement orparenteral
potassium
 Diet enriched with potassium
 Monitor the occurrence of hypokalaemia
 Follow safe administration of

51. HYPERKALEMIA
(POTASSIUM LEVEL > 5.0 MEQ/L)

52. ETIOLOGY
•Decreased Potassium Excretion
•Renal Failure
•Use Of Potassium Sparing Diuretics
•Hyperaldosteronisms
•Shift Of Potassium Out Of Cells
•High Potassium Intake

53. MANIFESTATIONS
•Muscle weakness.
•Respiratory paralysis
•Pares thesis of face and tongue
•GI symptoms
•ECG :- flat P wave and peak T wave

55. MANAGEMENT
• Avoid giving patients Potassium saving diuretics
• Avoid giving patients potassium supplement and salt
substitutes
• Follow safe administration of potassium
• IV calcium gluconate – calcium antagonizes the action
of hyperkalaemia on the heart
• IV soda-bicarb shifts the potassium to cell
• Glucose insulin therapy

56. HYPOCALCEMIA
(SERUM CALCIUM < 4.5 MEQ/L OR 8.5
MG/DL)

57. ETIOLOGY
• Surgical hyperparathyroidism
• Vitamin D deficiency
• Massive subcutaneous infection
• Chronic diarrhoea
• Metabolic Alkalosis
• Pancreatitis , renal failure , Cushing syndrome
• Medullary carcinoma
• Medication - magnesium sulphate

58. CLINICAL MANIFESTATIONS
• Chvostek’s sign (twitching of the facial muscles in
Response to tapping over the area of facial nerve)
• Trousseau’s sign (carpal pedal spasm caused by
inflating the blood pressure cuff to a level above
systolic pressure for 3 min.)
• Dyspnoea
• Increased peristalsis , diarrhoea
• Dysrhythmias
• Prolonged bleeding time.

59. CHVOSTEK’S SIGN AND TROUSSEAU’S
SIGN

60. MANAGEMENT
• Take seizure precautions
• Monitor conditions of airway
• Safety precautions
• Educate people about osteoporosis
• IV calcium administration ,oral calcium gluconate ,
calcium chloride
• Vitamin D therapy (administer calcium supplements 30
min before meals for better absorption and with glass of
milk because vit d is necessary for absorption of ca from

61. HYPERCALCEMIA
(SERUM CA LEVEL > 5.5MEQ/L OR 11 MG/DL)

63. ETIOLOGY :-
Hyperparathyroidism
Malignant tumours
Prolonged immobilization
Vitamin A & D intoxication
Over use of calcium supplement
Thiazide diuretics therapy

64. CLINICAL MANIFESTATIONS

65. MANAGEMENT
Increased mobilization
Administer fluids :- IV normal saline
 (0.9%nacl) given rapidly with frusemide to prevent
fluid overload , promote urinary calcium excretion.
Restrict calcium intake in diet
Take fluid for the prevention of renal stones
Administration of calcitonin decreases serum calcium
level by inhibiting the effects of PTH and increasing
urinary calcium excretion.

66. NURSING DIAGNOSIS
• Impaired cardiac out put related to fluid Shifts
and hypovolemic shock.
• Impaired peripheral tissue perfusion related
oedema
• Risk for fluid volume excess related to IV therapy

67. • Altered elimination pattern related to decrease
fluid intake.
• Risk for injury related to increased neuromuscular
irritability resulting from hypocalcaemia.
• Impaired physical mobility related to oedema
• Impaired nutrition less than the body requirement

68. ECG VARIATIONS
HYPOCALCAEMIA
• PROLONGED ST INTERVAL
• PROLONGED QT INTERVAL
HYPERCALCEMIA
• SHORTENED ST SEGMENT
• WIDENED T WAVE

69. HYPERKALEMIA
• Tall, peaked T wave
• Flat P waves
• Widened QRS complexes
• Prolonged PR interval
HYPOKALEMIA
• ST depression
• Shallow, flat, inverted T
wave
• Prominent U wave

70. CONCLUSION
• Fluids are essential for life . homeostasis is
sustained by very many processes. As nurses ,
one of our main responsibility in dealing with
most kind of patient is the maintenance of fluid
volume and electrolyte balance . thus it is very
essential to know regarding the fluid and
electrolyte balance and imbalances.