Fluid, electrolyte, and acid base balance.drjma

Dr. James Malce Alo, MAN, MAP, PhD

 The most important practical lesson that can
be given to nurses is to teach them what to
observe—how to observe—what are of
importance.
—Nightingale (in Skretkowicz, 1992)
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1. Review the physiological processes and core
concepts relative to body fluid and acid-base
balance and imbalances.
2. Identify the function, distribution, composition and
types of body fluid & electrolyte movement.
3. Describe the regulation of ECF, fluid output, causes
of electrolyte imbalances and client at risk of f/e
imbalances.
4. Relate the common disturbances in body fluid and
acid-base balance to their clinical manifestations
and nursing interventions.
5. Describe the common nursing interventions for
clients with alterations in body fluid and acid-base
balance in the scope of nursing process.
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 About 46% to 60% of the average adult weight
is water.
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 Medium of metabolic reaction with cells.
 Transporter for nutrients, waste products and
other substances.
 A lubricant.
 Shock absorber.
 Regulate and maintain body temperature.
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 The proportion of water decreases with aging
because of fats, age and sex effect of the
total body water.
 Infant (70-80%).
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 The body fluids divided into 2 major
compartments:
 A. Intracellular fluid (ICF)
 Is found in the cells of the body. It constitute 2/3 of
the total body fluid in adult.
 B. Extracellular fluid (ECF)
 Is found outside the cell and account 1/3 of hkthe
total body fluid.
 It is subdivided in 3 compartments
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 1. Intravascular fluid or plasma - is found
within the vascular system.
 2. Interstitial fluid- is found surrounding the
cells an includes lymph.
 3. Transcellular – includes cerebrospinal
fluid, fleural, peritoneal and synovial fluid.
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Plasma osmolar concentration, interstitial and intracellular fluid. Note that the main cation in the
plasma and in the interstitial fluid is sodium, while in the intracellular fluid the main cation is
potassium. Adaptad from West JBE (10), 1985.
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Cation- a positively charged ion, i.e. one that would be attracted to the cathode in
electrolysis.
Anion - a negatively charged ion, i.e. one that would be attracted to the anode in
electrolysis.
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 ICF
 Vital to normal cell function.
 Contains solute such as oxygen, electrolytes and
glucose.
 Medium to metabolic purposes.
 ECF
 Transport system that caries nutrients and waste
product from the cell.
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 1. Osmosis
 It is the movement of water across cell
membranes from the less concentrated solution
to more concentrated solution.
 Water move toward higher concentration.
 Solutes are substance dissolved in liquid.
 Crystalloids are salts dissolved readily into true
solution.
 Colloids are substance such as large protein
molecules that do not dissolve in true solution.
 Sodium is the major determinant of serum
osmolality.
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 2. Diffusion
 Is the continual intermingling of molecules in
liquid, gases by random movement of the
molecules.
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 3. Filtration
 Is the process whereby fluid and solute move
together across a membrane from one
compartment to another.
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 4. Active transport
 Substance can move across cell membrane from
a less concentrated solution to a more
concentrated one by active transport.
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 The average adult drinks about 1500ml/day,
this added volume is acquired by the food.
 The thirst center is located in the brain, this
center is triggered by osmotic pressure and
angiotensin II.
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 1. Urine : normal urine output 1500ml/ 24
hrs or at least 30ml/hr
 2. Insensible loss: through the skin as
perspiration and through the lung as water
vapor in the expired air.
 3. Loss through the intestine (feces)
 4. Obligatory losses: approx. 500ml ‘of fluid
must be exerted through the kidney to
eliminate metabolic waste product and
feces, respiration and perspiration to
maintain body temperature.
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 The average daily fluid output for adult is
2500ml / day
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 Post-operative client.
 Client with severe trauma or burn.
 Client with chronic disease as congestive
heart failure.
 Client who are NPO.
 Client with intravenous infusion.
 Client with special drainage.
 Client receiving diuretic.
4/22/2014drjma

 1. Age : infant have greater water need and
greater loss due to greater metabolic rate.
 2. Environment: excess heat stimulates the
sympathetic nervous system and cause
person to sweat.
 3. Diet : in nutritional deficiency, the body
preserved the protein, by breaking down the
fat and glycogen.
 4. Stress : water retention & increase the
production of antidiuretic hormone.
 5. illness : burn & renal disorder.
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 1. Hypovolemia – decrease blood volume
 2. Hypovolemic – when intravascular fluid is
depleted
 3. Hypervolemia – increase blood volume
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 4. Edema: is collection of fluid in the tissue.
 Types of edema
 1. Dependent edema – found in the lowest part of the
body.
 2. Pitting edema – edema that leaves a depression or
pit after finger pressure is applied on the swollen
area.
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 occurs when fluid collects in the tissue. By pressing a thumb or finger firmly against
the tissue for a few seconds, a dent can be produced.
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 Is the most abundant cation in ECF & major
contributor to serum osmolality.
 Functions:
 1. controlling & regulating water balance
 2. maintaining blood vol
 3. transmit nerve impulses
 Normal level : 135-145mg/dl
 Hyponatremia- Na deficit in the blood
 Hypernatemia – Na excess in the blood
 Na is found in many foods, such as
;processed cheese & table salt.
4/22/2014drjma

 Is the major cation in ICF
 Functions:
 Maintain ICF osmolality
 Transmitting nerve impulses
 Regulate cardiac impulses
 Skeletal & smooth muscle function
 Regulate acid-base balance
 K is found ;in many fruits & vegetables, meat,
fish & milk
 Normal level of K is 3.5-5.3 meq/L
 Hypokalemia : K deficit in the blood
 Hyperkalemia : K excess in the blood
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 Normal Ca level in the blood: 9-10.5 mg/dl
 Hypocalcemia: Ca deficit in the blood
 Hypercalcemia : Ca excess in the blood
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 Loss of h2o & electrolyte due to:
 Vomittting
 Diarhea
 Excessive sweating
 Polyuria
 Fever
 Nasogastric suction
 Abnormal drainage
 Anorexia
 Nausea
 Impaired swallowing
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 1. Skin : dry, pale, cool skin, reduce skin
turgor
 2. Oral cavity ; dry mucous membrane,
absence of salivation.
 3. Weak rapid pulse
 4. Decreased blood pressure.
 5. Decreased central venous pressure.
 6. Decreased urine output.
 7. Increased hematocrit.
 8. Thirst
 9. Flat neck vein
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 Excess intake of Na containing intraveous
fluid.
 Excess ingestion of Na in a diet.
 Heart failure.
 Renal failure.
 Liver cirrhosis.
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metabolic acidosis
= acidosis and bicarbonate concentration in the body fluids resulting either from the
accumulation of acids or the abnormal loss of bases from the body (as in diarrhea or renal
disease)
metabolic alkalosis
= alkalosis resulting from hydrogen-ion loss or excessive intake of alkaline substances
respiratory acidosis
= acidosis resulting from reduced gas exchange in the lungs (as in emphysema or pneumonia);
excess carbon dioxide combines with water to form carbonic acid which increases the acidity
of the blood
respiratory alkalosis
= alkalosis resulting from increased gas exchange in the lungs (as in hyperventilation
associated with extreme anxiety or aspirin intoxication or metabolic acidosis)
4/22/2014drjma

Fluid, electrolyte, and acid base balance.drjma

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