This document discusses various fluid and electrolyte imbalances including their causes, clinical manifestations, treatment, and nursing interventions. It covers fluid volume deficit and excess, as well as electrolyte imbalances involving sodium, potassium, and calcium levels. Fluid volume deficit can result from conditions like diarrhea, vomiting or fever that cause fluid loss. Treatment involves oral or IV fluid replacement depending on severity. Fluid volume excess has causes like congestive heart failure and is treated with diuretics and fluid restriction. Electrolyte imbalances are also discussed including hypocalcemia, hypokalemia, hyponatremia, and hyperkalemia.

1. PRESENTED BY: -
Ms. SUKHRAJ KAUR
M.Sc. (N) IST YEAR
ACON, PATIALA

2. FLUID IMBALANCE
The basic type of fluid imbalances
are isotonic and osmolar. Isotonic
deficit and excess exist when water
and electrolytes are gained and lost
in equal proportions.

3. CAUSES
Fluid losses from GI tract

4. FLUID VOLUME DEFICIT
• It occurs when the fluid intake of the body is not sufficient to
meet the fluid needs of the body.
• Fluid volume deficit (hypovolemia) should not be confused
with the term dehydration, which refers to loss of water alone
with increased serum sodium levels. FVD may occur alone or
in combination with other imbalances.

5. CAUSES
• Acute weight loss
• Decreased skin turgor
• A weak, rapid heart rate
• Decreased central venous pressure
• Diarrhea, Nausea, Vomiting
• Fever

6. CLINICAL MANIFESTATIONS
• Weight loss
• Thirst
• Changes in pulse rate and Bp
• Weak, rapid pulse
• Decreased urine output
• Dry mucous membrane

7. TREATMENT / INTERVENTIONS (FVD)
• Diet therapy – Mild to moderate dehydration. Correct with
oral fluid replacement.
• Oral rehydration therapy – Solutions containing glucose
and electrolytes. E.g. Pedialyte, Rehydralyte.
• IV therapy – Type of fluid ordered depends on the type of
dehydration and the client’s cardiovascular status.

8. NURSING INTERVENTIONS

9. Conti...
• Administer medications as prescribed, such as antidiarrheal,
antimicrobial, antiemetic, and antipyretic medications, to
correct the cause and treat any symptoms.
• Administer oxygen as prescribed.
• Monitor electrolyte values and prepare to administer
medication to treat an imbalance, if present.

10. FLUID VOLUME EXCESS
• is also called Overhydration or fluid overload

11. COMMONCAUSES
• Congestive Heart Failure
• Early renal failure
• IV therapy
• Excessive sodium ingestion
• Corticosteroids

12. CLINICAL MANIFESTATIONS

13. TREATMENT/ INTERVENTIONS (FVE)
 Drug therapy
 Diuretics may be ordered if renal failure is not the cause.
 Restriction of sodium and saline intake
 Weight

14. LABORATORY FINDINGS

15. MANAGEMENT
 ICFVE is treated by the addition of solutes to IV fluids.
 Use of D5%, 0.45% Nacl will help to correct ICFVE
when the cause is water excess.
 Oral fluids such as water and soft drinks should be given in
addition to water and ice chips.
 IV therapy should be monitored every hour.

16. Conti…
 Monitor vital signs and intake- output Every 1-8 hrs.
 Weight should be checked daily to measure fluid gain or loss.
 Administer prescribed antiemetic as needed to allow food
and fluids to be ingested.
 Safety measures are necessary when the client displays
behavioral changes.

17. NURSING INTERVENTIONS
• Monitor cardiovascular, respiratory, neuromuscular, renal,
integumentary, and gastrointestinal status.
• Prevent further fluid overload and restore normal fluid
balance.
• Administer diuretics; osmotic diuretics typically are
prescribed first to prevent severe electrolyte imbalances.

18. Conti…
• Restrict fluid and sodium intake as prescribed.
• Monitor intake and output; monitor weight.
• Monitor electrolyte values, and prepare to administer
medication to treat an imbalance if present.

19. ELECTROLYTE IMBALANCES

20. HYPONATREMIA
Hyponatremia is a serum sodium level below 135 meq / L

21. ETIOLOGY

22. CLINICAL MANIFESTATION

23. MEDICAL MANAGEMENT
• Determine cause of hyponatremia and to correct it.
• If client has hyponatremia due to fluid volume excess, intake
of fluids will be restricted to allow the sodium to regain
balance.
• If the serum sodium level falls below 125 meq / L, sodium
replacement is needed.

24. PHARMACOLOGICMANAGEMENT
• For client with moderate hyponatremia 125 meq/ L I/V saline
solution (0.9% Nacl) or lactated Ringer solution may be
ordered.
• When the serum sodium level is 115 meq / L or less, a
concentrated saline solution such as 3 % Nacl is indicated.

25. DIETARY MANAGEMENT
• A balanced diet is usually adequate for mild hyponatremia
(126 to 135 meq/ L)
• More severe hyponatremia may require sodium replacement
• If the clients have hyponatremia due to excess fluids, a fluid
restricted diet may be prescribed.
• Fluids may be restricted 800 to 1000 ml / day.

26. NURSING INTERVENTIONS
• Monitor cardiovascular, respiratory, neuromuscular, cerebral,
renal, and gastrointestinal status of the patient.
• If hyponatremia is accompanied by a fluid volume deficit
(hypovolemia), IV sodium chloride infusions are administered
to restore sodium content and fluid volume.

27. Conti…
• If hyponatremia is accompanied by fluid volume excess
(hypervolemia), osmotic diuretics are administered to
promote the excretion of water rather than sodium.
• Instruct the client to increase oral sodium intake and inform
the client about the foods to include in the diet.
• If the client is taking lithium (Lithobid), monitor the lithium
level, because hyponatremia can cause diminished lithium
excretion, resulting in toxicity.

28. HYPERNATREMIA
• Hypernatremia is a serum sodium level over 145 meq / L

29. ETIOLOGY
• Diabetes insipidus.
• Excess NaCl IV fluid intake.
• Accidental or international salt intake.
• Canned vegetables.
• Renal losses.

30. CLINICAL MANIFESTATIONS

31. LABORATORY FINDINGS

32. MEDICAL MANAGEMENT
• To decrease total body sodium and replace fluid loss either a
hypo-Osmolar electrolyte solution (0.2 % or 0.45 % Nacl) or
D5% is administered.
• Hypernatremia caused by sodium excess can be treated with
D5% and diuretic such as furosemide.

33. DIETARY MANAGEMENT
• Dietary restrictions of sodium are useful to prevent
hypernatremia in high risk clients
• Clients with renal disease may need to have their sodium
intake restricted to 500 to 2000 mg / day.

34. NURSING INTERVENTIONS
• Monitor cardiovascular, respiratory, neuromuscular, cerebral,
renal, and integumentary status.
• If the cause is fluid loss, prepare to administer IV infusions.
• If the cause is inadequate renal excretion of sodium, prepare
to administer diuretics that promote sodium loss.
• Restrict sodium and fluid intake as prescribed.

35. HYPOKALEMIA
Hypokalemia is a serum potassium level of less than 3.5 meq /L

36. ETIOLOGY

37. CLINICAL MANIFESTATIONS
•

38. LABORATORY FINDINGS
Serum potassium <3.5 meq / L

39. MEDICAL MANAGEMENT
• Determining & correcting the cause of the imbalance.
• Extreme hypokalemia requires cardiac monitoring.

40. PHARMACOLOGICMANAGEMENT
• Oral potassium replacement therapy is usually prescribed for mild
hypokalemia
• Potassium is extremely irritating to gastric mucosa; therefore the
drug must be taken with Glass of water or juice or during meals
• Potassium chloride can be administered intravenously for
moderate or severe hypokalemia & must be diluted in IV fluids.

41. Conti…
• Administration of potassium by IV push may result in cardiac
arrests. Potassium can be given in doses of 10 to 20 meq/ hour
diluted in IV fluid if the client is on heart monitor.
• High concentration of potassium is irritating to heart muscle.
Thus correcting a potassium deficit may take several days.

42. DIETARY MANAGEMENT
• The administration of foods that are high in potassium help to
correct the problem as well as prevent further potassium
losses.
• Common sources of food containing potassium – Cabbage,
Carrot, Cucumber, Mushrooms, Spinach, Tomato, Fruits-
Banana, Guava, Orange.

43. NURSING INTERVENTIONS
• Monitor cardiovascular, respiratory, neuromuscular,
gastrointestinal, and renal status, and place the client on a
cardiac monitor.
• Monitor electrolyte values.
• Administer potassium supplements orally or intravenously, as
prescribed.
• Liquid potassium chloride has an unpleasant taste and should
be taken with juice or another liquid.

44. Conti…
Oral potassium supplements may cause nausea and vomiting
and they should not be taken on an empty stomach; if the
client complains of abdominal pain, distention, nausea,
vomiting, diarrhea, or gastrointestinal bleeding, the
supplement may need to be discontinued.
• Instruct the client about foods that are high in potassium
content.

45. HYPERKALEMIA
Hyperkalemia is an Elevated potassium level over 5.0 meq/L.

46. ETIOLOGY
• Retention of Potassium – Renal insufficiency, renal failure,
decreased urine output, potassium sparing diuretics.
• Excessive release of Cellular Potassium - severe traumatic
injuries. Severe burns, severe infection, metabolic acidosis.
• Excessive IV infusions or Oral administration of potassium.

47. CLINICAL MANIFESTATIONS
•

48. LABORATORY FINDINGS

49. MEDICAL MANAGEMENT
• When serum potassium level is 5.0 to 5.5 meq/L restrict of
potassium intake.
• If potassium Excess is due to metabolic acidosis, correcting
the acidosis with sodium bicarbonate promotes potassium
uptake into the cells.
• Improving urine output decreases elevated serum potassium
level.

50. DIETARY MANAGEMENT
• When hyperkalemia is severe, immediate actions are needed to be
taken to avoid severe Cardiac disturbances.
• The administration of foods that are high in potassium help to
correct the problem as well as prevent further potassium looses.
• Common sources of food containing potassium – Cabbage, Carrot,
Cucumber, Mushrooms, Spinach, Tomato, Fruits- Banana, Guava,
Orange.

51. NURSING INTERVENTIONS
• Monitor cardiovascular, respiratory, neuromuscular, renal, and
gastrointestinal status; place the client on a cardiac monitor.
• Discontinue IV potassium and hold oral potassium
supplements.
• Prepare to administer potassium-excreting diuretics if renal
function is not impaired.

52. Conti…
• Initiate a potassium-restricted diet.
• If renal function is impaired, prepare to administer sodium
polystyrene sulfonate (Kayexalate).
• Prepare the client for dialysis if potassium levels are critically
high.
• Prepare for the IV administration of hypertonic glucose with
regular insulin to move excess potassium into the cells.

53. Conti…
• Monitor renal function.
• Teach the client to avoid foods high in potassium.
• Instruct the client to avoid the use of salt substitutes or other
potassium-containing substances.

54. HYPOCALCEMIA
• Hypocalcemia is serum calcium below 4.5 meq/L or 8.5 mg/dl

55. ETIOLOGY
• Malabsorption of fat in intestine.
• Metabolic alkalosis
• Renal failure with hyperphsophatemia, acute pancreatitis,
Burns, Cushing‘s disease, hypoparathyrodism.
• Medications – Magnesium sulfate.

56. CLINICAL MANIFESTATIONS
• Neuromuscular: Tetany symptoms: Twitching around
mouth, tingling and numbness of fingers, facial spasm,
convulsions.
• Respiratory: Dyspnea, laryngeal spasm.
• Gastrointestinal: increased peristalsis, diarrhea.
• Cardiovascular: Dysrhythmias, palpitations

57. MEDICAL MANAGEMENT
• Determining & correcting the cause of hypocalcemia.
• Asymptomatic hypocalcemia is usually corrected with oral
calcium gluconate, calcium lactate or calcium chloride.
• Administer calcium supplements 30 minutes before meals for
better absorption and with glass of milk because vitamin D is
necessary for absorption of calcium from the intestine.

58. DIETARY MANAGEMENT
• Intravenous calcium chloride or calcium gluconate (10%) is
given slowly to avoid hypertension, bradycardia & other
arrhythmias.
• Chronic or mild hypocalcemia can be treated in part by
having the client consume a diet high in calcium: e.g: Cheese,
milk, spinach.

59. NURSING INTERVENTIONS
• Monitor cardiovascular, respiratory, neuromuscular, and
gastrointestinal status; place the client on a cardiac monitor.
• Administer calcium supplements orally or calcium
intravenously.
• When administering calcium intravenously, warm the injection
solution to body temperature before administration and
administer slowly, monitor for electrocardiographic changes,
and monitor for hypercalcemia.

60. Conti…
• Administer medications that increase calcium absorption. i.e.
Vitamin D aids in the absorption of calcium from the intestinal
tract.
• Initiate seizure precautions.
• Keep 10% calcium gluconate available for treatment of acute
calcium deficit.
• Instruct the client to consume foods high in calcium.

61. HYPERCALCEMIA
Hypercalcemia is a serum level over 5.5 meq/L or 11 mg/L

62. ETIOLOGY
• Metastatic malignancy-lung, breast, Ovarian, Prostatic,
bladder, leukemia, Kidney.
• Hyperparathyroidism.
• Thiazide diuretic therapy.
• Prolong immobilization.
• Excessive intake of calcium supplements and vitamin D.

63. CLINICAL MANIFESTATIONS
• Gastrointestinal: Anorexia, Vomiting, Constipation,
Neuromuscular: Mild to moderate hypercalcemia state –
weakness, Severe hypercalcemic state-Extreme lethargy
• Cardiovascular: Dysrhythmias, Electro-cardiographic
Changes: Shortened ST Segment and lengthened QT interval.
• Musculoskeletal: Bone pain, fracture.

64. LABORATORY FINDINGS

65. MEDICAL MANAGEMENT
• Treatment consists of correcting the underlying cause.
• Intravenous normal saline (0.9% Nacl) given rapidly with
furosemide to prevent fluid overload, Promote urinary
calcium excretion.
• Corticosteroid drugs decrease calcium levels by competing
with vitamin D thus resulting in decreased intestinal
absorption of calcium.

66. Conti…
• If the cause is excessive use of calcium or vitamin D
supplements or calcium containing antacids these agents
should be either avoided or used in reduced dosage.
• A newer form of drug therapy is etidronate di-sodium. This
drug reduces serum calcium by reducing normal and
abnormal bone reabsorption of calcium and secondarily by
reducing bone formation.

67. NURSING INTERVENTIONS
• Monitor cardiovascular, respiratory, neuromuscular, renal, and
gastrointestinal status; place the client on a cardiac monitor.
• Discontinue IV infusions of solutions containing calcium and
oral medications containing calcium or vitamin D.
• Discontinue thiazide diuretics and replace with diuretics that
enhance the excretion of calcium.

68. Conti…
• Administer medications as prescribed that inhibit calcium
resorption from the bone, such as phosphorus, calcitonin,
bisphosphonates, and prostaglandin synthesis inhibitors
(aspirin, nonsteroidal anti-inflammatory drugs).
• Prepare the client with severe hypercalcemia for dialysis if
medications fail to reduce the serum calcium level.
• Instruct the client to avoid foods high in calcium.

69. 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.

70. SUMMARIZATION
 FLUID IMBALANCE
 CAUSES
 TYPES OF FLUID IMBALANCE
 ELECTROLYTE IMBALANCE
 HYPONATREMIA
 HYPERNATREMIA
 HYPOKALEMIA
 HYPERKALEMIA
 HYPOCALCEMIA
 HYPOCALCEMIA
 CONCLUSION
 BIBLIOGRAPHY

71. BIBLIOGRAPHY
• Basher. P Shebeer, Khan Yaseen. A concise text book of
advanced nursing practice. First edition. Banglore: Emmess;
2012.P. p 212- 223
• Silvestri anne linda. saunders comprehensive review for the
NCLEX- RN EXAMINATION Fifth edition. America:
Elsevier 2011 .p 245-249

72. Conti…
• Suddhartha & Brunner. Medical-Surgical Nursing, 10th
edition - Pp- 256- 260, 261- 272
• Potter A Patrica, Perry Griffin Anne. Fundamentals of
nursing. 7th edition. Noida: Elsevier;2009. Pp- 967-972.