This document discusses fluid and electrolyte balance, imbalances, and treatment. It covers maintaining balance through the kidneys, adrenal glands, and ADH hormone. Common imbalances are fluid volume deficit and excess. Fluid volume deficit can be isotonic, hypertonic, or hypotonic and is assessed through various systems before being treated with oral or IV fluid replacement. Fluid volume excess can also be isotonic, hypertonic, or hypotonic and is assessed in a similar way before being treated with diuretics and fluid restriction.

1. FLUIDS AND ELECTROLYTES

2. PYRAMID POINTS
• Maintaining fluid and electrolyte balance
• Description of the common fluid and electrolyte
imbalances
• Causes of common fluid and electrolyte
imbalances
• Assessment of common fluid and electrolyte
imbalances
• Treatment and evaluation of response to
treatment for common fluid and electrolyte
imbalances

3. MAINTAINING FLUID AND
ELECTROLYTE BALANCE
• DESCRIPTION
– Homeostasis is a term that indicates the
relative stability of the internal environment
– Concentration and composition of body fluids
must be nearly constant

4. MAINTAINING FLUID AND
ELECTROLYTE BALANCE
• DESCRIPTION
– In the client, when one of the substances—
fluids or electrolytes—is deficient, it must be
replaced either normally by the intake of food
and water or by therapy such as IVs and/or
medications
– When the client has an excess of fluid or
electrolytes, therapy is directed towards
assisting the body to eliminate the excess

5. MAINTAINING FLUID AND
ELECTROLYTE BALANCE
• Kidneys
– Play a major role in controlling all types of
balance in fluid and electrolytes
• Adrenal glands
– Through the secretion of aldosterone, the
adrenal glands also aid in controlling
extracellular fluid volume by regulating the
amount of sodium reabsorbed by the kidneys
• Antidiuretic hormone (ADH)
– ADH from the pituitary gland regulates the
osmotic pressure of extracellular fluid by
regulating the amount of water reabsorbed by
the kidney

6. FLUID VOLUME DEFICIT
• DESCRIPTION
– Dehydration in which the body’s fluid intake is
not sufficient to meet the body’s fluid needs
– The goal of treatment is to restore fluid
volume, replace electrolytes as needed, and
eliminate the cause of the fluid volume deficit

7. FLUID VOLUME DEFICIT
• CAUSES
– Isotonic dehydration
• Inadequate intake of fluids and solutes
• Fluid shifts between compartments
• Excessive losses of isotonic body fluids
– Hypertonic dehydration
• Conditions that increase fluid loss such as
excessive perspiration, hyperventilation,
ketoacidosis, prolonged fevers, diarrhea,
early-stage renal failure, and diabetes
insipidus

8. FLUID VOLUME DEFICIT
• CAUSES
– Hypotonic dehydration
• Chronic illness
• Excessive fluid replacement (hypotonic)
• Renal failure
• Chronic malnutrition

9. FLUID VOLUME DEFICIT
• ASSESSMENT
– Cardiovascular
• Thready, increased pulse rate
• Decreased blood pressure and postural
hypotension
• Flat neck and hand veins in dependent
positions
• Diminished peripheral pulses

10. FLUID VOLUME DEFICIT
• ASSESSMENT
– Respiratory
• Increased rate and depth of respirations
– Neuromuscular
• Decreased central nervous system activity
from lethargy to coma
• Fever
– Renal
• Decreased urinary output
• Increased specific gravity

11. FLUID VOLUME DEFICIT
• ASSESSMENT
– Integumentary
• Dry and scaly skin
• Poor turgor, tenting present
• Dry and fissured mouth, paste-like coating
present

12. FLUID VOLUME DEFICIT
• ASSESSMENT
– Gastrointestinal (GI)
• Decreased motility and diminished bowel
sounds
• Constipation
• Thirst

13. FLUID VOLUME DEFICIT
• ASSESSMENT
– Hypotonic dehydration
• Skeletal muscle weakness
– Hypertonic dehydration
• Hyperactive deep tendon reflexes
• Increased sensation of thirst
• Pitting edema

14. FLUID VOLUME DEFICIT
• IMPLEMENTATION
– Monitor cardiovascular, respiratory,
neuromuscular, renal, integumentary, and GI
status
– Prevent further fluid losses and increase fluid
compartment volumes to normal ranges
– Provide oral rehydration therapy if possible; IV
fluid replacement if the dehydration is severe

15. FLUID VOLUME DEFICIT
• IMPLEMENTATION
– Generally, isotonic dehydration is treated with
isotonic fluid solutions; hypertonic
dehydration with hypotonic fluid solutions;
and hypotonic dehydration with hypertonic
fluid solutions
– Administer medications as prescribed to
correct the cause
– Administer oxygen as prescribed
– Monitor electrolyte values and prepare to
administer medication to treat an imbalance if
present

16. FLUID VOLUME EXCESS
• DESCRIPTION
– Fluid intake or fluid retention exceeds the
body’s fluid needs
– Also called overhydration or fluid overload
– The goal of treatment is to restore fluid
balance, correct electrolyte imbalances if
present, and eliminate or control the
underlying cause of the overload

17. FLUID VOLUME EXCESS
• CAUSES
– Isotonic overhydration
• Poorly controlled IV therapy
• Renal failure
• Long-term corticosteroid therapy
– Hypertonic overhydration
• Excessive sodium ingestion
• Rapid infusion of hypertonic saline
• Excessive sodium bicarbonate therapy

18. FLUID VOLUME EXCESS
• CAUSES
– Hypotonic overhydration
• Early renal failure
• Congestive heart failure
• Syndrome of inappropriate antidiuretic
hormone
• Poorly controlled IV therapy
• Replacement of isotonic fluid loss with
hypotonic fluids
• Irrigation of wounds and body cavities with
hypotonic fluids

19. FLUID VOLUME EXCESS
• ASSESSMENT
– Cardiovascular
• Bounding, increased pulse rate
• Peripheral pulses full
• Elevated blood pressure; decreased pulse
pressure
• Elevated central venous pressure
• Distended neck and hand veins
• Engorged venous varicosities

20. FLUID VOLUME EXCESS
• ASSESSMENT
– Respiratory
• Increased respiratory rate
• Shallow respirations
• Dyspnea
• Moist crackles on auscultation

21. FLUID VOLUME EXCESS
• ASSESSMENT
– Neuromuscular
• Altered level of consciousness
• Headache
• Visual disturbances
• Skeletal muscle weakness
• Paresthesias

22. FLUID VOLUME EXCESS
• ASSESSMENT
– Integumentary
• Pitting edema in dependent areas
• Skin pale and cool to touch
– GI
• Increased motility

23. FLUID VOLUME EXCESS
• ASSESSMENT
– Isotonic overhydration
• Liver enlargement
• Ascites
– Hypotonic overhydration
• Polyuria
• Diarrhea
• Nonpitting edema
• Dysrhythmias
• Projectile vomiting

24. FLUID VOLUME EXCESS
• IMPLEMENTATION
– Monitor cardiovascular, respiratory,
neuromuscular, integumentary, and GI status
– Administer diuretics; osmotic diuretics are
typically prescribed first to prevent severe
electrolyte imbalances
– Restrict fluid and sodium intake
– Monitor I&O and weight
– Monitor electrolyte values and prepare to
administer medication to treat an imbalance if
present