Fluid,electrolyte, acid base balance and homeostasis
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This document discusses fluid and electrolyte balance in the human body. It covers several topics: - The body maintains homeostasis of fluids, electrolytes, acids, and bases through physiological processes that regulate intake and output. The kidneys, hormones, and other systems play key roles. - Imbalances can occur if there is too much or too little fluid volume, or abnormalities in electrolyte levels like sodium, potassium, calcium, and others. - Various illnesses, medications, treatments and other factors can disrupt fluid and electrolyte balance and cause issues like dehydration, overhydration, or electrolyte abnormalities. - Symptoms depend on the specific imbalance, but can include changes in mental status, muscle
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Fluid,electrolyte, acid base balance and homeostasis
- 1. BY VANA JAGAN MOHAN RAO M.S.Pharm, MED.CHEM NIPER-KOLKATA Asst.Professor, MIPER-KURNOOL Email: jaganvana6@gmail.com
- 2. FluidandElectrolyteBalance • Homeostasis Balanceoffluids,electrolytes,acidsandbases • Physiologicprocessesthatcontrol intake and output Bodycomposedof46– 60%ofadultweight Everyillnesshaspotentialtoupset thebalance
- 4. RegulatingBodyFluids • Fluidintake – Thirst • Fluidoutput – Urine – Insensibleloss – Feces • Maintaining homeostasis – Kidneys – ADH – Renin-angiotensin- aldosteronesystem – Atrialnatriureticsystem
- 9. •Volumeimbalance: • Netvolumegain – hypervolemia • Netvolumeloss - hypovolemia • Waterintoxication – overhydration FLUID AND ELECTROLYTE BALANCE
- 11. • Filtration • Hydrostatic Pressure • Osmotic Pressure FACTORS AFFECTING DISTRIBUTION
- 12. • Hypertonic • Isotonic • Hypotonic
- 13. • Sodium • Potassium • Calcium • Magnesium • Chloride • Phosphate • Bicarbonate Regulating the electrolytes
- 16. • LowpH=acidic • HighpH= alkalinic • BodyfluidsmaintainedbetweenpHof7.35and7.45by • Buffers • Respiratorysystem • Renalsystem RegulatingAcid-BaseBalance
- 17. Carbonicacid–bicarbonateratioandpH. • Preventexcessive changesinpH • MajorbufferinECF isHCO3 andH2CO3 • Otherbuffers include: – Plasmaproteins – Hemoglobin – Phosphates
- 28. FactorsAffectingBodyFluid, Electrolyte,andAcid- Base Balance • Age • Gender • Bodysize • Environmentaltemperature • Lifestyle
- 29. RiskFactorsforFluid,Electrolyte,andAcid-Base Imbalances • Chronicdiseases • Acuteconditions • Medications • Treatments • Extremesofage • Inabilitytoaccessfoodandfluids
- 30. SpecificIllnesses • COPD,Asthma,Cystic Fibrosis • CHF • Kidneydisease • DiabetesMellitus • Cushing’sorAddison’s disease • Cancer • Malnutrition,anorexia nervosa,bulimia • Ileostomy • Gastroenteritis • Bowelobstruction • Headinjury • Fever,draining wounds,fistulas • Surgery
- 31. • Diuretics – Waterdepletion – Electrolytedepletion • Corticosteroids – Waterretention • NSAIDS/Opoiods – Constipation Medications to monitor
- 32. • Chemotherapy • IVtherapyor TPN • Nasogastricsuction • EnteralFeedings • MechanicalVentilation Treatment that affect fluid imbalance
- 33. • Isotoniclossofwaterandelectrolytes(fluidvolumedeficit) • Isotonicgainofwaterandelectrolytes(fluidvolumeexcess) • Hyperosmolarlossofonlywater (dehydration) • Hypo-osmolargainofonlywater (overhydration) Fluid imbalances
- 35. • Sodium – 145mEq/L • RiskFactors – waterdeprivation,hypertonictubefeedings,withinadequatewater supplements,fever,unusuallyhighNa+intake,profusesweating, heatstroke,diabetesinsipidus • DefiningCharacteristics – thirst,drystickymucusmembranes,red,dryswollentongue,dyspnea, fatigue,disorientation,convulsions Hypernatremia
- 36. • Sodium – 135mEq/L • RiskFactors – lossofGIfluids,adrenalinsufficiency,sweating,diuretics,gainofwater,hypotonictube feedings,oralingestionofwater,excessadministrationofDextrose,diseasestatesheadinjury, AIDS, malignanttumors • DefiningCharacteristics – headache,muscletwitching,seizureactivity,abdominalcramps,N&V,anorexia,lethargy, confusion Hyponatremia
- 37. • Potassium • 5.5mEq/L (serum) • RiskFactors – decreaseK+excretion,renalfailure,K+conservingdiuretics, hypoaldosteronism,High K+intakeduringrenalinsufficiency, toorapidK+infusion,toohighdoseofK+PCNor KCLdose • DefiningCharacteristics – ECGchanges,vaguemuscleweakness, GIhyperactivity diarrhea,nausea,irritability,apathy,confusion,cardiacarrhythmias,arrest,absenceof reflexes,flaccidmusclesparalysis,numbnessandparesthesiasinextremities,faceand tongue Hyperkalemia
- 38. • Potassium • 3.5mEq/L (serum) • RiskFactors – vomiting,gastricsuction,diarrhea, heavydiaphoresis, use ofK+wastingdrugslikelasixandthiazidediuretics,steriodadminstration,lowintake ofK+fromETOHismoranorexia,hyperaldosteronism,osmoticdiuresisfrom uncontrolledDM • DefiningCharacteristics – ABGsshowalkalosis,ECGchanges,cardiacarrhythmias,muscleweakness, paresthesias,musclesoreness,legcramps,fatigue,lethargy,anorexia,N&V, decreasebowelsoundsandmotility, Hypokalemia
- 40. Hypokalemia
- 41. • Calcium – 5.5mg/dL • RiskFactors – hyperparathyroidism,prolongedimmobility,megadosesofvitaminD,bonemalignancy, paget’sdisease,thiazidediuretics,overuseofCa+containingantacidsandsupplements • DefiningCharacteristics – ECGchanges,lethargy,weakness,depresseddeeptendonreflexes,constipation,anorexia, N&V,polyuria,polydipsia,decreasedmemoryandattentionspan,confusion,renalstones, flankpain,neuroses,psychosisreversible,cardiacarrest Hypercalcemia
- 42. • Calcium • 4.5mEq/L • RiskFactors – hypoparathyroidism,malabsorption,vitaminD deficiency,acute pancreatitis,thyroidCA, hypomagnesemia,alkalosis,sepsis,alcohol abuse • DefiningCharacteristics – numbness,tingling,hyperactivedeeptendonreflexes,muscletremors, cramps,progressingtotetanyandconvulsions,cardiacarrhythmias,mental changes,Chvostek’ssign,Trousseau’s sign Hypocalcemia
- 44. • IntravenousFluids – Hypotonic • osmoticpressurelesstothatofplasma. • 0.45%NaCLorhalfnormalsaline • usedfordehydration and • promoteswasteeliminationofkidneys Correcting imbalances
- 45. • Isotonic – osmoticpressureequaltothatofplasma • Example#1- 5% dextrose in H2O (D5W) – suppliesfreewatertoaidinrenalexcretionofsolutes – Expandsintracellularandextracellularvolumes • Example#2- Lactated Ringers, 0.9% NaCL or normal saline (NS) – expandsvascularvolume – containsmultipleelectrolytesinphysiologicalconcentrations – usedtotreathypovolemia,burns,anddiarrhea – usedtotreatmildmetabolicacidosis Intravenous fluids
- 46. • Hypertonic – osmoticpressureabovethatofplasma • Example#1- 5% dextrose in 0.45%NaCl (D5 ½ NS) – treatshypovolemia – maintainshydration – drawsfluidoutoftheintracellularandinterstitialspacesinto thevascularspace – expandsvolume Intravenous fluids
- 47. • Hypertonic – Example#2- 5% dextrose 0.9% NaCl (D5NS) • replacescaloriesand electrolytes • temporarytreatmentof • hypovolemia Intravenous fluids