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Fluids and Electrolytes
- 2. Water 3/30/2020 2 Is simple inorganic compound H2O 50 to 60 % of Adult body weight Fluid Balance = Required amount of water is present and proportioned normally among the various compartments in body. Total body water is mainly determined by total amount of salt in body Salt & Water Concentration is controlled by Kidney.
- 3. Distribution of Fluid in The Body Intracellular Fluid 66% in Cells Extracellular Fluid 34% In Blood & Intestinal Fluid 3/30/2020 3
- 4. Extracellular Fluid (ECF) Intravascular (Present in Blood As a Plasma) Extra vascular •Interstitial Fluid (Between the Cell) •Lymph •Brain, Aqueous humor of Eye •Pericardium & Pleural Cavities 3/30/2020 4
- 5. Fluid 3/30/2020 5 Plasma Membrane separate ICF & ECF Blood Vessel Wall separate Blood Plasma & Interstitial Fluid (between the cells) The major component of Fluid include Water & Solute Solute = Mostly Electrolytes –in organic Ions Cations – Positive Charged Atoms e.g. Na, K, Ca, Mg, Co3 Anions –Negative Charged Atoms e.g. Chloride, Sulphide, Phosphate & Bicarbonate
- 6. Movement of Body Fluid 3/30/2020 6 Fluids & Electrolytes constantly move from one compartment to another for Metabolism Tissue oxygen Acid-base Balance Movement of Fluids & Solutes By 4 Way 1 Osmosis 2 Diffusion 3 Filtration 4 Active Transport.
- 7. Osmosis Definition: Osmosis is process by which the Solvent- Water movesacross aSemi permeable Membrane from an area of lesser Solute Concentration to an Higher Solute Concentration. Thus the concentration of both the side become Equal. 3/30/2020 7
- 8. Rate of Osmosis depend on 3/30/2020 8 Concentration of Solutes Temperature Electrical Charges of Solutes Osmotic Pressures of Solution.
- 9. Diffusion Definition: Diffusion refers to movement of a solute in a Solution across Semi permeable membrane from higher concentration to Lower concentration 3/30/2020 9
- 10. Filtration Definition: Filtration is the process by which Water & Substances that move across Semi permeable membrane from an area of higher Pressure to Lower Pressure 3/30/2020 10
- 11. Active Transport Active Transport require energy to move Substances across Semi permeable membrane. By this process move molecules from Lower Concentration to Higher Concentration. Na -> Pump Out from cell K -> Pump in to cell 3/30/2020 11
- 12. Functions of Water Essential for cell & Body environment Serve as a Transport media of Nutrient & Excretory Product Act as media of Biochemical reaction Act as a Solvent It play a vital role in Maintenance of body Temperature Work as Protector e.g. Amniotic Fluid Help in Swallowing e.g. Saliva Help in Maintaining Texture of Tissue Help in Maintenance of Acid-base & Electrolyte Balance Good source of minerals 12
- 13. Water Requirement 3/30/2020 13 The body has no Water storage Facility so we maintain its requirement every 24 hrs. Factors Affecting on Water Requirement Surrounding Temperature High Temp. Water losses is High Activity Level High Physical Activity High Water requirement Functional Losses E.g. Diarrhea Metabolic Need 1000 ml Water needed / 1000 kcal Age Infant 150ml / kg wt./day Adult 8 – 10 glass / day
- 14. Water Requirement 3/30/2020 14 Climate Dietary Constituents Surface Area of Body Daily Input of Water 2400 – 3000 ml / Day By Food, Drink & Metabolism 1500-1750 ml Drink 600-900 ml Solid Food 300-350 ml Oxidation of Car ., Fat &Proteins.
- 15. Daily Output of Water 3/30/2020 15 By Urine, Sweat, Breathing, Faeces Total output=2400 to 3000 ml / day 1200-1500 ml Urine => Kidney 700 – 900 ml Perspiration => Skin 400 ml Respiration => Lungs 100- 200 ml Faeces => Intestine
- 16. Regulation of Fluid Gain 3/30/2020 16 Normal condition Water loss = Water Gain The body regulate water intake by Thirst Reflex
- 17. Thirst Reflex 1. Level of Saliva Drops resulting in a Dry Mucosa in Mouth & Pharynx 2. Increase blood Osmotic Pressure which stimulates osmoreceptors in the Hypothalamus 3. Drop in Blood Volume which stimulate thirst centre in the Hypothalamus NB. Drinking of Water Inhibit Thirst Centre by Stretching Stomach & Intestines.
- 18. Regulation of Fluid Loss Three Hormones play important role in maintenance of Fluid volume • Antidiuretic Hormone (ADH) • Aldosterone • Atrial Natriuretic Peptide (ANP) 3/30/2020 18
- 19. Regulation of Fluid Loss body Fluid •Increase Body tonicity A drop in •Decrease Blood Volume Release of Renin in Kidney •Stimulate osmoreceptors of Hypothalamus Release ADH from Pituitary Gland •ADH Targets Kidney Gland Reducing Fluid Loss •Arterioles constrict 3/30/2020 19
- 20. Regulation of Fluid Loss 3/30/2020 20 Aldosterone : Increase retention of Na & Cl ions as well as Water by the Kidney Increase body Fluid & Blood Pressure Atrial Natriuretic Peptide (ANP): Increase in body Fluid results in increases Blood Volume => -Which Stimulates the release of ANP Hormone - That increases the loss of Fluid in Urine - At the same time the level of ADH & Renin Decreases
- 21. Other Factors that Regulate Fluid Loss Severe Dehydration Decrease Blood Pressure & Glomerular Filtration Rate Decreases Loss of Water in Urine 3/30/2020 21
- 22. Other Factors 3/30/2020 22 that Regulate Fluid Loss Water overload will increase Blood Pressure & Glomerular Filtration Rate => Which increase Loss of Water in Urine. Hyperventilation increase Fluid Loss Via Vapour in lungs Vomiting & Diarrhea Increase Fluid Loss via GIT. Fever, Heavy Perspiration & Skin Loss (burns) increase Fluid Loss via skin.
- 23. Overhydration 3/30/2020 23 Overhydration = Excess of Water in body Overhydration occurs when High intake & Low output of Water Electrolytes Imbalances : Na Level is diluted Intake more than 2 Gallon Water (1 gallon = 3.78 L) Kidney Function is impaired Doctor / Nurses administer large amount of fluid & Medications
- 24. Overhydration 3/30/2020 24 Causes & Symptoms People with Heart, Kidney or Liver disease have high risk Change in behavior Patient may become confused, Drowsy or Inattentive Burred vision Muscle Cramps & Twitching (jerky motion) Paralysis on one side of the body Poor coordination
- 25. Overhydration 3/30/2020 25 Causes & Symptoms Nausea & Vomiting Rapid Breathing Sudden weight gain & weakness High blood Pressure Acidosis (High acidity in Blood & Tissue) Anemia Cyanosis (Decrease Oxygen level in Blood) Hemorrhage & shock Confusion & Seizures (A sudden occurrence of a disease) coma
- 26. Risk Factors of Overhydration 3/30/2020 26 Chronic illness Malnutrition Tendency to retain Water Kidney Diseases Infant due to over hydrated Mental disorder Alcoholics
- 27. Mild Overhydration => Limited Fluid Intake Serious Overhydration => Diuretics may Prescribed Inpatient with sever Neurological Symptoms => A powerful Diuretics & Fluid to restore normal Na Level. 3/30/2020 27 Treatment of Overhydration
- 28. Dehydration 3/30/2020 28 Dehydration (Hypohydration) is the removal of Water from object.
- 29. Causes of Dehydration 3/30/2020 29 External/ Stress Related Causes • Prolonged Activity • Prolonged exposure to Dry Air • Survival situation in Dessert • Blood loss • Diarrhea • Hyperthermia • Shock • vomiting Malnutrition • Electrolyte Imbalance • Hypernatremia • Hyponatremia • Excessive consumption of Alcohol • Fasting • Recent RapidWeight Loss • Patient refusal of Nutrition & Hydration
- 30. Causes of Dehydration 3/30/2020 30 Infectious Causes • Cholera • Gastroenteritis • Shigellosis • Yellow Fever Other Causes • Sever Hyperglycemia in Diabetes mellitus • Glycosuria
- 31. Symptoms of Dehydration 31 • Dehydration noticeable after 2 % Water loss than normal • Thirst & Discomfort • Loss of Appetite • Dry Skin • Low endurance (stamina) • Rapid Heart Rate • Elevated body Temperature • Headache • A sudden episode of visual snow • Decreased Blood Pressure • Dizziness • Untreated Dehydration causes Delirium (restlessness), Unconsciousness & Death.
- 32. Symptoms of Mild Dehydration 3/30/2020 32 • Thirst • Decrease Urine Volume • Urine that is darker than Usual • Tiredness • Lack of Tears when crying • Headache • Dry Mouth • Dizziness (lacking boldness and courage)
- 33. Symptoms of Moderate to Sever Dehydration 3/30/2020 33 • No Urine output • Lethargy • ExtremeSleepiness • Seizures (A sudden occurrence of a disease) • Sunken fontanel (Soft Spot) in infants • Fainting & Sunken eyes.
- 34. Symptoms of Sever Dehydration 3/30/2020 34 • Greater Water loss • Hearts & Respiration Rate increase • If 5-6 % water loss => Become Sleepy Nausea Tingling sensation (Itching) • If 10 -15% water Loss => Fluid Loss Muscles may become spastic Skin may Shrivel & Wrinkle Vision may dim Urination greatly Reduced & Painful
- 35. Treatment of Dehydration 3/30/2020 35 • Replacement of Water & Electrolytes – By Oral or Intravenous Rehydration • Unnecessary Sweating should be Avoided • Give Liquid Food • Give ORS Drink • Don’t give Dry Food • Give Fluid rich of Electrolytes.
- 36. Preventing of Dehydration 3/30/2020 36 • Dehydration is best prevented by replacement of Water & Electrolytes • Drink water frequently • Unnecessary Sweating should be Avoided • Give Fluid rich in Electrolytes • High Liquid Food intake in summer.
- 37. Electrolytes 3/30/2020 37 • Definition: Substances dissolved in water as Ion with positive or Negative Charged is known as Electrolytes • Fluid balance linked with Electrolytes • Electrolytes established Osmotic Pressure • ICF & ECF is Maintained by Electrolytes • Electrolytes help to balance pH & Acid-base balance • Electrolytes regulate functions of Neuromuscular, Endocrine & Excretory system
- 38. The Serum Electrolytes • Sodium ( Na) + Ve • Potassium (k) + Ve • Calcium (Ca) + Ve • Magnesium (mg) • Chloride (Cl) - Ve • Phosphate (PO4) - Ve • Bicarbonate (HCO3) – Ve 3/30/2020 38
- 39. Sodium ( Na) + Ve 3/30/2020 39 – Help in Water Balance – Help in Neuromuscular Functions – Normal Serum Na Level = 135 – 145 mEq/L Hypernatremia – Cause By inadequate intake of Water – Excessive fluid loss – Diuretic Drugs – Disease of Kidney.
- 40. Sodium ( Na) + Ve 3/30/2020 40 Symptoms of Hypernatremia • Thirst • Orthostatic hypotension • Dry mouth & mucosa membrane • Dark, Concentrated Urine • Loss of elasticity in the skin • Irregular Heart beat • Irritability • Fatigue • Lethargy • Heavy, Labored Breathing • Muscle twitching.
- 41. Hyponatremia Causes • Diuretics • Certain Psychoactive Drug • Ecstasy Drugs • Inadequate intake of Na • Impaired Adrenal Gland. Sodium ( Na) + Ve 3/30/2020 41
- 42. Sodium ( Na) + Ve 3/30/2020 42 Symptoms of Hyponatremia • Nausea, Abdominal Cramp, Vomiting • Headache • Edema • Muscle Weakness • Paralysis • Disorientation • Slowed Breathing • seizure • Coma
- 43. • Help in Neuromuscular Functions & Osmotic Pressure • Maintain body water Balance (intracellular Fluid) • Transmission of Nerves impulses • Regulate Normal Heart beat • Normal Serum K Level = 3.5 – 5.5 mEq/L Potassium (K) + Ve 3/30/2020 43
- 44. Potassium (K) + Ve 3/30/2020 44 Hyperkalamia: Causes by Ketoacidosis (Diabetic coma) Myocardial Infraction ( Heart Attack) Sever Burns Kidney Failure Fasting Bulimia nervosa (excessive eating followed by periods of fasting ) GI Bleeding Adrenal insufficiency Diuretics Drugs.
- 45. Potassium (K) + Ve 3/30/2020 45 Symptoms of Hyperkalemia Weakness Nausea & Abdominal Pain Irregular Breathing Diarrhea Muscle Pain.
- 46. Potassium (K) + Ve 3/30/2020 46 Hypokalemia : Causes • Sever Dehydration • Aldosteronism • Kidney Disease • Long term diuretic therapy • Certain Penicillin • Cognitive Heart Failure • Adrenal Gland Impairment.
- 47. Potassium (K) + Ve 3/30/2020 47 Symptoms of Hypokalemia : • Weakness • Paralysis • Increase Urination • Irregular Heart beat • Orthostatic Hypotension • Muscle Pain • Tetany.
- 48. Calcium (Ca) + Ve Functions 3/30/2020 48 • Need for Growth & Strong Bone • Needed for Muscle Contraction • Essential for Blood Clotting • Ca is needed for Functioning of Neuro Transmitters • Normal Ca Level is 9 – 11 mg/dl.
- 49. Calcium (Ca) + Ve 3/30/2020 49 Hypercalcemia : Causes • Thyroid Disorder • Multiple Myeloma (A tumor of the bone marrow) • Metastatic Cancer • Multiple Bone Fractures • Milky- alkali Syndrome • Excessive use of Calcium.
- 50. Calcium (Ca) + Ve 3/30/2020 50 Symptoms Of Hypercalcemia : Fatigue Constipation Depression Confusion Muscle Pain Nausea & Vomiting Dehydration Increase Urination Irregular Heartbeat.
- 51. Calcium (Ca) + Ve 3/30/2020 51 Hypocalcaemia : Causes Thyroid Disorder Kidney Failure Sever Burns Sepsis Vitamin D Deficiency Medication such Heparin & Glucagon.
- 52. Calcium (Ca) + Ve 3/30/2020 52 Symptoms of Hypocalcaemia : • Muscle Cramps & Spasms • Tetany & Convulsions • Mood Changes • Dry Skin • Brittle nails • Facial Twitching.
- 53. Essential for Transmission of Impulses between Nerves & Muscles Production of ATP Involved in Enzymic Activity Mg & Ca Act as Synergistically & Antagonistically Maintain Ca & P Level Normal Serum Mg Level is 1.4-2.1 mEq/L Magnesium (mg) 3/30/2020 53
- 54. Causes : • End Stage Renal Disease • Addison’s Disease (A glandular disorder caused by failure of function of the cortex of the adrenal gland and marked by anemia and prostration with brownish skin) • Overdose of Magnesium Salts. Hypermagnesemia 3/30/2020 54
- 55. • Lethargy • Hypotension • Decreased Heart & Respiratory Rate • Muscle Weakness • Diminished tendon reflex. Symptoms of Hypermagnesemia 3/30/2020 55
- 56. Causes : • Inadequateintake of Mg • ChronicAlcoholic • Malnutrition • Malabsorption Syndromes • Pancreatitis • Burns • Hyper parathyroidism • GIT Disorders • Use of Diuretics. Hypomagnesaemia 3/30/2020 56
- 57. • Leg & Foot Cramps • Weight loss • Vomiting • Muscle spasm • Seizures • Muscle Weakness • Arrhythmia (abnormal rate of cardiac muscle contraction) Symptoms of Hypomagnesaemia 3/30/2020 57
- 58. Chloride (Cl) - Ve Regulate Blood Pressure Maintain body water Balance (extracellular Fluid) HCl Production in Stomach Normal Serum Cl Level is 100-108 mEq/L 3/30/2020 58
- 59. Hyperchloremia 3/30/2020 59 Causes: • Sever Dehydration • Kidney Failure • Hemodialysis • Brain Injury • Aldosteronism • Drugs : Boric acid, Ammonium Chloride • IV infusion of NaCl.
- 60. Symptoms of Hyperchloremia 3/30/2020 60 Weakness Headache Nausea Cardiac arrest.
- 61. Hypochloremia Causes: Due to Na & K depletion Hyponatremia Hypokelemia Sever depletion of serum Cl level Metabolic Alcolosis. 3/30/2020 61
- 62. Symptoms of Hypochloremia 3/30/2020 62 • Mental Confusion • Slowed Breathing • Paralysis • Muscle Tension or Spasm.
- 63. Phosphate 3/30/2020 63 • Metabolism of Energy- ATP Production • Chemical reaction in body • As Phospholipids & Phosphoproteins in cell membrane • Acid-base Balance • Mineralization of bone • Absorption & Transport of nutrients • Regulation of Protein activity • Normal Serum P level is 2.5-4.5 mEq/L.
- 64. Hyperphosphatemia 3/30/2020 64 Causes : • Skeletal Fractures • Kidney Failure • Hypoparathyroidism • Diabetic Ketoacidosis • Acromegaly (Enlargement of bones of hands and feet and face) • Systemic Infection • Intestinal Obstruction.
- 65. Hyperphosphatemia 3/30/2020 65 Symptoms : • Tingling Sensation in Hand & Fingers • Muscle spasm and Cramp • Convulsions • Cardiac Arrest.
- 66. Hypophosphatemia 3/30/2020 66 Causes : • SerumP below 2mg/dl • Hypomagnesemia & Hypokelemia • SeverBurns • Alcoholism • Hyperparathyroidism & Hypothyroidism • Diabetic Ketoacidosis • Kidney Disease • Malnutrition • Vitamin D Deficiency.
- 67. Hypophosphatemia 3/30/2020 67 Symptoms : • Muscle Weakness • Weight Loss • Bone Deformities.
- 68. Electrolytes in the body Electrolytes Function Distribution Sodium Na+ -Fluid & Electrolyte Balance -Maintain Osmotic Pressure of ECF 90 % in ECF Level in Blood Controlled by ANP & ADH Potassium K+ -Essential for Nervous & Muscle Tissue -Maintain Fluid Volume -Regulate pH Abundant in ICF - Controlled by Aldosterone Calcium Ca+ 3/30/2020 -Essential for Blood Clotting - Maintenance of Muscle Tone & Nervous Tissu -Abundant in Bone - Controlled by Parathyroid Hormone 71
- 69. Electrolytes in the body 3/30/2020 69 Electrolytes Function Distribution Chloride Cl- -Help to balance Anions in ICF & ECF -Most prevalent ECF Anions -Controlled by Aldosterone Bicarbonate (HCO3)- Major Buffer of H+ In Plasma Maintain Anions & Cations in ECF & ICF Abundant in ICF - Controlled by Aldosterone
- 70. Acid-base Balance • Maintain pH at level 7 – Above 7 pH = Acidic – Below 7 pH = Alkaline • Most body Fluid are near Neutral pH of Some Solution 0 - HCl 2 - Gastric Juice 3 – Orange Juice 4 – Grape Juice 5 – Coffee 6 – Urine 7 - Water , Blood 8 - Sea Water 14- NaoH 3/30/2020 70
- 71. 3/30/2020 71