This document provides an overview of fluid and electrolyte balance and imbalance. It defines key terms related to fluids, electrolytes, and body composition. It describes the normal regulation of fluids and electrolytes in the body, including through passive and active transport mechanisms, hormones, and the sensation of thirst. It then discusses various abnormalities in fluid and electrolyte balance that can occur, including deficits, excesses, and shifts of extracellular fluid as well as various electrolyte imbalances.

1. Seminar On Fluid and
Electrolyte Imbalance
Aneez. K
Ist Year MSc. Nursing
EMCH CON

2. Terminologies
 Homeostatic
 Hydrostatic Pressure
 Osmolarity
 Osmolality
 Isotonic
 Hypotonic Solution
 Hypertonic Solution
 Anabolism
 Catabolism

3.  Total Body Water (TBW)
 Intracellular Fluid (ICF) Volume
 Extracellular Fluid (ECF) Volume
 Interstitial Fluid Volume
 Intravascular Fluid Volume
 Salt
 Electrolyte
 Solution
 Crystalloid
 Colloid
 Balanced Crystalloid

4.  Anion Gap
 Maintenance
 Replacement
 Resuscitation

5. Normal Anatomy and Physiology

6. Why women have less water than men if
they are the same weight?
The water content of adipose (fat)
tissue is less than that of muscle,
while women have more adipose tissue
at the effect of feminine hormone.

7.  Body fluids are distributed in two
distinct area:
 intracellular fluid (ICF)
40% body weight
 Extracellular fluid (ECF)
20% body weight
Interstitial fluid -15% body
weight
Plasma -5% body weight

9. Fluid and Electrolyte Balance between Body
and Environment
Intake of fluid and electrolytes X output
Insensible loss
Kidneys
Gastrointestinal tract
Skin
Lungs

10. Intake

11. Output
 Lungs and Skin 0.5 – 1 l/day
 GI 100-150 ml/day
 Kidney

12. Regulation of Fluid and Electrolyte
 Passive transport mechanism
 Active transport mechanism

13. Passive transport mechanism
 Simple Diffusion through Lipid Layer
 Simple Diffusion through Protein Layer
 Facilitated or Carrier Mediated Diffusion

14. Simple Diffusion through Lipid Layer
Watertransport
Simple diffusion
Intracellular fluid Interstitial fluid
cell
Water
Water channel

15. Simple Diffusion through Protein Layer

16. Facilitated or Carrier Mediated Diffusion

17. Special Types of Passive Transport
1. Bulk Flow

18. 2. Filtration

19. 3. Osmosis

20. Active Transport
 Primary Active Transport
 Secondary Active Transport

21. Primary Active Transport

22. Secondary Active Transport

23. Hormonal Regulation of Fluid Balance
 Aldosterone
 Antidiuretic hormone
 Natriuretic peptide (NP)

24. Aldosterone
 Hormone secreted from the
zona glomerulosa cells of
adrenal cortex
 Stimulates kidneys
Retain sodium
Retain water
Secrete potassium

25. Antidiuretic hormone
 Also called arginine vasopressin
(AVP).
 ADH is produced in neuron cell
bodies in supraoptic and
paraventricular nuclei of the
Hypothalamus, and stored in
posterior pituitary.
 Physiological function
Promote the reabsorption of
water in the collecting duct.

26. The natriuretic peptide family
 Four peptides of this family have been identified, including:
Atrial natriuretic peptide (ANP)
Brain natriuretic peptide (BNP)
C-type natriuretic peptide (CNP)
Urodilatin
 Function:
Diuretic and natriuretic actions

27. Atrial Natriuretic Peptide: Function

28. The sensation of thirst
 Conscious desire for water
 Major factor that determines fluid intake
 Initiated by the osmoreceptors in hypothalamus that are
stimulated by increase in osmotic pressure of body fluids
 Also stimulated by a decrease in the blood pressue through the
receptor of baroreceptor

29. Osmoreceptors stimulate AVP secretion and thirst
 These cells project to
the paraventricular
nuclei (PVN) and
supraoptic nuclei (SON)
to produce AVP
secretion
The vascular organ of the lamina terminalis (OVLT) contains
osmoreceptive neurons – also the subfornical organ (SFO)
and the median preoptic n. (MnPO)

30. The regulation of thirsty reaction
 The stimulus sensed by osmoreceptor:
• Not a change in the extracellular fluid osmolality
• But a change in osmoreceptor neuron size or in the some intracellular substance.

33. Abnormalities in the Regulation of Body Fluid.
 Extra Cellular Fluid Volume Deficit (ECFVD)
 Extra Cellular Fluid Volume Excess
 Extra Cellular Fluid Volume Shift

34. Extra Cellular Fluid Volume Deficit (ECFVD)
 A decrease in intravascular and interstitial fluids.
 It is a common and serious fluid imbalance that
results in vascular fluid volume loss
(hypovolemia).

35. Risk Factors
 Diabetic ketoacidosis
 Hemorrhage
 Difficulty to swallowing
 Aged
 Severe mentally ill patient

36. Laboratory findings
 Increased Osmolality
 Increased or normal serum sodium level
 BUN (> 25 mg/d1)
 Hyperglycaemia (> 120 mg / dl)
 Increased specific gravity of urine
 Elevated hematocrit (>55%), Increased Specific
gravity

37. Management of Dehydration
 Pharmacologic Management
 Dietary management
 Nursing Management
 Nursing Diagnoses and Collaborative Problems
 Nursing Intervention

38. Falls Precautions:
 Assess for orthostatic hypotension
 Assess muscle strength in legs
 Orient the patient to the environment
 Remind the patient to call for help before getting
out of bed or a chair
 Help the patient get out of bed or a chair
 Provide, or remind the patient to use, a walker or
cane for ambulating

39.  Help the incontinent patient toilet every 1 to 2 hours
 Clean up spills immediately
 Provide adequate lighting at all times, especially at night
 Keep the call light within reach, and ensure that the patient
can use it
 Place the bed in the lowest position with the brakes locked
 Place objects that the patient needs within reach
 Ensure that adequate handrails are present in the patient's
room, bathroom, and hall
 Encourage family members or significant other to stay with
the patient

40. Extra Cellular Fluid Volume Excess
 ECFVE is increased fluid retention in the
intravascular & interstitial spaces

41. Extra Cellular Fluid Volume Shift
 Fluid volume shift is basically a change in the location of
extra cellular fluid between the intravascular and the
interstitial spaces.

42. Electrolyte Balance and Imbalance
 Sodium
 Hyponatremia
 Hypernatremia

43. Hyponatremia
• Definition:
– Commonly defined as a serum sodium
concentration <135 meq/L
– Hyponatremia represents a relative excess of
water in relation to sodium.

44. Hyponatremia is the most common electrolyte disorder
Acute hyponatremia (developing over 48 h or less) are
subject to more severe degrees of cerebral edema
sodium level is less than 105 mEq/L, the mortality is over
50%
Chronic hyponatremia (developing over more than 48 h)
experience milder degrees of cerebral edema

45. Types
Hypovolemic hyponatremia
Euvolemic hyponatremia
Hypervolemic hyponatremia
Redistributive hyponatremia
Pseudohyponatremia

46. Hypovolemic hyponatremia
 Develops as sodium and free water are lost
and/or replaced by inappropriately hypotonic
fluids
 Sodium can be lost through renal or non-renal
routes

47.  Nonrenal loss
GI losses
Vomiting, Diarrhea, fistulas, pancreatitis
Excessive sweating
Third spacing of fluids
ascites, peritonitis, pancreatitis, and burns
Cerebral salt-wasting syndrome
traumatic brain injury, aneurysmal
subarachnoid hemorrhage, and intracranial
surgery
Must distinguish from SIADH

48.  Renal Loss
Acute or chronic renal insufficiency
Diuretics

49. Euvolemic hyponatremia
 Normal sodium stores and a total body excess of free
water
Psychogenic polydipsia, often in psychiatric patients
Administration of hypotonic intravenous (5% DW) or
irrigation fluids ( sorbitol, glycerin) in the immediate
postoperative period

50. administration of hypotonic maintenance
intravenous fluids
Infants who may have been given inappropriate
amounts of free water
bowel preparation before colonoscopy or
colorectal surgery

51. Hypervolemic hyponatremia
 Total body sodium increases, and TBW increases to a greater
extent.
 Can be renal or non-renal
acute or chronic renal failure
dysfunctional kidneys are unable to excrete the ingested
sodium load
cirrhosis, congestive heart failure, or nephrotic syndrome

52. Hypervolemic hyponatremia
 Total body sodium increases, and TBW increases to a greater
extent.
 Can be renal or non-renal
acute or chronic renal failure
dysfunctional kidneys are unable to excrete the ingested
sodium load
cirrhosis, congestive heart failure, or nephrotic syndrome

53. Redistributive hyponatremia
Water shifts from the intracellular to the extracellular
compartment, with a resultant dilution of sodium. The TBW
and total body sodium are unchanged.
This condition occurs with hyperglycemia
Administration of mannitol

54. Hypernatremia
 Hypernatremia is usually due to water deficit
Excess water loss :eg- heat exposure
diabetes insipidus
Impaired thirst:eg-primary hypodypsia,
comatose
Excessive Na retension

55. Clinical feature
 Excessive thirst,polyuria,nausea
 Muscular weakness, neuromuscular irritability
 Altered mental status,focal neurological deficit
occasionally coma or seizures

56. Treatment
 correct water deficit
water deficit =
(plasma Na-140)/140*0.6*body wt in kg
 Rate of correction :
-Acute hypernatremia- 1mEq/L/hr
-Chronic hypernatremia-1mEq/L/hr or 10mEq/L over 24hr
-rapid correction may lead to cerebral oedema

57. Potassium
 Hypokalemia
 Hyperkalemia

58. Calcium
 Hypocalcemia
 Hypercalcemia

59. Phosphorus
 Hypophosphatemia
 Hyperphosphatemia

60. Magnesium
 Hypomagnesemia
 Hypermagnesemia

61. Bibliography
 Priscilla Lemone, Karen Burke. “Medical surgical nursing, critical
thinking in client care”. 4th edition (2008). Page no. 185-198
 Ignatavicius Workman. “Medical surgical nursing, Patient centred
collaborative care”. 6th edition (2010). Elsevier publication. Page no.
1022-1024
 Brunner and Suddharth. “Text book of medical surgical nursing”.
Page no. 249-255
 Guyyton and Hall. “Text book of medical physiology”. 11th edition
(2006). Elsevier publications. Page no. 642-650
 Gerard.J.Tortora. “Principles of anatomy and physiology”. 11th
edition (2006). Wiley publication. Page no. 1122-1130

62.  K. Sembulingam, Prema Sembulingam. “Essentials of medical
physiology”. 5thedition (2010). Jaypee publications. Page no. 302-309
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63. THANK YOU…………