FLUID, ELECTROLYTE, AND ACID-BASE BALANCE

Rini Rachmawarni Bachtiar

Physiology Departement Hasanuddin University

BODY FLUIDS

Body fluids

Extracellular fluids (ECF)

Interstitial

fluid - fills the spaces between most cells of the body Intravascular fluid - plasma (WBC, RBC and platelets in this fluid)

Body fluids

Intracellular fluids (ICF)

Liquids

within cell membranes 40% of body weight

COMPONENT S IN BODY FLUIDS

Components in body fluids

Electrolyte
an

element that when dissolved can carry an electrical current Conduct electricity and control fluid levels. Pass electricity from the brain through our nerves and into our muscles and organs Cations - (+) ; Anions - (-) neuromuscular function acid-base balance

Components of body fluids

Minerals
ingested

compounds serve as catalysts in nerve response, muscle contraction, and metabolism of nutrients in foods, regulate electrolyte balance

MOVEMENT OF BODY FLUIDS

Movement of body fluids

Diffusion
Area

of higher concentration to an area of lower concentration till even distribution of a pure solvent, e.g. water through a semipermeable membrane from a solution that has a lower solute concentration to one that has a higher solute concentration

Osmosis
Movement

Osmosis

Osmotic pressure

Drawing power of water (dependent on the number or molecules in solution)

Isotonic Hypotonic Hypertonic

Osmotic pressure on blood cells

Movement of body fluids

Filtration
Water

and diffusible substances move together in response to fluid pressure

Active transport
Requires

energy Able to move larger molecules and go from less to greater concentration

FLUID INTAKE & OUTPUT

Fluid Intake

Hypothalamus - thirst control center Oral fluid intake requires an alert state Osmoreceptors - monitor osmolality

The hypothalamus links the nervous system to the endocrine system by stimulating the secretion of hormones from the pituitary gland. It controls our emotions, body temperature, hunger, thirst, fatigue, and circadian cycles.

Fluid Output

Loss through the kidneys and GI tract Insensible Sensible

CATION S

Cations

Sodium (Na+)
Most

abundant in the extracellular fluid Maintains water balance, transmits nerve impulses, contracts muscles Values - 135-145 mEq/L

Cation

Potassium (K+)
Major

intracellular cation Regulates neuromuscular excitability, muscular contraction, and acid-base Value - 3.5 -5.3 mEq/L

Cation

Calcium (Ca2+)
Cardiac

conduction, blood coagulation, bone growth and formation, & muscular relaxation Value - 4 - 5 mEq/L

Cation

Magnesium (Mg2+)
Second

most important of intracellular fluids Enzyme activities, muscular excitability Value - 1.5 - 2.5 mEq/L

ELECTROLYTE IMBALANCES

Electrolyte Imbalances

Hyponatremia
GI

losses, sweating, & diuretics S/S: N/V/D, abd cramps, personality change

Hypernatremia
Ingestion

of large amounts S/S: Dry tongue and mucous membranes, restlessness, convulsions, thirst, dry skin

Electrolyte imbalances

Hypokalemia Causes: K+ wasting diuretics N/V/D polyuria S/S: weak, irregular pulse
hypotension weakness

Electrolyte imbalances

Hyperkalemia
Causes:

Renal failure S/S: irregular slow pulse, weakness, irritability

Electrolyte Imbalances

Hypocalcemia
Causes:

Vitamin D deficiency S/S: Numb and tingling fingers and circumoral region, muscle cramps

Hypercalcemia
Causes:

osteoporosis, prolonged immobilization S/S: decreased muscle tone, weakness, lethargy, kidney stones

Electrolyte imbalances

Hypomagnesemia
Causes:

malnutrition and alcoholism polyuria S/S: muscular tremors, hyperactive deep tendon reflexes

Hypermagnesemia
Causes:

Renal failure S/S: hypoactive deep tendon reflexes, shallow and slow respirations

ACID - BASE BALANCE

Acid - Base Balance

Blood pH - 7.35 - 7.45 paCO2 - 35 - 45 Bicarbonate (HCO3) - 22-26 mEq/L

Respiratory Acidosis

pH < 7.35 paCO2 > 45 mm Hg Causes: Respiratory failure Hypoventilation Resp muscles paralysis Airway obstruction

Respiratory Alkalosis

pH > 7.45 paCO2 < 35 mm Hg Causes: excessive exhalation of CO2 (hyperventilation)

Metabolic Acidosis

pH < 7.35 bicarbonate - < 22 mEq/L Causes: Starvation, DKA, Diarrhea, drug use

Metabolic Alkalosis

pH > 7.45 bicarbonate > 26 mEq/L Causes: excessive vomiting, prolonged gastric suctioning

FLUID & ELECTROLYTE IMBALANCES

Fluid & Electrolyte Imbalances

Burns - body fluid loss Renal D/O - abnormal retention of Na, Cl, K GI Disturbances - Loss of fluid, potassium, and chloride Exercise

S/S electrolyte imbalance

Head: irritability Fontanels: depressed, bulging Eyes: sunken periorbital edema Mouth: mucous membranes CV: neck veins, edema, blood pressure Resp: Crackles

Imbalances

GI: abdomen, V/D Renal: Oliguria or anuria (FVD, FE) Diuresis (FVE) Increased urine spec. gravity (FVD) Skin (Temp)
increased

- met acidosis, hypernatremia decreased - FVD

REPLACEMENT OF FLUIDS AND ELECTROLYTES

Replacement of fluids and electrolytes

Types of IV fluids Isotonic Hypertonic Hypotonic

IV complications

Infiltration Phlebitis
vein

inflammation S/S: pain, redness, warmth

Fluid overload
Fluids

given too rapidly

Bleeding

Discontinuing an IV

Stop infusion Remove tape 1 - 2 minute pressure

Blood transfusions

Large bore catheter (18 ga or larger) Give with normal saline Baseline vital signs Double check Begin transfusion slowly Observe closely for first 15 min

Transfusion Reactions

Caused by:
blood

incompatibility allergic sensitivity S/S: fever, chills, rash, hypotension, shock

Treatment: stop transfusion, save tubing, prepare for emergency drugs