Overview of
Fluids,Fluids, ElectrolytesElectrolytes BalanceBalance
MOHAMMED ALHABSI INDANAN,RNClinical Instructor
King Abdul Aziz Specialist Hospital-Taif
sketch out of my talkssketch out of my talks
Concept of Fluid & Electrolyte Balance:Concept of Fluid & Electrolyte Balance: Properties & components of Electrolytes Description & Measurement of Electrolytes Body Fluid Compartments Third Spacing Edema Description & Constituent of Body Fluids Body Fluid Transport Movement of Body Fluid Body Fluid Excretion
Surah Surah AL- MURSALATAL- MURSALAT (Those Sent Forth) (Those Sent Forth)
“ مهين” ماء من نخلقكم “ألم مهين” ماء من نخلقكم ألمآيه المرسالت 20سورة
““Have We not created You Have We not created You from a fluid (Held) from a fluid (Held) despicable?” despicable?” Holy Qur’anHoly Qur’an
Body Fluids
Intercellular
Intravascular
Interstitial
Body Water = 60% of a patient’s body weight
16%
4%40%
Figure 1-1
Fluid CompartmentsFluid Compartments
Intracellular spaceExtracellular space
InterstitialIntravascular
Solutethe substance that dissolved
Solventsubstance in which solute is dissolved
Osmolalityconcentration of solute per kg of water
Osmolarityconcentration of solute per L of solution
Solution- substance that dissolve in other substances
Composition of the Body FluidsComposition of the Body Fluids
The fluids circulating throughout the body in ECF & ICF spaces contain:
1. Electrolytes
2. Minerals
3. Cells
Movement of BODY FLUIDSMovement of BODY FLUIDS
DiffusionOsmosisActive TransportFiltration
Definition:Definition:Diffusion is the natural tendency of a substance to
move from an area of higher concentration to one of lower concentration.
OsmosisOsmosis fluid shift to the membrane from the region of low concentration to the region of high concentration.
Active TransportActive Transport this is movement of molecules against a concentration as they move from an area of lower concentration to an area of higher concentration and requires an energy.
FiltrationFiltration movement of water & solutes occurs from an area of high hydrostatic pressure to an area of low.
OsmosisOsmosisFigure 2.
FluidFluid
High Solution High Solution Concentration, Concentration,
Low Fluid Low Fluid ConcentrationConcentration
Low Solute Low Solute Concentration, Concentration,
High Fluid High Fluid ConcentrationConcentration
DiffusionDiffusion
High Solute ConcentrationHigh Solute Concentration Low Solute ConcentrationLow Solute Concentration
FluidFluid
SolutesSolutes
Figure 3.
Active transportActive transport
K K ++
K K ++
K K ++
K K ++ K K ++
K K ++ K K ++
K K ++
K K ++ K K ++
K K ++
K K ++
K K ++
K K ++
K K ++
K K ++
K K ++ATPATP
ATPATP
ATPATP
ATPATP Na Na ++
Na Na ++
Na Na ++
Na Na ++ Na Na ++
Na Na ++
Na Na ++
Na Na ++
Na Na ++
Na Na ++
Na Na ++
Na Na ++
Na Na ++
Na Na ++
Na Na ++
Na Na ++
Na Na ++
Na Na ++
Na Na ++
Na Na ++
Figure 4.INTRACELLULAR FLUIDINTRACELLULAR FLUID
EXTRACELLULAR FLUIDEXTRACELLULAR FLUID
BLOOD BLOOD VESSELVESSEL
NORMAL NORMAL CELLCELL
ISOTONIC ISOTONIC
BLOOD BLOOD VESSELVESSEL
SHRUNKEN SHRUNKEN CELLCELL
HYPERTONICHYPERTONIC
HYPOTONICHYPOTONIC
BLOOD BLOOD VESSELVESSEL SWOLLEN SWOLLEN
CELLCELL
Electrolytes
Chemically, electrolytes are substances that become ions in solution & acquire the capacity to conduct electricity.
Essential for normal function of the cells & our organs.
Sodium, Potassium, chloride, & Bicarbonate
Sodium (Na)Sodium (Na)
135 to 145 mEq/L (135-145 mmol/L)Major positive ion in fluid outside the cells.Regulates the total amount of water in the
body & the transmission of into & out of cells.
Potassium (K+)Potassium (K+)
3.5 to 5.0 mEq/L (3.5 to 5.0 mmol/L)Major positive ion found inside the cells.Regulation of the heartbeat & function of
the muscles.
Chloride (Cl-)Chloride (Cl-)
98 to 108 mmol/LMajor anion (negatively charged ion) found
outside the cells & in the blood.Helping the body maintain a normal
balance of fluids
Bicarbonate (HCO3)Bicarbonate (HCO3)
22 to 30 mmol/LActs a buffer to maintain the normal level
of pH in the blood & other fluids in the body.
Measured to monitor the acidity of the blood & body fluids.
Third Spacing
Occurs when the fluid is “trapped” in the interstitial spaces.
Fluids shifts from the vascular space into an area where it is not readily accessible as extracellular fluid.
This fluid is remains in the body but is essentially unavailable for use, causing an isotonic fluid volume deficit.
Pt. may not manifest fluid loss or weight loss.
Decreased Oncotic Pressure
Loss of albumin or protein leads to decreased oncotic pressure, causing fluid to “leak” from the intravascular space to the interstitial space
Due to the loss in circulating fluid volume, cardiac output decreases
Causes of Fluid Shifts Albumin losses can occur in liver failure, liver
dysfunction, and malnutrition
Albumin losses can lead to fluid shifting into the peritoneum, causing ascites
Destruction of endothelial cells, such as in bowel surgery, can cause fluid to move and be trapped in the interstitial spaces
Fluid trapped in the lungs can lead to pulmonary edema
Inside the CellsInside the CellsInterstitial fluid trapping can cause
compression of the microvasculature, resulting in hypoperfusion and ischemia
Inflammatory “mediators” are released into the bloodstream, which can lead to systemic inflammatory response syndrome (SIRS)
Multiple organ dysfunction syndrome (MODS) occurs, leading to organ failure and death
What Happens When Fluids Shift? With decreased circulating volume,
baroreceptors in the aorta are activated Sympathetic nervous system releases
epinephrine and norepinephrine, causing vasoconstriction and an increased heart rate
Kidneys launch the renin-angiotensin-aldosterone system in response to a lower glomerular filtration rate
All this happens with the goal of increasing circulating volume, blood pressure, and cardiac output
Fluid Shift in the BowelFluid Shift in the Bowel
Causes abdominal distentionMeasure bladder pressure and
abdominal girth at least every 4 to 8 hours while signs are abnormal.
Monitoring the PatientMonitoring the PatientFluid shift will either resolve over the next
several hours (up to 48 hours) or the patient will continue to develop bowel edema and, eventually, ischemia
Closely monitor vital signs, urine output, peripheral perfusion, mental status, ventilation/perfusion status, hematocrit/hemoglobin, serum electrolytes (elevated lactate may indicate bowel ischemia)
Fluid ResuscitationFluid ResuscitationAdminister maintenance I.V. isotonic fluid
plus intermittent colloids (i.e., albumin); pulls fluid from the interstitial spaces into the intravascular space
Small dose of a loop diuretic, such as furosemide (Lasix) may be ordered if kidneys can’t get rid of the excess fluid
If hemoglobin is low, infuse blood products, such as packed red blood cells, as ordered to help increase oxygen and pull fluid from the interstitial space
EDEMAEDEMAIn fluid volume excess, both intravascular
& interstitial spaces have an increased water & Na content.
Excess interstitial fluidMost apparent areas where the tissue
pressure is low like around the eye.Dependent tissues known as dependent
edema , where hydrostatic capillary pressure is high.
3 MAIN MACHANISM OF EDEMA3 MAIN MACHANISM OF EDEMA
1. Increase capillary hydrostatic pressure
2. Decrease plasma oncotic pressure
3. Increase capillary permeability
1. Due to FVE that increase capillary hydrostatic pressure, pushing fluids into the interstitial tissues. This type of edema seen in dependent tissue such as feet, ankles, & sacrum.
2. Low level of plasma proteins from malnutrition or liver or kidney disease can reduce the plasma oncotic pressure.
3. With tissue trauma & some disorders like allergic reactions, capillaries becomes more permeable, allowing fluid to escape into interstitial tissues.
Pitting EdemaPitting Edema
That leaves a small depression or pit after finger pressure is applied to the swollen area.
The pit is caused by movement of fluid to adjacent tissue, away from the point of pressure.
Within 10 to 30 seconds the pit normally disappears.
MagsukulMagsukul
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