Fluid & Electrolyte Imbalances

Safe & High Quality Nursing Care

knowledge of basics in FE balance is necessary to provide

Health & Well-Being

* FE balance is essential to
* = balance

Imbalance

* diseases
* illnesses
* chronic conditions
* poor health

Keen Observational Skills & Expertise in Monitoring/Assessment

managing FE status is one of the most difficult aspect in nursing due to

Functions of FE in the Body

* regulate body temperature
* lubricates joints
* lessens burden on kidneys & liver by flushing out waste products
* carries nutrients & oxygen to cells
* help dissolve minerals & nutrients to make accessible to the body
* help prevent constipation
* protect body organs & tissues
* moisten tissues (mouth, eyes, nose)

Brain

90% water

Muscle

75% water

Bone

22% water

Blood

83% water

Adult Body

* 40L water
* 60% of body weight
* 2/3 intracellular
* 1/3 extracellular (80% interstitial, 20% intravascular)

Infant (6 months)

70-80% water

Elderly

40-50% water

Neonate

80% water

Child (5 yo)

65% water

Adult Male

60% water

Elderly Male

50% water

Adult Female

50% water

All Age Group

what age group is prone to FE imbalance?

Infant

what age group is **more prone** to FE imbalance?

Elderly

what age group is **most prone** to FE imbalance?

Infant & Elderly

* prone to FE imbalance
* considered as the **extremes** in the age group

Fluid

* osmolar
* volume
* fluid shifts

Electrolytes

* Na
* K
* Mg
* Ca
* Cl
* P

Sodium

Na

Potassium

K

Magnesium

Mg

Calcium

Ca

Chloride

Cl

Phosphorus

P

Acid Base

* Acidosis
* Alkalosis

Intake & Output

primary causes of imbalance in the body

Deficit

low intake, high output

Excess

high intake, low output

Osmolar

concentration of **water** in relation to entire solution

H20 Deficit + Solute Excess

hyper-osmolar imbalance

Dehydration

clinical picture of **hyper-osmolar imbalance**

Infant (Assessment)

* sunken fontanel (sunken soft spot on top of head)
* sunken eyes

Adult (Assessment)

* ask to open mouth
* dry, cracked lips
* whitish film on tongue w/dry sticky mucus

Skin (Assessment)

* pinch test
* skin w/**decreased turgor remains elevated** after being pulled up & released = **positive pinch test**

1\.5L (lost)

thirst

3L (lost)

* sluggishness
* fatigue
* nausea
* emotional instability

4L (lost)

* clumsiness
* headache
* high body temp
* elevated PR & RR

5L (lost)

* dizziness
* slurred speech
* weakness
* confusion

6L (lost)

* delirium
* swollen tongue
* circulatory problems
* decreased blood volume
* kidney failure

9L (lost)

* inability to swallow
* painful urination
* cracked skin
* no urination (anuria)

12L (lost)

imminent death

rehydration/replacement

ways to manage dehydration

Sugar & Salt

* 1L of **clean water**
* **half level** teaspoon of **salt**
* 8 teaspoons of **sugar**
* mix properly
* add/use coconut water/fruit juice if clean water is unavailable
* mix then drink gradually

Powdered Cereal & Salt

* **powdered rice** is best/finely ground **maize, wheat, flour**
* 1L of **water**
* **half level** teaspoon of **salt**
* 8 teaspoons/2 handfuls of **powdered cereal**
* boil 5-7 ms. to form **liquid gruel/watery porridge**
* cool & give to child

Oral Rehydration Solution (ORESOL)

placed into glass of water (250cc)

H20 Excess + Solute Deficit

hypo-osmolar imbalance

Edema

clinical picture of hypo-osmolar

Face (Assessment)

* moon face
* puffy eyelids

Skin (Assessment)

finger test

Finger Test

applying pressure to area that causes **indentation that persists for some time**

Pitting Edema

indentation on the skin

Anascara

generalized edema

Hydrothorax

* accumulation of fluid in **pleural cavity**
* causes DOB & rales

Hydropericardium

accumulation of fluid in pericardial activity (cardiac tamponade)

Cardiac Tamponade

difficulty of pumping blood & oxygen to body cells

Hydroperitoneum

abnormal accumulation of fluid in peritoneal activity (ascites)

Diuretic

* management for edema
* water pills
* help rid body of salt (sodium) & water
* make kidneys put more sodium into urine
* sodium takes water from the blood
* decreases amount of fluid flowing through blood vessels
* reduces pressure on arterial walls

Thiazide

Loop

Potassium Sparing

Osmotic

types of diuretics

Thiazide Diuretics

* proximal part of distal convoluted tubule (PCT)
* chlorothiazide (Hydrochlorothiazide/Microzide)
* indapamide (Metolazone/Zaroxolyn)
* brings out sodium
* monitor sodium level

Loop Diuretics

* loop of Henle in glomerulus
* bumetanide ethacrynic acid (Edecrin)
* Furosemide (Lasix)
* Torsemide (Demadex)
* brings out potassium
* monitor potassium level

Potassium-Sparing Diuretics

* distal part of distal convoluted tubule (DCT)
* amiloride eplerenone (Inspra)
* spironolactone (Aldactone)
* Triamterene (Dyrenium)
* monitor potassium level

Osmotic Diuretic

* all parts of kidney
* PCT
* loop of Henle
* DCT
* collecting ducts & tubes
* very potent
* relieve excess water
* excessive urination (polyuria)
* Mannitol

Mannitol

given to relieve cerebral edema

Isotonic Volume Deficit

* hypovolemia
* equal **loss of Na + H2O** together

Isotonic Volume Excess

* hypervolemia
* equal **gain of Na + H2O** together

Cause of Hypovolemia

* extreme weight loss (cancer)
* bleeding (surgical bleeding, postpartum hemorrhage)
* severe vomiting (chemotherapy, food poisoning)
* marasmus
* dehydration
* heat stroke (heavy sweating)
* diuretic use
* blood donation
* vasodilators
* ACE inhibitors
* severe burns
* protein energy malnutrition
* perionitis

Marasmus

type of malnutrition characterized by extreme deficiency of both **calories & protein**

Vasodilators

dilate blood vessels

ACE Inhibitors

relaxes blood vessels

Severe Burns

may cause **significant** fluid loss & edema

Protein Energy Malnutrition

* lack of **adequate protein intake** to meet body’s metabolic needs & demands
* lack of **dietary intake, poor quality protein intake, increased demand** due to other diseases

Peritonitis

lining of abdominal cavity becomes **inflamed**

Causes of Hypervolemia

* excessive fluid/sodium intake
* IV therapy
* transfusion reaction by blood transfusions
* high intake of sodium
* sodium/water retention (output)
* heart failure
* liver cirrhosis
* nephrotic syndrome
* corticosteroid therapy

Hypovolemia (Management)

rehydration/replacement

Hypervolemia (Management)

diuretics

Fluid Shifts

position changes in **extracellular fluid**

Circulation

assessment cue in fluid shifts

Plasma - Interstitial Shift

* 6 - 24%
* circulatory collapse (shock)
* pallor
* cold, clammy skin
* BP palpatory/0
* oliguria

Interstitial - Plasma Shift

* 24 - 6%
* circulatory overload
* red, flushed cheeks
* neck vein distended
* elevated BP
* signs of pulmonary edema, DOB

Anaphylactic

* severe allergic reactions
* venom & bites
* crustacean food (shrimp, crab, seashells)
* antibiotic (perform skin test)

Neurogenic

* TIP
* trauma
* injury
* pain

Septic

severe infection

Cardiogenic

* cardiac conditions
* myocardial infarction
* atrial fibrillation

Psychogenic

* extreme emotions
* happiness
* depression

Plasma Expanders

* management for **plasma-interstitial shift**
* Dextran

Infusion Pumps

* management for **interstitial-plasma shift**
* rebound **mobilization** of fluid

135 - 145 mEq/L

* Na+ (Sodium)
* table salt

3\.5 - 5.0 mEq/L

* K+ (Potassium)
* fruits

1\.5 - 2.5 mEq/L

* Mg++
* Seafood

4\.5 - 5.5 mEq/L

* Ca++ (Calcium)
* dairy products

1\.8 - 2.5 mEq/L

* PO4 (Phosphate)
* eggs

96 - 105 mEq/L

* Cl- (Chloride)
* salty food

Dietary Sources of K+

* grapes
* orange
* watermelon
* cantaloupe (melon)
* honeydew
* cherries
* papayas
* banana - *“A banana a day, keeps the doctor away.”*
* green leafy vegetables

K+ (function)

primary intracellular cation

Na+ (function)

primary extracellular cation