Fluid Balance and Electrolytes

Diffusion

Moves particles from areas of high concentration to low concentration

Osmosis

Moves fluids from areas of low concentration to high concentration

Recommeded Fluid Intake

For men: 15.5 cups / 3.7 liters

For women: 11.5 cups / 2.7 liters

How to assess hydration status

Urine color

Urine frequency

Skin Turgor

Mucous Membrane

Thirst

Things that will affect hydration

Physical activity

Climate

Diet

Health conditions

S+S that indicate dehydration

Strong sense of thirst

Dry mouth and throat

Headache

Muscle cramps

Fatigue

Dark urine

Reduced urine

Dizziness/Lightheadedness/Confusion

Rapid heart rate

Osmolality

Natural body concentration of solutes

Tonicity

Concentration of IV fluids

Hypotonic

Fluid that has a lower osmolality than the body

Isotonic

Fluid that has the same osmolality as the body

Hypertonic

Fluid that has a higher osmolality than the body

Hydrostatic pressure

The pressure within a blood vessel that tends to push water out of the vessel

ICF

Intracellular fluid

ECF

Extra cellular fluid

Discuss the RAAS system and its role in Fluid balance and regulation

Activated when blood pressure drops tells kidneys to reabsorb water and sodium tells body to vasoconstrict

Discuss the role of electrolytes in the movement of fluid and the process of osmosis

Electrolytes (sodium) helps maintain fluid balance through osmosis

Dehydration (twitching cardiac dysrhythmia) = Electrolyte imbalance

Isotonic fluid alterations

Normal concentration of sodium (solutes) in the ECF

No change in shifts or fluid in or out of cells

Hypotonic fluid alterations

Hyponatremia decreases the ECF osmotic pressure

Water moves into the cell

Hypertonic fluid alterations

Related to water loss or sodium gain

Water moves out of the cell

Signs and symptoms of fluid volume deficiency (FVD)

Tachycardia

Hypotension

Dizziness

Cool/clammy

Causes of fluid volume deficiency (FVD)

Blood/Fluid loss

NPO

Underlying illness

Treatment for fluid volume deficiency (FVD)

Hypotonic or isotonic solutions

Signs and symptoms of fluid volume excess (FVE)

Pulmonary congestion / Shortness of breath

Bounding pulse

Hypertension

Jugular vein distention (JVD)

Late sign edema

Causes of fluid volume excess (FVE)

Heart/Liver failure

Cancer

Endocrine disorders

Treatments for fluid volume excess (FVE)

Stop/Limit fluids

Hypertonic solutions

Diuretics

BP meds

Examples of hypotonic, isotonic and hypertonic fluids

Hypotonic: less then 0.9% saline and D5W saline

Isotonic: 0.9% NS and lactated ringers

Hypertonic: D5 saline >0.9%NS

What happens when we administer hypo, iso and hypertonic fluids?

Isotonic fluids stay in the cell

Hypotonic fluids move into the cell

Hypertonic fluids move out of the cell

How do fluids move from one compartment to another?

Fluids shift in response to concentration of SOLUTES in the other compartments

Sodium (Na+): Normal levels

136 - 145 mEq/L

Sodium (Na+): Signs of Deficit (Hyponatremia)

Lethargy

Headache

Confusion

Seizures

Coma

Sodium (Na+): Signs of Excess

Thirst

Elevated temp

Dry, swollen tongue

Sticky mucosa

Neruo symptoms

Restlessness

Weakness

Sodium (Na+): Hyponatremia Treatment

Depends on underlying disorder

Restrict fluid intake

Sodium (Na+): Hypernatremia Treatment

Hypotonic solution

Encourage fluids

Restrict sodium

Potassium (K+): Normal levels

3.5 - 5.0 mEq/L

Potassium (K+): Signs of Deceit (Hypokalemia)

Decreased neuromuscular excitability

Skeletal muscle weakness

Smooth muscle atony

Cardiac dysrhythmias (Flattened/ Depressed T Wave + U wave)

Potassium (K+): Signs of Excess (Hyperkalemia)

Mild attacks: Tingling of fingers and toes, restlessness, intestinal cramping and diarrhea, and peaked T-Waves on ECG

Severe attacks: Muscle weakness, loss of muscle tone, paralysis

Potassium (K+): Hypokalemia Treatment

Replace potassium orally and/or intravenously

Potassium (K+): Hyperkalemia Treatment

Calcium gluconate

Insulin and glucose

Buffered solutions

Dialysis

Calcium (Ca+): Normal levels

9 -11 mEq/L

Calcium (Ca+): Signs of Deceit (Hypocalcemia)

Dysrhythmias

Chvostek sign

Trousseau sign

Seizures

Muscle spasms

Circumoral numbness

Increased DTRsTetany (spasms)

Calcium (Ca+): Signs of Excess (Hypercalcemia)

Dysrhythmias

Muscle weakness

Kidney stones

Bone pain

GI manifestations

Decreased muscle tone

Fatigue

Depression

Calcium (Ca+): Hypocalcemia treatment

Intravenous (IV) calcium gluconate

Oral Ca / Vit D

Calcium (Ca+): Hypercalcemia treatment

Phosphates

Bisphosphonates

Calcitonin

Labs (ionized Ca level)

Isotonic solutions

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