Fluids and Electrolytes

• Body fluids consist of water, electrolytes, blood plasma and component cells, proteins, and other soluble particles called solutes.

• 40% to 60% of the average adult’s weight is composed of water

• Females have higher proportion of BW as water

• Infants have 75% to 80% water

Maintaining fluid and electrolyte balance

• Kidneys - play a major role in controlling all types of balance

• ADH - from the pituitary gland regulates the osmotic pressure of extracellular fluid by regulating the amount of water reabsorbed by the kidney

• Adrenal Gland - Through the secretion of aldosterone, the adrenal glands also aid in controlling extracellular fluid volume by regulating the amount of sodium reabsorbed by the kidneys

Renin Angiotensin Aldosterone system (Raas)

Fluid Balance

Water in

• Food/Drink - 2.2L/day

• Metabolism - 0.3L/day

Water Out

• “Insensible” water loss = 0.9L/day (skin or lungs)

• Urine - 1.5L/day

• Feces - 0.1L/day

Total

• 2.5L/day - 2.5L/day = 0L/day

Movement of Body Fluids and Electrolytes

• Filtration - fluid and solutes move together across a membrane from one compartment to another

FLUID IMBALANCE

FLUID VOLUME DEFICIT

• occurs when loss of fluid is greater than fluid input

• common causes of fluid volume deficit are diarrhea, vomiting, excessive sweating, fever, and poor oral fluid intake

High risks

• Older adults

• Infants and children

• Patients with chronic diseases such as diabetes mellitus and kidney disease

• Patients taking diuretics and other medications that cause increased urine output

• Individuals who exercise or work outdoors in hot weather

Adult symptoms of dehydration

• Feeling very thirsty

• Dry mouth

• Headache

• Dry skin

• Urinating and sweating less than usual

• Dark, concentrated urine

• Feeling tired

• Changes in mental status

• Dizziness due to decreased blood pressure

• Elevated heart rate

Infant and young symptoms of dehydration

• Crying without tears

• No wet diapers for three hours or more

• Being unusually sleepy or drowsy

• Irritability

• Eyes that look sunken and sunken fontanel

FLUID VOLUME EXCESS

• occurs when there is increased fluid retained in the intravascular compartment

High risks

• Heart Failure

• Kidney Failure

• Cirrhosis

• Pregnancy

signs and symptoms

• pitting edema

• ascites

• dyspnea

• crackles from fluid in the lungs.

Treatment

• Depends on the cause of the fluid retention

• Sodium and fluids are typically restricted

• Diuretics are often prescribed to eliminate the excess fluid.

Management

• enteral fluid and electrolytes replacement

• fluid intake modifications

• dietary changes

• oral electrolyte supplements

• parenteral fluid and electrolyte replacement

INTRAVENOUS SOLUTIONS - ISOTONIC

• IVF that have a similar concentration of dissolved particles as blood.

• used for patients with fluid volume deficit (also called hypovolemia) to raise their blood pressure

0.9 NaCl - Green

• 0.9% Normal Saline (0.9% NaCl)

• Plain Normal Saline Solutions (PNSS)

Lactated Ringer’s Solution (PLR) - Blue

5% Dextrose in Water (D5W) - Red

INTRAVENOUS SOLUTIONS - HYPOTONIC

• have a lower concentration of dissolved solutes than blood.

• hypotonic fluids are used to treat cellular dehydration.

0.45% NaCl

D5W

INTRAVENOUS SOLUTIONS - HYPERTONIC

IV THERAPY

• administration of water, nutrients, electrolytes, blood products and medications

• fluid replacement

• dehydration

• malnutrition

• electrolyte imbalance

• hyperalimentation

• rapid delivery is required

• drug is irritating to the tissues

• drug needs to be administered over a specified period of time

IV FLUID

• Parenteral nutrition

• Administration of drugs

• Transfusion of blood or blood components

Equipment for IV infusion

• Parenteral nutrition

• Administration of drugs

• Transfusion of blood or blood components

• Drop Chamber/Drip Chamber

  • located at the site of the entrance of the tubing into the container of intravenous solution

  • allow to count the number of drops per minute that the client is receiving (flow rate)

• Roll Valve Clamp or clip

  • connected to tubing and can be manipulated to increase or decrease the flow rate

• Access ports

  • used to infuse secondary medications and to administer IV push medications. These may also be referred to as “Y ports.”

IV PIGGYBACK

• administering medicines through a port in an existing IV line

• used to administer small amounts of medication along with the IV solution

IV COMPUTATION

• Manufacturer Drip Factor

• Abbott- 15 drops per ml.

• Baxter- Trevenol- 10 drops per ml.

• Cutter- 20 drops per ml.

• IVAC- 20 drops per ml.

• McGraw- 15 drops per ml.

Complication from IV therapy

• INFILTRATION - occurs when the tip of the catheter slips out of the vein. The catheter passes through the wall of the vein, or the blood vessel wall allows part of the fluid to infuse into the surrounding tissue, resulting in the leakage of IV fluids into the surrounding tissue. Infiltration may cause pain, swelling, and skin that is cool to the touch.

• PHLEBITIS - inflammation of a vein

  

• CIRCULATORY OVERLOAD

• AIR EMBOLISM

• CATHETER EMBOLISM

• SYSTEMIC INFECTION

• INFECTION OF VENIPUNCTURE

• SPEED SHOCK

• ALLERGIC REACTION

• PULMONARY CONGESTION

I&O SHEET