Fluid and Electrolytes

Fluid & Electrolyte Balance

Julius U. Tepora, RN, RM, MSN

Lecturer, Medical-Surgical Nursing

CvSU College of Nursing

The Kidney

Functional Unit: Nephron

U-L Urinary Tracts

Terminologies Solute, Solvent and Solution

concentration of solute per Kg of H2O

Normal = 275 - 295 mOsm / kg of H2O

concentration of solute per L of H2O;

Since 1L : 1kg = osmolality : osmolarity

Osmolality

Osmolarity

Electrolytes ions (Na, K, Cl, etc.) necessary to regulate electric charge and flow of H2O across cell membrane

Hydrostatic P. Osmotic P.

IV (higher) to IT (lower pressure)

From < to > plasma CHON concentration

Transport Passive (-) energy = diffusion, f. diffusion, osmosis; Active (+) energy

Fluid Compartments & ElectrolytesINTRACELLULAR

(40%)

K+ = major cation

PO4-3 = major anion

EXTRACELLULAR

(20%)

Na+ = major cation

Cl- = major anion

Intravascular Interstitial

ELECTROLYTE NORMAL VALUE

1. Sodium 135 - 145 mEq / L

2. Potassium 3.5 - 5.0 mEq / L

3. Calcium 4.5-5.5 mEq / L; 8.5-10.5 mg / dl

4. Magnesium 1.5 - 2.5 mEq / L

5. Phosophorus 1.8 – 2.6 mEq / L2.5 - 4.5 mg / dl

6. Chloride 95 - 108 mEq / L

pH Balance

Deficient Fluid Volume

Sensible Fluid Losses - Wound drainage - GI tract losses (vomitus) - Urination - Suctioned secretions Insensible Fluid Loss

- Lungs - Skin

1. Thirst2. Decreased LOC3. Dry skin and mucus membranes4. Decreased skin turgor5. Increased temp and pulse; flushed skin6. Increased Hct and specific gravity7. Late: hypotension, oliguria, depressed

fontanels, decreased wt.

Signs and Symptoms:

Excessive Fluid Volume

Signs and Symptoms:

1. Weight gain, edema, ascites2. Crackles, dyspnea3. Distended neck veins4. Bounding pulse5. Confusion, weakness6. Increased CVP7. Decreased Hct, BUN8. Children: bulging fontanels

IV Solutions: CrystalloidsTYPE OF SOLUTION COMPONENTS INDICATIONS

Saline Solutions:

NS, 0.9%, NaCl, 3%, 5%

Na and Cl - Alkalosis- Fluid Loss- Na Depletion

Dextrose Solutions:

D5W, D10W

Dextrose in H2O - Calorie and CHO rep.- Prevent DHN- Maintain H2O balance

- Promote Na diuresis

Dextrose and Saline: Mixtures: D5NS, D10NS

Dextrose in Saline - Promote diuresis- Correct mod. fluid loss- Px alkalosis- Provide calorie, NaCl

Multielectrolyte Solutions:

Lactated Ringer’s, Ringer’s Lactate

Na, Cl, K, Ca, and Lactate

- Replaces fluid loss- Tx DHN- Restores fluid balance

Note: Crystalloids contain water, dextrose and electrolytes. Colloids (plasma or volume expanders) are w/ increased osmotic pressure, remaining in IV longer.

IV Solutions: ColloidsTYPE OF SOLUTION COMPONENTS INDICATIONS

Albumin

5% and 25%

Human plasma CHON - 5%: Rapid volume expansion and mobilize interstitial edema

- 25%: Hypoproteinemia

Plasma plasmanate

Plasma CHON fraction

Human plasma CHON in NS

- To increase serum colloid osmotic pressure

Dextran:

40% and 70%

Synthetic colloid made of glucose

polysaccharides

- Volume expansion- Mobilize interstitial

edema

Hetastarch:

Hespan

Synthetic colloid made from corn

- Volume expansion- Mobilize interstitial edema

Note: Crystalloids contain water, dextrose and electrolytes. Colloids (plasma / volume expanders) are w/ increased osmotic pressure, remaining in IV longer.

Hemodynamic Stability