Fluids, Electrolytes and Acid Base Imbalance

Transcellular fluid

Transcellular Fluid= Accounts for approximately 1L and include cerebro-spinal fluid; fluid in the gastro-intestinal GI tract and joint spaces; and pleural, peritoneal, intraocular, and pericardial fluid.

Intracellular and Extracellular Fluids

Intracellular Space (Inside the Cells)-Approximately two-thirds of body water is located within cells and is called Intracellular Fluid.Intracellular Fluid (ICF)-The ICF constitutes approximately 42% of body weight. The body of a 70-kg man would contain approximately 42L of , which 30L would be Intracellular.-In the ICF the most prevalent cation is POTASSIM, with small amount of MAGNESIUM and SODIUM.-The Predominant ICF anion is PHOSPHATE, with some protein and small amount of BICARBONATE.Extracellular Fluid (ECF)- ECF consists primarily of Interstitial fluid and Intravascular fluid (PLASMA). -The ECF constitutes one-third of the body water; or approximately 17% of total weight; this amount would be Amount to approximately 11L in 70-Kg man. -One-third of the ECF is in the plasma space(3Lin a 70 Kg man) and two-thirds is in the INTERSTITIAL space(8L-in a 70Kg man).Other ECF components include lymph and Transcellular fluids.-Transcellular fluids account for approximately 1L and include Cerebrol-Spinal Fluid; Fluid in the Gastro-Intestinal(GI) tract and joint spaces; and Pleural, Peritoneal, Intraocular and Pericardial Fluid. -In the ECF, main cation is SODIUM, with Small amounts of POTASSIUM, CALCIUM, and MAGNESIUM.-ECF primary anion is CHLORIDE, with Small amounts of BICARBONATE, SULFATE and PHOSPHATE anions.


Electrolytes- Are substances whose molecules dissociate or split into IONS when placed in solution.-They balance the amount of water in your body.-Electrolytes also balance the body's ACID/BASE(pH) level.-Move nutrients into your cells.-They regulate nerve and muscle function, hydrate the body, balance blood acidity and pressure and help rebuild damaged tissue.-Electrolytes are chemicals that conduct electricity when dissolve in water.


Ions- Are electrically charged molecules.-Classified in two; Cations which are Positive Ions and Anion which are negative Ions.CATIONS; are positively charged Ions. Eg. SODIUM(Na+), POTASSIUM(K+), CALCIUM(Ca2+) and MAGNESIUM(Mg2+) ions.ANIONS; are negatively charged Ions.Eg. BICARBONATE(HCO3-), CHLORIDE(CL-) and PHOSPHATE (PO4 3-).


Potassium(K+)= Function is to maintain and contract heart and muscle contraction,HIGH POTASSIUM LEVELS=(5.0 or more) HEART-Causing Hyperkalemia which makes heart tight and contracted.-ST elevation and peaked T waves -Severe Hyperkalemia = V fib or Cardiac Standstil -Hypotension, Bradycardia.IG TRACT-It also makes the IG TRACT Tight and Contracted-Causing Diarrhea -Hyperactive bowel soundsNEUROMUSCULAR-Tight and Contracted -Paralysis in the Extremities-Increase DTRProfound Muscle Weakness,(General Felling of Heaviness)LOW POTASSIUM LEVELS=(3.5 or less)HEART=LOW & SLOW-Flat waves, ST depression and prominent U waveMUSCULAR=LOW & SLOW-Decrease DTR-Muscle Cramping-Flaccid Paralysis(paralyzed limps)GI=LOW & SLOW-decrease motility, HYPOactive to absent bowel sounds.-Constipation-Abdominal distention-Paralytic lieu's, paralyzed intestines-PRIORITY for SBO(small bowel obstruction) because intestines can explored


Sodium(NA+)= 135-1453 Functions-Blood pressure-Blood Volume-PH BalanceHIGH SODIUM LEVELS(higher than 145)-Can cause HYPERNATREMIA=big & bloated1. SKIN-Flush "red & Rosy"-Edema "waterbed skin"-Low grade Fever2.POLYDIPSIA(excess thirst)3.LATE SERIOUS SIGN-Swollen DRY Tongue-GI= Nausea and Vomiting-INCREASED muscle toneLOW SODIUM LEVEL (less than 135)-Causing HYPONATREMIA= DEPRESS AND DEFLATED.NEURO-Seizures and ComaHEART-Tachycardia, and Weak Thready PulsesRESPIRATORY ARREST!!!TREATMENT FOR SODIUM EXCESS-Dilute the sodium concentration with Salt-free IV fluids, such as 5% dextrose in water and to promote excretion of the excess sodium by administering DIURECTICS.


Chloride3 Functions-Blood Volume-Blood Pressure-PH BalanceHIGH LEVELS OF CHLORIDE (more than 107)-Nearly the same as high Sodium-Nausea and Vomiting-Swollen Dry Tongue-ConfusionLOW LEVELS OF CHLORIDE(less than 97)-Nearly the same as Low Sodium-Excessive Diarrhea-Vomiting-Sweating-FEVER (the only difference from low Sodium)


Magnesium(Mg2+) Function-Calms the muscles main in the HEART, UTERES, and the DEEP TENDED REFLEX-Magnesium is required for VITAMIN D and CALCIUM Absorption.HIGH LEVELS OF MAGNESIUM(more than 2.1)CARDIAC=Calm and Quite-Heart Block-Prolonged PR Intervals-VITALS=Bradycardia and HYPOtensionDEEP TENDON REFLEXES=Calm and Quiet-HYPOREFLEXIA- Decreased DTRLUNGS=Calm and Quiet-Depressed Shallow RespirationsGI=Calm and Quiet-HYPOactive bowel soundsLOW LEVELS OF MAGNESIUM(less than 1.3)CARDIAC=GOING CRAZY-EKG: ST depression, T wave, Torsades de pointes-SEVERE= V fib-VITALS=TachycardiaDEEP TENDON REFLEXES=CRAZY-Hyporeflexia(increased DTR)EYES-Going Crazy-Abnormal eye movement(Nystagmus)GI=Going Crazy-DiarrheaLUNGS-Will have SHALLOW RESPIRATION


Calcium Function-BONES-BLOOD(Clotting Factors)BEATS(Heart Beats)HIGH LEVELS OF CALCIUM(over 10.5)Causing HYPERCALCEMIA-Swollen & Slow-CONSTIPATION-BONE PAIN-STONES=RENAL CALCULI(kidney stones)DEEP TENDON REFLEXES-Decreased DTR-Severe Muscle WeaknessLOW CALCIUM LVELS(9.0 or less)Causing HYPOcalcemia-Trousseau's Signs-Chvostek's Signs-Diarrhea-Circumoral Tingling-Risk for fractures-Risk of Blood Clotting -Cardiac Dysrhythimia: In this case being too slow(under 60 beats per minute)


Phosphate Function:-Bone and Teeth Formation-Helps REGULATE Calcium-Calcium and Phosphate always work inverselymeaning that when Calcium is High Phosphate is low and When Phosphate is High, Calcium is Low.HIGH LEVELS OF PHOSPHATE-Causing HYPERPHOSPHATEMIA meaning that Calcium Levels are below 3.0.-Trousseau's Signs-Chvostek's Signs-Diarrhea-Weak B's1.weak bones2.Risk of Blood Clots3.Weak Heart BeatLOW LEVELS OF PHOSPHATE -Causing HYPOPHOSPHATEMIA-Constipation-Decreased DTR & SEVERE muscle weakness-Decreased HR, RR-Increased BP.


Diuretics: Are drugs that accelerate the rate of urine formation through a variety of mechanism. -They Decrease blood pressure by draining Fluids (Urinate) to Dehydrate HEART Tai'ler patients.LOOP diuretics: -Furosemide(Lasix.), Torsemide, Bumetamide:(water pills) Is use to reduce extra fluid in the body.(EDEMA) caused by conditions such as HEART failure, LIVE disease and KIDNEY disease. -It's works in the Kidney to get rid of extra water and electrolytes(Sodium & Potassium).Thiazide DIURECTICS prototype Drug: -HYDROCHLOROTHIAZIDE.-CHLOROTHIADONEThiazide & LOOP DIURETICS Mechanism of action-Thiazides achieve their diuretic action via Inhibition of the Sodium(Na+)/Chloride(Cl-) contrannsporter (NCC) in the renal distal convoluted tubules back in the interstitial. -This transport system moves both Na+ and Cl- into the cell using the free energy produced by the Na+, K+, ATP.POTASSIUM SPARING DIURETICS -PROTOTYPE= Spironolactone(Aldactone): POTASSIUM SPARING MECHANISM of action:-Is an antagonist of Aldostone, acting primarily through Competitive binding of Receptors at the aldosterone-dependent Sodium-Potassium exchange site in the distal convoluted renal tubule.POTASSIUM WASTING DIURETICS-PROTOTYPE= Furosemide, HYDROCHLOROTHIAZIDE


Dehydration(fluid deficit)- kidneys excrete excess glucose and glucose also draws water. This way fluids are expelled from the body and dehydration occurs.-When Free water LOSS exceeds Free water INTAKE.-Diuretics & DKA-Restricting Fluid Intake-Increased Ventilation=Hyperventilation(Urination)-Excessive Sweating (DIAPHORESIS)-Diabetes Insipidus2 Types of fluid LossSENSIBLE WATER LOSS (measurable)-Vomit-Urine-DiarrheaINSENSIBLE WATER LOSS (not measurable)-Respirations-Sweating(DIAPHORESIS)CLINICAL MANIFESTATIONSCARDIAC=-Low Blood Pressure(Hypotension)-PULSE: Fast, weak and thready-Tachycardia(first sign of hypovolemic shock)-Orthostatic Hypotension(Low BP upon Standing)-FLAT Neck and Hand Veins-Decreased Central venous pressure-ECG DysrhythmiasRESPIRATORY-High RR Called Tachypnea-Dyspnea(difficulty Breathing)URINARY-Urine Specific Gravity Increased(Dark Thick Smelly Urine)SKIN-Dried & Flat (like leather)-Tough & Rigid-Turgor (slow & sluggish)BLOOD LABS(High and Dry)- H & H (Hemoglobin and Hematocrit)-Electrolyte Panel-Serum Osmolality(thick blood)-BUN(Blood Urea Nitrogen)-Increased Urinary Specific GravityNURSING INTERVENTION-Weight Daily (best indicator)-Administer IV Fluids(Isotonics or Hypotonics)-Teach the patient to monitor their symptoms and how they feel(s/s, daily weight & BP)-Evaluate the cause of Dehydration(VPPS)-Reposition Slowly (you don't want you patient to pass-out)

Anti diarrheal Drugs

Anti diarrheal DrugsLOPERAMIDE(Imodium)Opioid Agonist-The most effective drugs are opioids derivatives because they Slow Intestine Motility to permit greater time for the absorption of water and Electrolytes. LOPERAMIDE MECHANISM of ACTION-Works by decreasing the flow of Fluids and Electrolytes into the bowel and slowing down the movement of the bowel to decrease the number of bowel movement.-This allows more Fluid to be absorbed into your body which helps in having less Diarrhea and more formed and bulky stool.DIPHENOXYLATE/ATROPINE(Lomotil)-It works by Slowing the Movement of the Intestine. Diphenoxylate is similar to opioid but it acts mainly to Slow the gut. Atropine belongs to the Anticholinergics, which help dry up body fluids and slow gut Movement.DIPHENOXYLATE/ATROPINE MECHANISM of ACTION:-Diphenoxylate is an opioid agonist that acts on the presynaptic opioid receptors(predominantly Mu receptors) in the enteric Nervous System.-Atropine is an Anticholinergics that competitively blocks the effects of ACETYLCHOLINE, including excess Acetylcholine due to organophosphorus poisoning, at Muscarinic Cholinergic receptors on smooth muscle, cardiac muscle, Secretory Gland Cells, and in Peripheral Autonomic Ganglia and the Central Nervous System.

Metabolic Acidosis

Metabolic Acidosis-Is when Ketoacidosis(DKA) in the body is present leading to a life threaten condition resulting in Metabolic Acidosis.-Which is caused by a build up of acid in the blood as the KIDNEYS are unable to remove the acid from the blood.-also pH level is below normal.CLINICAL MANIFESTATIONS-Rapid Breathing -Acetone Smell in the breath-dry/flush skinCAUSE:-Infection-Trauma-Myocardia Infractions-Stroke Treatment:-Oral or IV SODIUM BICARBONATE to raise the pH -INSULIN and IV fluids to treat metabolic acidosis due to distal renal tubular acidosis-Renal replacement (DIALYSIS)

Metabolic Alkalosis


Respiratory Acidosis

Respiratory Acidosis:-Is a condition that occurs when the LUNGS cannot remove all of the Carbon Dioxide the body produces.CAUSES:-Low & SLOW RR-Sleep Apnea-Post Operative-Drugs= CNS depressants1.Opioid Overdose2.Alcohol Intoxication3.Benzodiazepines(Diazepam)-Pneumonia-COPD or Asthma Attack

Respiratory Alkalosis

REspiratory Alkalosis-Arise in blood pH due to hyperventilation (excessive breathing) and a resulting decrease in CO2.CAUSES;-PANIC ATTACKS-