Fundamentals of Fluids and Electrolytes Balance Presentation

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Sodium (Na++)

Physiological roles of Sodium

  • Sodium helps to transmit nerve impulses
  • Sodium assists in the osmolality of vascular fluids

The combination of sodium with chlorides or bicarbonate helps to regulate Acid -base balance.

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  • Sodium is responsible in maintaining water balance.
  • Sodium is responsible for ECF volume.

Sodium Imbalance occurs when:

  • There is a change in the sodium volume of the ECF
  • There is a change in the chloride content
  • There is a change in the quantity of water in the ECF

Sodium (Na++)

Effects of Serum Sodium Deficit

Hyponatremia

  • Hyponatremia is a condition that occurs when the serum sodium level falls below normal [ that is less that 135nEq/L], so it occurs when there is High amount of water or reduction in sodium content. Sodium deficits are related to Hypervolemia conditions.
  • Hyponatremia can also occur when there is an abnormal loss of gastrointestinal secretions.
  • It also occurs when excessive sweating results in high volume of water consumption.
  • Labor induction in women with Oxytocin can cause the reduction of sodium volume thereby, causing a dilutional Hyponatremia

 Effects of Serum Sodium Deficit

Clinical Manifestations of Hyponatremia

Hyponatremia affects cells of the central nervous system, thus patients will experience:

  • Impaired sensation of taste
  • Muscle cramps
  • Anorexia
  • Anxiety
  • Exhaustion
  • Weakness

Treatment and Management of Hyponatremia

Patients can be treated using:

  • Diets [ for those that can eat and drink]
  • Parenteral routes [ patients unable to eat will have to take the electrolytes]
  • Note that this treatment aims at replacing lost sodium
  • Restoring the ECF volume to normal
  • Correcting other losses in electrolytes
  • Carefully examine laboratory test with emphasis on serum sodium
  • Examine GI losses
  • Monitor the intake , output plus daily weight of the patients
  • Examine the signs and symptoms of Hyponatremia
  • Restrict water intake.

Clinical Manifestations of Hyponatremia

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Effects of Serum Sodium Excess

Hypernatremia

  • Hypernatremia occurs when there is an elevation of serum sodium volume and a loss of water content
  • Clinical Manifestations of Hypernatremia
  • Patients’ experiences marked thirst
  • High body temperature
  • Swollen tongue
  • Red, dry and sticky mucous membrane.

Treatment and Management of Hypernatremia

  • The aim of this treatment is to lower the serum sodium content
  • This can be achieved by infusion of a hypotonic electrolyte solution
  • The use of diuretics
  • The administration of Desmopressin acetate
  • Discontinuing any medication that may be the cause of this elevated sodium content

Effects of Serum Sodium Excess

Potassium (K+)

  • Potassium is an intracellular electrolyte with 98% in the ICF and 2% in the ECF it is acquired through diet.
  • Potassium helps to regulate fluid volume in the cell
  • It promotes nerve impulse transmissions
  • Potassium controls the hydrogen ion balance
  • Potassium plays a part in the enzyme action of cellular energy production.
  • Influences skeletal and cardiac muscle activity
  • Potassium imbalance can occur when there is either an increase or decrease in the volume of serum potassium

Potassium (K+)

Effects of potassium deficit [Hypokalemia]

  • When the potassium level drops below 3.5mEq/L
  • Excessive sweating
  • Gastrointestinal loss due to laxative overuse or prolonged gastric suction

Clinical Manifestations

  • Patients suffer weakness
  • Diminished tendon reflexes
  • Flaction paralysis
  • Vomiting
  • Increased sensibility to digitals
  • Cardiac arrest

Treatment and Management of Hypokalemia

  • This treatment must be administered slowly to watch for dysrhythmias
  • Potassium replacement can be by mouth or intravenous.
  • Salt substitutes can be used
  • Never give a potassium I.V. push/Bolus.
  • Make sure the test results are carefully examined
  • Monitor signs and symptoms of hypokalemia
  • Monitor changes in cardiac arrest

Effects of potassium deficit [Hypokalemia]

Effect of Potassium Excess [Hyperkalemia]

  • Occurs less frequent. But more deadly than Hypokalemia. it is a function of excess serum potassium

Causes of Hyperkalemia

  • It is caused by an increase in the volume of serum potassium
  • It occurs when there is a decrease of urinary excretion of potassium
  • It is caused by the movement of potassium out of the cells into extracellular space.
  • Some drugs can predispose an individual to hyperkalemia , these drugs include potassium penicillin, beta blockers, amphetamines

Clinical Manifestations

  • Irregular pulse
  • Vague muscle weakness
  • Paralysis
  • Anxiety
  • Cramping
  • Nausea

Treatment / Management

  • The aim of treatment is to return the serum potassium to the normal level while treating the cause.
  • Stop the intake of potassium
  • Discontinues supplements of potassium
  • Introduction of cation – exchange resins
  • Dialysis may be ordered
  • Glucose and insulin should be administered to facilitate movement of potassium

Effect of Potassium Excess [Hyperkalemia]

Calcium (CA++)

Physiological Roles of calcium include:

  • Maintaining skeletal elements for strong bones and teeth
  • Regulates neuromuscular activity
  • Influences enzyme activity
  • Calcium helps in holding the cells together
  • Calcium is present in three forms
  • Ionized calcium, bound calcium and complex calcium

Calcium (CA++)

Effects of Serum Calcium deficit [Hypocalcaemia]

  • Hypocalcaemia occurs when serum is low
  • It is caused by inadequate secretion of PTH
  • It can also result from calcium loss through diarrhea
  • It can also result from radiographic contrast media

Clinical Manifestations

  • Patients with hypocalcaemia show symptoms of neuromuscular such as numbness
  • Cramps
  • Deep tendon reflexes
  • Deep irritability
  • Memory impairment
  • Development of laryngospasm and tetany contractions

Effects of Serum Calcium deficit [ Hypocalcaemia]

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Effects of Serum Calcium Excess Hypercalcemia

  • It is caused by an increase in calcium content from its intake.
  • Some drugs predispose Hypercalcemia, and they include Calcium salts , Megadozes of Vitamins A or D

Treatment / Management

  • Causative disease must be treated
  • Administer saline diuresis
  • Administer inorganic phosphate salts orally
  • Use furosemide to prevent volume overloading during saline administration
  • Give bisphosphonates to inhibit bone reabsorption
  • Administer calcitonin 4 to 8 U/kg intramuscularly.
  • Monitor changes in vital signs
  • Keep accurate fluids intake and output records
  • Keep the patient off calcium foods.

Effects of Serum Calcium Excess  Hypercalcemia

Magnesium (MG++)

Physiologic Roles of Magnesium

  • Magnesium influences enzyme action
  • It regulates neuromuscular activity
  • It regulates electrolyte balance

Effect of Serum magnesium Deficit [ Hypomagnesaemia]

  • It occurs when the serum magnesium content drops below 1.0mEq/L
  • It can result from chronic alcoholism, prolonged malnutrition , prolonged diarrhea

Clinical Manifestations

  • Patients with Hypomagnesaemia show signs of neuromuscular symptoms
  • Painful cold hands and feet
  • Muscle cramps
  • Coarse tremors

Laboratory Findings

  • Serum magnesium drops less than 1.5mEq/L
  • Urine magnesium helps to identify renal causes of magnesium depletion
  • Serum calcium is reduced because of a reduction in the release and action of PTH

Treatments / Management

  • Administer oral magnesium salts
  • Give 4g diluted in 250mL of 5% dextrose in water at 3mL/min
  • Give 1 to 2 g diluted 10mL of 5% dextrose in water by direct I.V push at a rate of 1.5ml/min

Magnesium (MG++)

Effect of Excess Serum Magnesium Hypomagnesaemia

  • It occurs when the patients serum magnesium is greater than 2.5mEq/L,
  • It is caused by renal failure in patients who has increased intake of magnesium

Clinical Manifestations

  • It causes depression of peripheral and central neuromuscular transmissions
  • Vomiting
  • Seizures
  • Nausea

Treatment / Management

  • The goal is to remove the cause of Hypomagnesaemia avoid using medications containing magnesium
  • Administer diuretics and then administer I.V calcium gluconate
  • Support respiratory function
  • Administer peritoneal or hemodialysis
  • Observe for flushing of skin and monitor for ECG changes
  • Encourage fluid intake and provide ventilatory assistance

Effect of Excess  Serum Magnesium Hypomagnesaemia

Phosphate (PO4-)

  • Phosphorus is essential to all cells
  • Influences metabolism
  • Essential to energy formation
  • It is a cellular building block
  • It helps to deliver oxygen

Effects of Serum Phosphate deficit [ Hypophosphatemia]

  • When the serum level drops below 2.5mg/dL Hypophosphatemia can occur

Clinical manifestations

  • It affects the CNS
  • Patients experience disorientation
  • Confusion
  • Weakness
  • Profound muscle weakness
  • Congestive cardiomyopathy

Laboratory Findings

  • Serum phosphorus drops less than 2.5mg/dL
  • Patients show skeletal changes of osteomalacia
  • Patients show increase osteoblastic activity
  • PTH is elevated

Treatments / Management

  • Oral phosphate supplements are given
  • Administer I.V sodium phosphorus

Phosphate (PO4-)

Effects of Serum Phosphate deficit [ Hypophosphatemia]

Hypophosphatemia occurs whenever there is renal insufficiency , hyperparathyroidism, or increased catabolism. This illness can be seen in severe cancer conditions such as myelogenous and lymphoma.

Clinical Manifestations

  • Patients with hypophosphatemia experience confusion
  • Coma, and increased 2,3- DPG levels in red blood cells

Treatment / Management

  • Identify the cause if illness
  • Restrict dietary intake
  • Administer the intake of phosphate -binding gels
  • Monitor for cardiac, GI abnormalities
  • Keep accurate records

Effects of Serum Phosphate deficit [ Hypophosphatemia]

Chloride (CL-)

Physiological Role

  • Chloride regulates serum osmolality
  • Regulates fluid balance
  • Control acidity of gastric juice
  • Regulate acid-base balance
  • Influences oxygen carbon dioxide exchange

Chloride (CL-)

Acid – Base Balance

The regulation of hydrogen ion concentration of body fluids is the key component of acid -base balance.

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Three mechanisms operate to maintain the pH of the blood

  • Chemical buffer systems in the ECF and within the cells
  • Removal of carbon dioxide from the lungs
  • Renal regulation of the hydrogen ion concentration

Acid - Base Balance

There are two types of Acid -base Imbalance

  • Metabolic deficit or excess
  • Respiratory deficit or excess

Chemical Buffer Systems

  • Buffer systems protect against changes in the hydrogen ion of the ECF
  • A buffer is a substance that reacts to minimize pH changes whenever acid or base is released into the system
  • Hemoglobin and deoxyhemoglobin acts as buffer pairs together with their potassium salts.
  • Plasma proteins act as a buffer
  • The bicarbonates buffer system maintains the blood’s pH
  • Acid Imbalance occurs when a strong acid is added to the body

Respiratory Regulation

  • Lungs form a defense mechanism in maintaining acid – base balance
  • Rate of respiration affects the hydrogen ion concentration
  • The combination of carbon dioxide with water produces H2CO3so an increase in the acid , lowers the pH of the blood

There are two types of Acid -base Imbalance

There are two types of Acid -base Imbalance

Renal Regulation

  • The Kidney regulates the Hydrogen ion by increasing or decreasing HCO3- in the body fluids
  • The kidney regulates the extracellular concentration of H2CO3
  • Phosphate buffer system and ammonia buffer systems helps the kidney to eliminate excess hydrogen

Renal Regulation

Metabolic Acid- Base Imbalance

  • Metabolic Acidosis : Base Bicarbonate Deficit
  • Metabolic Acidosis is a clinical disturbance which consist of a low pH and low plasma level
  • This condition occurs by a gain of hydrogen ion or a loss
  • Occurs with loss of HCO3- from diarrhea, draining fistulas

Clinician manifestations

  • Patients experience headache,
  • Confusion nausea
  • Vomiting
  • Increased respiratory rate

Laboratory findings

  • ABG values PH less than 7.35
  • Paco2 : Less than 38 mm Hg
  • Serum electrolytes : Elevated potassium possible
  • ECG : Dysrhythmias caused by hyperkalemia

Treatment/ Management

  • Reverse underlying cause
  • Eliminate the source
  • Administer NaHCO3
  • Potassium replacement

Key Nursing Interventions

  • Provide safety precautions when patient is confused
  • Monitor for signs and symptoms of Metabolic Acidosis
  • Monitor laboratory changes

Metabolic Acid- Base Imbalance

Metabolic Alkalosis : Bicarbonate Excess

  • It is a clinical disturbance Characterized by a high pH and high Plasma and can be
  • Produced by the gain or loss of hydrogen ion
  • It occurs with GI loss of hydrogen ions from gastric suction and vomiting.
  • Occurs when excessive ingestion of alkalis

Clinical Manifestations

  • Dizziness and depressed respirations
  • Hyperventilation

Laboratory findings

  • ABG values pH greater than 7.45
  • Low serum potassium
  • Low serum chloride

Treatment / Management

  • Reverse the cause
  • Administer sufficient chloride for the kidney to excrete the excess ion
  • Replace hydrogen
  • Carbonic anhydrase inhibitors

Metabolic Alkalosis : Bicarbonate Excess

Metabolic Alkalosis : Bicarbonate Excess

  • It is a clinical disturbance Characterized by a high pH and high Plasma and can be
  • Produced by the gain or loss of hydrogen ion
  • It occurs with GI loss of hydrogen ions from gastric suction and vomiting.
  • Occurs when excessive ingestion of alkalis

Clinical Manifestations

  • Dizziness and depressed respirations
  • Hyperventilation

Laboratory findings

  • ABG values pH greater than 7.45
  • Low serum potassium
  • Low serum chloride

Treatment / Management

  • Reverse the cause
  • Administer sufficient chloride for the kidney to excrete the excess ion
  • Replace hydrogen
  • Carbonic anhydrase inhibitors

Metabolic Alkalosis : Bicarbonate Excess

Respiratory Acidosis : carbonic Acid Excess

  • Caused by inadequate excretion of carbon dioxide and inadequate ventilation
  • Chronic respiratory acidosis results from obesity, and tight abdominal binders

Clinical Manifestations

  • Dizziness
  • Flushed skin
  • Ventricular fibrillation

Nursing process

  • It is a five or six step process for problem solving
  • Laboratory findings
  • ABG values pH less than 7.35
  • Serum electrolytes not altered
  • Drug screen

Treatment / Management

  • Restore normal acid -base balance
  • Administer bronchodilators or antibiotics
  • Administer oxygen and adequate fluids

Respiratory Acidosis : carbonic Acid Excess

Respiratory Alkalosis : Carbonic Acid Deficit

  • Caused by hyperventilation which causes blowing off of carbon dioxide and a
  • Decrease in hydrogen ion content
  • Caused by congestive heart failure, asthma,
  • Inhalation of irritants

Clinical manifestations

  • Cause light- headedness
  • Inability to concentrate
  • Blurred vision, seizures, loss of consciousness

Treatment/ Management

  • Treat source of anxiety
  • Administer a sedative as indicated
  • Oxygen therapy
  • Adjust ventilators

Respiratory Alkalosis : Carbonic Acid Deficit

Case Study 2

The 28 year old woman lost 9.2% of her body weight upon admissionю

Laboratory Findings include

  • Drop in serum potassium level
  • Increased pH and bicarbonate ions [ Arterial blood gas]
  • Increase insulin secretion and osmotic pressure
  • Depression

Nursing Interventions

  • This treatment must be administered slowly to watch for dysrhythmias
  • Potassium replacement can be by mouth or intravenous
  • Salt substitutes can be used
  • Never give a potassium I.V. push/Bolus
  • Make sure the test results are carefully examined
  • Monitor signs and symptoms of hypokalemia
  • Monitor changes in cardiac arrest
  • Never administer potassium by I.V push

Case Study 2

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IvyPanda. 2022. "Fundamentals of Fluids and Electrolytes Balance." October 2, 2022. https://ivypanda.com/essays/fundamentals-of-fluids-and-electrolytes-balance/.

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