FLUID AND ELECTROCYTE IMBALANCE

BY
MISS ANJU CHANU
 INTRODUCTION
• Fluid and electrolyte balance is a dynamic process that is crucial for life.
• It plays an important role in homeostasis.
• Imbalance may result from many factors and it is associated with the
illness.
 Composition of Body
fluids
Total body fluid 60% of body
weight

Intracellular Fluids Extracellular Fluids

(55%-75%) (25-45)%

Extravascular Intravascular Fluid

fluid(Interstitial (Plasma)
fluid)
 Electrolyte
• Electrolyte are substances that have a natural positive or negative
electrical charges within the body.
• Cations : having positive charge; Like Sodium, Potassium, Magnesium
and Hydrogen ions
• Anions : Having Negative Charge; Like Chloride, Bicarbonate,
Phosphate, Sulfate
 Regulation of body
fluids
• Osmosis : Fluid shifts through the membrane from the region of low
solute concentration to the region of high solute concentration until the
solution are of equal concentration.
• Diffusion : Movement of solute from higher concentration to
lower concentration.
 Routes of fluid and electrolyte
balance
• Kidney
• Skin
• Lungs
• GI Tracts
 Fluid Volume Distubances
• Hypovolemia : Fluid Volume
Deificit
• Hypervolemia: Fluid volume excess
 Electrolyte Imbalance
• The main electrolyte imbalance
are :
• Sodium Deficit: Hyponatremia
• Sodium Excess: Hypernatremia
• Potassium Deficit: Hypokalemia
• Potassium Excess : Hyperkalemia
• Calcium Deficit : Hypocalcemia
• Calcium Excess : Hypercalcemia
 HYPONATREMIA
• It results from loss of sodium containing fluids (or) hypo- Osmolality with
a shift of water into the cells
• CAUSES:
• GI LOSS : Diarrhea, Vomiting, NG Suction
• Renal Loss: Diuretics, adrenal Insufficiency, a wasting renal diseases
• Skin Loss : Burns, Wound Drainage
 HYPONATREMIA
• Sodium replacement : Administration of sodium by mouth who eat
and drink
• Lactated Ringer’s Solution : 0.9% sodium chloride is prescribed
• Serum Sodium must not increase greater than 12meq/L in 24 hours to
avoid neurological damages.
 HYPERNATREMIA
• Hypernatremia is a higher than normal sodium level exceeding (145
mEq/L)
• Causes :-
• a) Gain of sodium in excess of water
• Inadequate water intake
• Increased serum sodium concentration
 HYPERNATREMIA
• Management:
• Gradual lowering of the sodium level by the infusion of a
hypotonic electrolyte solution 0.3% sodium chloride.
• Diuretics also may be prescribed to treat the sodium gain.
 Potassium Imbalance
• Potassium is major ICF cation, with 98% of the body potassium
being intracellular.
• The kidneys are the primary route for potassium loss 90% of daily
potassium intake is eliminated by kidney.
 HYPERKALEMIA
• When the level of potassium is more than 5.5
mEq/L
• Causes:
• Excess potassium intake:
• Shift of Potassium out of cell
• Failure to eliminate potassium
 HYPERKALEMIA
• Management :
• Immediate ECG should be obtained
• Serum potassium level from vein without IV fluid infusion.
• Restriction of dietary potassium
• Potassium containing diuretics.
• IV Calcium gluconate administration in serum potassium level
are dangerously elevated.
 HYPOKALEMIA
• Hypokalemia can results from abnormal losses of potassium from a shift
of potassium from ECF to ICF or rarely from deficient dietary potassium
intake.
• Causes:
• Potassium loss
• Shift of potassium into cells
• Lack of potassium intake
 HYPOKALEMIA
• It is treated with oral or IV replacement
• Administer 40 to 30 mEq/L of potassium
• When oral administration of potassium is not feasible the IV route
is indicated.
• For patient at risk for hypokalemia diet containing potassium should
be provided.
 CALCIUM
IMBALANCE
• More than 99% of the body’s calcium is located in skeletal system.
• It is a major component of bone and teeth, about 1% of skeletal calcium
is exchanged with blood calcium.
• Calcium plays a major role in transmitting nerve impulses and helps
to regulate muscle contraction and relaxation, including cardiac
muscle.
 HYPOCALCEMIA
• Any condition that causes a decreased in the production of PTH may result in
the development of hypocalcemia.
• CAUSES
• Multiple blood transfusion
• Chronic renal failure
• Elevated phosphorous
• Chronic alcoholism
• Alkalosis
 HYPOCALCEMIA
• SIGNS OF HYPOCALCEMIA : Chvostek’s sign, Carpopedal spasm
• MEDICAL MANAGEMENT:
 IV administration of calcium like : Calcium gluconate, Calcium
chloride, Calcium gluceptate
 Vitamin D therapy be initiated to increase calcium absorption from GI
Tract.
 Increasing the dietary intake of calcium at least 1,000 to 1,500 mg/day
 HYPERCALCEMIA
• Hypercalcemia (excess of calcium in the plasma) is dangerous
imbalance when severe.
• Hypercalcemia crisis has a mortality rate as high as 50% if not
treated properly
• CAUSES : Multiple myeloma, Prolonged immobilization, Vit D over
dose, Thiazide diuretics(slight elevation)
 HYPERCALCEMIA
• MEDICAL MANAGEMENT
• Administer fluids to dilute serum calcium and promote its excretion by
the kidney.
• IV administration of 0.9% sodium chloride solution temporarily dilutes
the serum calcium level.
• Administering furosemide increases calcium excretion
• Calcitonin is administered to lower the serum calcium level.
 HYPOMAGNESEMIA
• Low level of magnesium in the blood, <1.7
mg/dl.
• Causes: Insufficient renal reabsorption
• Insufficient gastrointestinal absorption
• Hungry bone syndrome
• Risk factors: Alcohol use disorder
• Complications: Hypokalemia, Hypocalcemia
 HYPOMAGNESEMIA
• Sign and Symptoms : Excitable nerves, Cardiac arrhythmias, ECG
changes:- PR prolongation, QT prolongation, T wave flattering,
Seizures.
• Management : identify and treat any underlying magnesium
levels; Supplementation magnesium.
 HYPERMAGNESEMIA
• Blood magnesium levels above 2.4 mg/dl
• CAUSES: Renal failure, Excessive intake, Iatrogenic (excessive
IV administering)
• Cellular breakdown (excessive release)
• Complication: Muscle weakness, Cardiac bradyarrythmias
• Treatment: Identify and treat any underlying causes Administer
calcium gluconate that competes for magnesium binding sites.