FLUID AND ELECTROLYTES

IMBALANCE

WATER (H2O)

Water
the primary body fluid
approximately 60% of the average adult body weight is
water
this volume remains relatively constant

Functions of Water
provides a medium for metabolic reactions within cells
transports nutrients, waste products to and from the cells
acts as a lubricant
provides insulation
absorbs shock
regulates and maintains body temperature through evaporation
of perspiration

Factors Affecting Total Body Water

AGE (less with age)
after 65 y.= body water decreases to
45-50 % of total body weight;
Infant- 70-80% of water by weight.
GENDER (male >female)
AMOUNT OF BODY FAT (fat cells
contain little water=> proportion of
water to total body weight is less.

FLUID COMPARTMENTS
Water is distributed into 2 major compartments:
I.Intracellular (ICF)2/3 OF TOTAL BODY FLUID,
CONTAINS WATER AND ELECTROLYTES
INSIDE THE CELL
II. Extracellular (ECF)1/3 OF TOTAL BODY FLUID
INTERSTITIAL FLUID 75%,
INTRAVASCULAR 20%,
TRANSCELLULAR-5%)

F & E imbalance: Fluid

Compartments

Electrolyte Composition of Body Fluid Compartments

LeMone, page 188

PROTEINS IN Fluid Compartments

DIFFUSION
Is a mean of passive transport
Is the process by which particles (solid, liquid, or gas) move
from an area of higher concentration to one of lower
concentration, down their concentration gradient.
Types of diffusion
a. Simple diffusion-fat- soluble molecules diffuse
directly through the lipid bilayer of the plasma membrane,
in which they can dissolve. (eg., oxygen, CO2, fatsoluble vitamins, and alcohol).
Facilitated diffusion- moves large, lipid-insoluble
molecules (e.g. glucose) across the membrane after
binding to a transmembrane carrier protein.

Figure 105
Diffusion. Solute molecules move through a semipermeable membrane from an area
of high solute concentration to an area of low solute concentration.
LeMone, page 191

Types of diffusion

Factors affecting the rate of diffusion:

1.The size of the molecules (larger molecules
move more slowly than smaller ones because
large molecules require more energy to move).
2. The concentration of the solution (the
molecules move from a solution of higher
concentration to a solution of lower concentration)
3. The temperature of the solution (Increases in
temperature increases the rate of motion of
molecules)
4. whether the chemical is fat-soluble or liquidsoluble (fat soluble is faster)

OSMOSIS
ITS A DIFFUSION OF WATER
Osmolality is used to describe the concentration of body fluids
The osmolality of the extracellular fluid depends mainly on
sodium (Na+) concentration in the ECF; glucose and urea also
contribute to osmolality
potassium (K+), glucose and urea are the primary contributors
to the osmolality of intracellular fluid
Osmotic Pressure
the power of a solution to draw water across a membrane

Figure 103
Osmosis. Water molecules move through a selectively permeable membrane from an
area of low solute concentration to an area of high solute concentration
Kozier, page 1370

TONICITY
refers to the osmolality of a solution
refers to the effect a solutions osmotic pressure has on
water movement across the cell membranes of cells within
the solution
isotonic solutions have the same concentrations of solutes
as plasma

hypertonic solutions have a greater concentration of

solutes than plasma

hypotonic solutions have a lower solute concentration than

plasma

Figure 104
The effect of tonicity on red blood cells. A, In an isotonic solution, RBCs neither gain
nor lose water, retaining their normal biconcave shape. B, In a hypertonic solution, cells lose water
and shrink in size. C, In a hypotonic solution, cells absorb water and may burst (hemolysis)
LeMone, page 190

Figure 104 (continued)

The effect of tonicity on red blood cells. A, In an isotonic solution, RBCs
neither gain nor lose water, retaining their normal biconcave shape. B, In a hypertonic solution, cells
lose water and shrink in size. C, In a hypotonic solution, cells absorb water and may burst (hemolysis)
LeMone, page 190

Figure 104 (continued)

The effect of tonicity on red blood cells. A, In an isotonic solution, RBCs
neither gain nor lose water, retaining their normal biconcave shape. B, In a hypertonic solution, cells
lose water and shrink in size. C, In a hypotonic solution, cells absorb water and may burst
(hemolysis).
LeMone, page 190

Figure 31.2 Movement of fluids and solution tonicity

(Adams, Chapter 44, page 629)

ACTIVE TRANSPORT
Active transport-occurs when substances
can move across cell membrane from a
less concentrated solution to a more
concentrated one with the use of
metabolic energy .
active transport is important in maintaining
the differences in sodium and potassium
ion concentrations of ECF and ICF
sodium-potassium pump

Facilitated diffusion vs. Active

transport

Figure 107
The sodium-potassium pump. Sodium and potassium ions are moved across the cell
membranes against their concentration gradients. This active transport process is fueled by energy
from ATP.
LeMone, page 191

Filtration
is a process whereby fluid and solutes move together across a membrane
from one compartment to another.
The movement is from an area of higher liquid pressure to one of lower liquid
pressure.
Ex.: movement of fluid and nutrients from the capillaries of the arteries to the ISF
around the cells.
What creates a hydrostatic pressure?
is the pressure exerted by a fluid within a closed system;
The hydrostatic pressure of blood is the force exerted by blood against the vascular
walls (e.g. the artery walls).
The fluids move from the area of greater pressure to the area of lesser pressure.
What creates an osmotic pressure?
Osmotic pressure represents the driving force of water. It refers to the pressure
that has to be applied to prevent movement across a selectively permeable
membrane.
In the body, plasma proteins exert an osmotic pull called colloid osmotic
pressure or oncotic pressure, pulling water from the ISS into the vascular
compartments.

CAPILLARY
Blood flow arteries
arteriolescapillariesvenules
veins
Capillaries are smaller branches of
arterioles.
Extremely narrow, microscopic
blood vessels with a wall composed
of only one layer of endothelial
cells.
Capillary beds (network of many
capillaries) are present in all regions
of the body;
each supplies the needs of
neighboring cells;
Nutrients and waste molecules are
exchanged only across their thin
walls;
Oxygen and glucose diffuse out

Figure 106
Fluid balance between the intravascular and interstitial spaces is maintained in the
capillary beds by a balance of filtration at the arterial end and osmotic draw at the venous end.
LeMone, page 191

F & E imbalance: Movement of H2O

Hydrostatic pressure or push force
Osmotic pressure or pull
attraction force
in pull or push fluid movement
& volume in the compartment

F & E imbalance: Capillary Exchange

Capillary Exchange

F & E imbalance: Movement of H2O:

hydrostatic pressure

F & E imbalance: Movement of H2O

EDEMA

F & E Imbalance: Edema

Edema - the accumulation of fluid in the
interstitial space, which may impair tissue function.
Osmolarity concentration of solute in the fluid
(mol/L of solution)
Osmolality concentration of solute in solvent
(kg)
(mol/kg). Easier to evaluate
Visible / invisible
Dependent
Prolonged

Edema causes
1. capillary hydrostatic pressure (or BP d/t hypervolemia)
2. Low colloid osmotic pressure due to:
Liver disease (low synthesis of proteins),
kidney disease (excess loss of plasma proteins),
capillary permeability (ex. Inflammation, infection)
Loss of plasma proteins (ex. Albumin plasma osmotic pressure; more
fluid leaves & less returns)
3. Excessive Na in the ECF
4.Obstruction of the Lymphatic circulation:
Removal of lymphatic nodes, (ex. CA)
Infection (elephantitis)

F & E Imbalance: Edema

effects

1. Decreased perfusion/bl. Flow to tissue:

Local swelling- tissue compress local bl. Vessels;
Increased volume of ISF increase distance where
oxygen and nutrients diffuse to tissue cells;
Increase Interstitial pressure- may restrict arterial flow
into area prevents normal cell function, reproduction
tissue necrosis (susceptible for tissue break down; ulceration)
2. Functional Impairment:
functional impairment (joints, GI (absorbtion), Respiratory
systems gas exchange)
3. weight, pain, appearance (shinny tight skin)

F & E Imbalance: ThirdSpacing

Shift of fluid from the vasculature to the not readily
accessible area ( ex. peritoneal or pleural cavities)
Does a persons weight changes ?
Hypervolemia (H2O & Na retained; levels - normal)
What are some of the conditions that may lead to
hypervolemia?
CHF, Renal failure, cirrhosis of liver, Cushings
syndrome

Dehydration

REGULATION OF BODY
FLUIDS
Normally, intake of water = output of
water
water balance exists when intake =
output

F & E imbalance: Movement of H2O

DEHYDRATION
A decrease in intravascular, interstitial and/or
intracellular fluid

Mild dehydration = decrease of 2% in body

weight
Moderate dehydration = decrease of 5% in
body weight
Severe dehydration = decrease of 8% in body
weight

CAUSES
Excessive fluid losses
from the GI tract are the most common causes, such as
from vomiting, diarrhea, GI suctioning, intestinal drainage
Others causes of fluid loss include excessive sweating,
hemorrhage, chronic abuse of laxatives and/or enemas
renal losses due to kidney disease, inadequate ADH and
aldosterone levels
3rd space loss
Insufficient water intake
Uncontrolled diabetes with loss of fluid, electrolytes and
glucose in the urine

F & E Imbalance:
Dehydration: Causes

Vomiting & Diarrhea

Excessive sweating (Na, H2O)
Diabetic Ketoacidocis;
Insufficient H2O intake
Concentrated formula for infants

F & E Imbalance:
Dehydration:
> serious for infants and elderly
H2O loss accompanied by Lytes
depleation
Isotonic dehydration
Hypotonic dehydration (loss >Lytes;
<H2O)
Hypertonic dehydration (loss >
H2O; < Lytes)

TYPES OF DEHYDRATION

F & E Imbalance:
Dehydration: Effects

Dry mucous membrane

Decrease skin turgor
Low BP, weak pulse, fatigue
Increased Hematocrit (more RBC than H2O in
blood)
Decrease mental status

COMPENSATION
More ADH, aldosterone
Vasoconstriction
increased the specific Urine gravity.

Manifestations of dehydration

CONTROL OF FLUID
BALANCE
THIRST MECHANISM
ADH
RAAS

F & E imbalance: Movement of H2O

control / regulation

F & E imbalance: Movement of H2O: ADH

Flow Chart of Mechanisms Regulating Sodium and Water Balance to Help

Maintain Blood Pressure Homeostasis (Marieb, 8th edition, Chapter 15)

Figure 109
The reninangiotensinaldosterone system. Decreased blood volume and renal
perfusion set off a chain of reactions, leading to release of aldosterone from the adrenal cortex.
Increased levels of aldosterone regulate serum K+ and Na+, blood pressure, and water balance
through effects on the kidney tubules.
LeMone, page 192

DRUGS USED FOR DIURESIS

Nephron Functions

Figure 30.1 The nephron

(Adams, Chapter 43, page 617)

Drugs Used to treat

Diarrhea
2 major groups:
1. specific antidiarrheal drugs
-drugs that treat the underlying cause of the
diarrhea
-include the anti-infective drugs and drugs
used to treat
malabsorption syndrome
2. nonspecific antidiarrheal drugs
-agents that act on or within the bowel to
provide
symptomatic relief
-these drugs do not influence the actual cause


Nonspecific antidiarrheal agents
Prototype drug: Lomotil ( diphenoxylate + atropine)
Actions:
-activate opioid receptors in the GI tract
Effects:
- intestinal motility (peristalsis) and thus slow intestinal
transit, allowing more time for absorption of fluids and
electrolytes
- the secretion of fluid into the small intestine and
absorption of fluid and salt into the small intestine
-net effect is to present the large intestine with less water
-as a result, the fluidity and volume of the stools are reduced, as
is the frequency of defecation
Side Effects:
-at the doses used for diarrhea, subjective effects and
dependence do not occur
-excessive doses can elicit morphine-like subjective effects

Antidiarrheal drugs: Nursing

Consideration
Assess

liver, kidney function prior to

administration due to excretion in kidney
Due to possible dizziness advice no driving;
Obtain baseline Vital Signs, and perform
abdominal assessment;
Discontinue medication once diarrhea is
subsiding;
Seek MD care if blood present in stool;

Over the Counter Drugs

Fluids and electrolytes part II

Electrolytes
Na+

Electrolytes:
K+

Multisystem Effects of Hypokalemia

Electrolytes: Calcium

Figure 1012
Low calcium levels (hypocalcemia) trigger the release of parathyroid hormone
(PTH), increasing calcium ion levels through stimulation of bones, kidneys, and intestines.

Figure 1013

A, Positive Chvosteks sign. B, Positive Trousseaus sign.

Figure 1013 (continued)

A, Positive Chvosteks sign. B, Positive Trousseaus sign.