SEMINAR PRESENTATION

ON
 FLUID AND ELECTROLYTE IMBALANCE
  Grace Alexander
MSc Nursing I year
PION
 TERMINOLOGIES
1. Acid-base balance: Refers to homeostasis of
hydrogen ion (H+) concentration in the body fluids.
2. Homeostasis: The tendency to maintain relatively
constant condition.
3. Fluid volume excess: Increase in body water.
4. Fluid volume deficit: Occurs when there is less
water than normal in the body.
5. Extracellular fluid (ECF): Fluid outside the cell
6. Intracellular fluid (ICF): fluid inside the cell
7. Interstitial fluid: Fluid surrounding the cells.
 DEFINITION
1. FLUID
2. ELECTROLYTES
 PHYSIOLOGY OF FLUID AND
ELECTROLYTE REGULATION

1. ADH
2. ALDOSTERONE
3. THIRST
4. ATRIAL NATRIURETIC PEPTIDE
 PHYSIOLOGY OF ACID-BASE
EQUILIBRIUM
PARAMETER ARTERIAL BLOOD VENOUS BLOOD
pH 7.38 - 7.45 7.35 - 7.45
pCO2 35 - 45 45 - 50
HCO3 23 - 27 meq/L 24 - 25meq/L

The normal metabolic activity of tissues results in

production of 2 types of acid.
i. Carbonic acid: Volatile acid derived from CO2
ii. Non–volatile: Organic acids, uric acid, inorganic
phosphates produced from incomplete combustion of
carbohydrates, fats, proteins and organic phosphates.
 CLASSIFICATION OF ACID-
BASE IMBALANCE
i. Respiratory Acidosis: Hypoventilation results in CO2
retention and a rise in pCO2 causing respiratory acidosis.
ii. Respiratory Alkalosis: Hyperventilation results in CO 2
washout and consequent drop in arterial pCO2, causing
respiratory alkalosis.
iii. Metabolic Acidosis: Increased non-volatile acids in body
causes in metabolic acidosis.
iv. Metabolic Alkalosis: Decreased non-volatile acids in body
causes metabolic alkalosis.
CONDITION CAUSES pH HCO3 PaCO2

Respiratory Hypoventilation Decreased Normal Increased

Acidosis
Respiratory Hyperventilation Increased Normal Decreased
Alkalosis
Metabolic Diabetic Decreased Decreased Normal
Acidosis Ketoacidosis
Metabolic HCO3 Retention Increased Increased Normal
Alkalosis
 CLASSIFICATION OF
DYSELECTROLYTEMIA
i. Hyponatremia
ii. Hypernatremia
iii. Hypokalemia
iv. Hyperkalemia
v. Hypocalcemia
vi. Hypercalcemia
 
  
HYPONATREMIA
Hyponatremia is termed as serum sodium level less than
130meq/L

CAUSES
1. Actual deficiency of Sodium
Eg: Excessive Sodium loss in vomiting, diarrhea,
diaphoresis.
2. Increase in body water that dilutes sodium excessively
a. Excessive secretion of ADH (SIADH)
b. Nephrotic syndrome
c. CCF
 CLINICAL MANIFESTATIONS

i. Headache
ii. Muscle Weakness
iii. Fatigue
iv. Apathy
v. Confusion
vi. Abdominal cramps
vii. Orthostatic Hypotension
 MANAGEMENT

i. Restriction of fluids
ii. Hypertonic saline
iii. Diuretics (furosemide)
 HYPERNATREMIA
Hypernatremia is termed as serum sodium >150 meq/L.
It is a serious imbalance that can lead to death if not
corrected. The high level of sodium in the extracellular fluid
causes water to shift out of cells.This creates a condition of
cellular dehydration.

CAUSES:
Hypernatremia occurs when there is excessive loss of water
or excessive retention of sodium.
i. Vomiting
ii. Diarrhoea
iii. Diaphoresis
iv. Insufficient ADH
CLINICAL MANIFESTATION
Thirst, flushed skin, dry mucous membrane, low urine
output, restlessness, increased heart rate, convulsions,
postural hypotension.

MANAGEMENT
Replacement of water to restore balance
Fluids with reduced sodium content (like N/2 or N/3
or N/5 DNS)
 HYPOKALEMIA
Hypokalemia is termed as serum potassium < 3.5meq/L.

CAUSES
i. Vomiting
ii. Diarrhoea
iii. Nasogastric Suction
iv. Inadequate dietary intake of potassium
v. Diabetic Ketoacidosis
vi. Drugs such as potassium wasting diuretics,
corticosteriods
CLINICAL MANIFESTATIONS
As potassium is necessary for normal cellular functions,
deficiencies results in gastrointestinal, renal, cardiovascular
and neurologic disturbances.
Most important effect is on myocardial cells, which tend to
cause abnormal, potentially fatal, cardiac rhythms.

 
MANAGEMENT
•Potassium replacement by intravenous or oral route.
•Cardiac monitoring
•Include foods such as bananas, oranges or orange juice.
•Potassium is always diluted before intravenous administration.
Rapid infusion can cause cardiac arrest.
 
 HYPERKALEMIA
Hyperkalemia is termed as serum potassium > 5meq/L
It is a serious imbalance as it can cause life threatening
dysarrthymias.

CAUSES
i. Decreased renal function
ii. Metabolic acidosis
iii. Traumatic injuries(loss of potassium from
damaged cells into ECF)
iv.  
CLINICAL MANIFESTATION
1. Cardiovascular : Increased potassium first causes
bradycardia , then tachycardia, there is risk of cardiac arrest.
2. GI System: Explosive diarrhea, vomiting.
3. Neuromuscular: Muscle cramps, weakness, paresthesia.
4. Others: Irritability, anxiety, abdominal cramps, decreased
urine output.

MANAGEMENT
5. Treatment of underlying cause, restricting potassium intake
6. Kayexalate(Polysterene sulfonate) administration orally or
rectally.
7. Intravenous administration of calcium gluconate to
decrease effects of potassium on myocardium.
8. Administration of Insulin+ glucose or sodium bicarbonate
to promote the shifting of potassium into cells.
 HYPOCALCEMIA
Calcium in blood is regulated by parathyroid glands, which
secrete parathyroid hormone (PTH). Hypocalcemia
stimulates PTH secretion. PTH enhances calcium retention
by the kidneys, promotes calcium absorption in intestine
and mobilizes calcium from the bones to raise serum level.

CAUSES
1. Diarrhoea
2. Inadequate dietary intake of calcium, Vit D.
3. Multiple blood transfusions(banked blood contains
citrates that bind to calcium)
4. Hypothyroidism
 HYPERCALCEMIA
CAUSES
1. Hyperthyroidism
2. Immobility(causes stores of calcium in the bones to
enter bloodstream)
 
 FLUID IMBALANCES
It is divided into:

1. FLUID VOLUME DEFICIT

2. FLUID VOLUME EXCESS

 FLUID VOLUME DEFICIT
It occurs when there is less water than normal in body.They
are of two types:

1. Isotonic extracellular fluid deficit(hypovolemia)

2. Hypertonic extracellular fluid deficit(dehydration)
 
 FLUID VOLUME DEFICIT
ISOTONIC ECF DEFICIT
DEFINITION Deficiency of both water and
relative electrolytes.
ETIOLOGY  Decreased fluid intake
related to inability to to
obtain or ingest fluids.
 Excessive fluid loss related to
vomiting, diarrhea.
 Shifting of fluid into
interstitial space(third
spacing)related to increased
capillary permeability.
HYPERTONIC ECF
DEFICIT
Deficiency of water
without electrolyte
efficiency.
 Increased water loss
related to blood glucose
as in DM,inadequate
ADH production, high
fever, sweating.
 Decreased fluid intake
with continued intake
of electrolytes as with
concentrated tube
feedings.
 ISOTONIC ECF HYPERTONIC ECF
DEFICIT DEFICIT

CLINICAL
MANIFESTATIONS
BP Hypotension Hypotension
Heart Rate Increased Increased
Urine Output Decreased Increased or decreased

MANAGEMENT  Correct underlying  Correct underlyng

cause cause
 Replace water and  Replace water.
electrolytes
 FLUID VOLUME EXCESS
ISOTONIC ECF EXCESS HYPERTONIC ECF EXCES

DEFINITION Excess of both fluid and electrolytes Excess of body water without
excess electrolytes.

CAUSES Retention of water and electrolytes Overhydration in presence of

related to kidney disease, overload with renal failure
intravenous fluid

CLINICAL
MANIFESTATION
BP Increased Increased systolic
PULSE Bounding and increased rate Decreased rate

MANAGEMENT  Correct underlying cause Correct underlying cause

 Restrict water and sodium intake
 Diuretics
 Digitalis toimprove cardiac output
 Dialysis if kidney failure is a factor
 Salt restriction
Restrict water intake
Give demeclocycline
(declomycin) to decrease
kidney response to ADH.
THANK YOU
SSSS