BODY FLUID & ELEKTROLIT

The newborn and infant have a high percentage of body weight comprised of water, especially extracellular fluid,
which is lost from the body easily. Note the small stomach size which limits ability to rehydrate quickly.

Jane W. Ball and Ruth C. Bindler © 2006 by Pearson Education, Inc.

Upper Saddle River, New Jersey 07458
Child Health Nursing: Partnering with Children & Families All rights reserved.
 TBW
Factors influence TBW
1. Age: Infants need more fluids
• because of large surface area, high growth rate,
2. Body weight:
• in obese (fatty) persons decrease 10-20%
• while in muscular (lean) ones increase 10-20%.
3. Temperature:
• A rise in ambient temp. leads to hyper-ventilation,
• excessive sweating and insensible loss
• For a rise in body temp. of 1ºC, there is an extra
loss of 200ml/day
 TBW
4. Operation & Trauma: due to increased
aldosterone & ADH secretions in neuro-
endocrine response.
• Fluid collect in 3rd space.
• Dehydration
• Overhydration can lead to pulmonary edema,
wound dehiscence & hyponatremia.
Ionic composition of body fluids
 Blood Composition
• Blood: a fluid connective tissue composed of
– Plasma
– Formed elements
• Erythrocytes (red blood cells, or RBCs)
• Leukocytes (white blood cells, or WBCs)
• Platelets
 Blood Composition
• Hematocrit
– Percent of blood volume that is RBCs
– 47% ± 5% for males
– 42% ± 5% for females
 Formed
elements

Plasma
• 55% of whole blood
• Least dense component
Buffy coat
• Leukocytes and platelets
• <1% of whole blood
Erythrocytes
1 Withdraw 2 Centrifuge the • 45% of whole blood
blood and place blood sample. • Most dense
in tube. component
 Functions of Blood
1. Distribution of
– O2 and nutrients to body cells
– Metabolic wastes to the lungs and kidneys for
elimination
– Hormones from endocrine organs to target
organs
 Functions of Blood
2. Regulation of
– Body temperature by absorbing and distributing
heat
– Normal pH using buffers
– Adequate fluid volume in the circulatory system
 Functions of Blood
3. Protection against
– Blood loss
• Plasma proteins and platelets initiate clot formation
– Infection
• Antibodies
• Complement proteins
• WBCs defend against foreign invaders
 Blood Plasma
• 90% water
• Proteins are mostly produced by the liver
– 60% albumin
– 36% globulins
– 4% fibrinogen
 Blood Plasma
• Nitrogenous by-products of metabolism—
lactic acid, urea, creatinine
• Nutrients—glucose, carbohydrates, amino
acids
• Electrolytes—Na+, K+, Ca2+, Cl–, HCO3–
• Respiratory gases—O2 and CO2
• Hormones
 Formed Elements
• Only WBCs are complete cells
• RBCs have no nuclei or organelles
• Platelets are cell fragments
• Most formed elements survive in the
bloodstream for only a few days
• Most blood cells originate in bone marrow
and do not divide
 Sodium
- Total body Na is 5000meq
- Serum Na is 142 meq/L, affects ½ ECF osmolarity (142
mOsm/L of 300 mOsm/L)
- It is the principal cation in 44% ECF
- 9% in ICF and 47% stored in bone
- 50% of stored is water soluble & exchangeable
- The rest is inactive & requires acid for its solution

Roles in the body

Principal extracellular cation
Regulates extracellular volume
Assists in nerve impulse transmission and
muscle contraction
 Potassium
Serum K is - 4 meq/L
98%in I.C.F & 2% in ECF, 75% is found in skeletal muscles.
• Roles in body
– Principal intracellular cation
– Maintains normal fluid and electrolyte balance,
pH balance
– Facilitates many reactions
– Supports cell integrity
– Resting membrane potential & repolarization
– Assists in nerve impulse transmission and
muscle contractions
 Potassium balance
• Potassium ion concentrations in
ECF are low
– Not as closely regulated as
sodium
– Potassium ion excretion
increases as
• ECF concentrations rise
• Aldosterone secreted
• pH rises
– Potassium retention occurs
when pH falls
 Bicarbonate HCO3-
– Second most prevalent extracellular anion
– Concentration increases in blood passing through systemic
capillaries picking up carbon dioxide
• Carbon dioxide combines with water to form carbonic
acid which dissociates
• Drops in pulmonary capillaries when carbon dioxide
exhaled
– Chloride shift helps maintain correct balance of anions in
ECF and ICF
– Kidneys are main regulators of blood HCO3-
• Can form and release HCO3- when low or excrete excess
 Chloride
• Chlorine (Cl2) vs. chloride ion
(Cl-)
• Roles in body
– Principal extracellular anion
– Maintains normal fluid and
electrolyte balancebalancing
osmotic pressures between
compartments.
– Part of hydrochloric acid
found in the stomach,
necessary for proper
digestion
– hyperpolarization of neurons
– Important for anion balance (in
erythrocytes
 Calcium
Serum 45 meq/L ECF
99% in bone & teeth
Ionized, Non-ionized, pH changes
influence the level of ionized Ca
Parathyroid & calcitriol hormones
98% of Ca reabsorbed at the kidneys
Function :
- Neuromuscular transmission
- Blood coagulation
- enzyme regulation
- muscle contraction
- Formation of teeth and bone
 Phosphorus

• Chief functions in the body

– Mineralization of bones and teeth
– Part of every cell
– Important in genetic material, part of
phospholipids
– Used in energy transfer and in buffer
systems that maintain acid-base balance
• Phosphate (H2PO4-, HPO42-, PO43-)

- 85% calcium phosphate (bones and teeth)

- Remaining 15% ionized – H2PO4-, HPO42-, and
PO43- are important intracellular anions
- HPO42-  buffer H+, organic molecule, nucleic acids,
ATP
- PTH  HPO42- resorption  blood
 inhibition of HPO42- reabsorption in kidney
- Calcitriol  phosphate & Ca+2 absorption in GI tract
 Magnesium
– In adults, about 54% of total body magnesium is part of
bone as magnesium salts
– Remaining 46% as Mg2+ in ICF (45%) or ECF (1%)

• Chief functions in the body

– bone mineralization, maintenance of teeth
– building of protein, Na+ – K+ pumps
– enzyme action, enzymes cofactor
– normal muscle contraction, myocardial function
– nerve impulse transmission,
– functioning of immune system
 Fluid spaces
• 1st Spacing: Normal distribution within ECF and ICF
• 2nd spacing: accumulation within the interstitial
compartments: oedema formation but available for
physiological exchange between compartments
• 3rd spacing: Accumulation in parts of the body where it’s not
available for exchange between the different compartments,
fluid accumulation in areas that are normally have no or little
amounts of fluids : Ascites, tissue inflammation, oedema from
burns/surgery
 FLUID VOLUME DEFICITE

Hypovolemia: isotonic Dehydration: hypertonic

extracellular fluid deficit extracellular fluid deficit
• Deficiency of both water & • Deficiency of water
electrolytes • Caused by water loss
• Caused by decreased intake, related to high blood
vomiting, diarrhea, fluid glucose, inadequate ADH
shift production, high fever,
excess sweating
 Current Deficits
Hypernatraemia is a very
common feature of free
water loss Dehydration

Mild Severe
Moderate
C/O Thirst Cardiovascular signs
Objective clinical signs
But no clinical signs of of dehydration Tachycardia
dehydration /hypotension
Mucous membranes,
Up to 5% deficit in TBW skin turgor, mild Marked peripheral
tachycardia signs of dehydration
Will affect all fluid
compartments Reduced UOP >15% of TBW
5-15% of TBW