VTH93-TWTJW-PTTC7-8CP8X-2XV82

FLUID & ELECTROLYTES

I. PHYSIOLOGY
A. BODY FLUIDS - as primary body fluid, water is most important nutrient of life
- humans can survive for only a few days without water
1. FUNCTIONS OF WATER
• provide medium for transporting nutrients to cells, wastes from
cells, and substances such as
hormones, enzymes, blood platelets, and red and white blood
cells
• facilitate cellular metabolism an d proper cellular chemical
functioning
• act as solvent for electrolytes and nonelectrolytes
• help maintain normal body temperature
• facilitate digestion and promote elimination
• act as tissue lubricant
2. BODY FLUID COMPARTMENTS
a. Intracellular fluid (ICF) - within cells
b. Extracellular fluid (ECF) - all fluid outside cells, including intravascular (plasma – liquid
component of blood) and interstitial (fluid that surrounds tissue cells and includes lymph) fluids
total body water – total amt of water in body expressed as % of
body weight
3. VARIATIONS IN FLUID CONTENT
- in a healthy person, total body water constitutes about 50 – 60% of
body’s weight, depending on age,
lean body mass, and sex

- total body water differs by sex and person’s amt of fat cells
- fat cells contain little water while lean tissue is rich in water
- women tend to have proportionally more body fat than men, they also have less body fluid than men -
decreasing % body fluid in older people is related to increase in fat cells

B. ELECTROLYTES

electrolyte – substance capable of breaking into electrically charged ions

when dissolved in a solution
cations – ions that develop a positive charge
anions – ions that
develop a negative charge
1. SODIUm (NA+)-
chief electrolyte of ECF that moves easily between a vascular and interstitial
spaces and moves across cell membranes by active transport
- influential in many chemical reactions in body, particularly nervous and muscle tissue cells
- controls and regulates volume of body fluids; maintains water balance throughout the body
- primary regulator of ECF volume and influences ICF
- participates in generation and transmission of nerve impulses
- essential electrolyte in sodium-potassium pump
- normal extracellular concentration: 135 – 145 mEq/L
2. POTASSIUM (K+) – major cation of ICF working in reciprocal fashion with excessive intake of
sodium results in excretion of potassium, vice versa)
- chief regulator of cellular enzyme activity and cellular water content
- plays vital role in such processes as transmission of electric impulses, particularly nerve, heart, skeletal,
intestinal, and lung tissue; protein and carbohydrate metabolism, and cellular bldg.
- adequate qty. usually in well-balanced diet
- food sources include bananas, peaches, kiwi, figs, dates, apricots,
oranges, prunes, melons raisins, broccoli, potatoes, meat and dairy products

- excreted primarily by kidneys, however, there are large amts in GI

secretions and some in
perspiration and saliva
- normal range for serum: 3.5 – 5 mEq/L
3.CALCIUM (CA+) – most abundant electrolyte, with up to 99% of total found in iodized form of bones
and teeth
- close link between concentrations of calcium and phosphorus
- necessary for nerve impulse transmission and blood clotting
- catalyst for muscle contraction
- needed for vitamin B12 absorption and its use by body cells
- acts as catalyst for most cell chemical activities
- necessary for strong bones and teeth
- determines thickness and strength of cell membranes
- adult avg. daily requirement about 1 g, higher amts. according to
body wt. required for
children and pregnant and lactating women
- 1,500 mg/day recommended consumption for older adults, particularly postmenopausal women and men
older than 65
- sources include milk, cheese, and dried beans, some present in meats and vegetables
- excreted in urine, feces, bile, digestive secretions, and perspiration
4. MAGNESIUM (MG2+) – most cation found within body cells – heart, bone, nerve, and muscle tissues
- 2nd most important cation in ICF
- important for metabolism of carbohydrates and proteins
- important for many vital reactions involving enzymes
- necessary for protein and DNA synthesis, DNA and RNA transcription, and translation of RNA
- maintains normal intracellular levels of potassium
- helps maintain electrical activity in nervous tissue and muscle membranes
- adult daily avg. requirement about 18 – 30 mEq, with children requiring larger amts.
- found in most foods, but especially in vegetables, nuts, fish, whole grains, peas and beans
5. CHLORIDE (CI-) – chief extracellular anion, found in blood, interstitial fluid, and lymph and in
minute amts. in ICF
- acts with sodium to maintain osmotic pressure in blood
- plays a role in body’s acid-base balance
- has important buffering action when oxygen and carbon dioxide exchange in red blood cells
- essential for production of hydrochloric acid in gastric juices
- found in foods high in sodium, dairy products, and meat
- deficit leads to potassium deficit, and vice versa
- normal serum levels: 95 – 105 mEq/L
6. BICARBONATE (HCO3-) – anion that is major chemical base buffer within
- found in both ECF and ICF
- essential for acid-base balance; bicarbonate and carbonic acidconstitute body’s primary buffer system
- losses possible via diarrhea, diuretics, and early renal insufficiency
- excess possible via overingestion of acid neutralizers, such as sodium bicarbonate
- normal levels range between 25 – 29 mEq/L

7. PHOSPHATE (PO4-)- major anion in body cells

- buffer anion in both ICF and ECF
- helps maintain body’s acid-base balance
- involved in important chemical reactions in body (necessary for many B vitamins to be effective, helps
promote nerve and muscle action, plays a role in carbohydrate metabolism
- important for cell division and transmission of hereditary traits
- avg. daily requirements similar to calcium
- found in most foods but especially in beef, pork, and dried peas and beans
- inversely proportionate to calcium - - increase in one results in
decrease of the other
- normal range: 2.5 – 4.5 mEq/L

C. FLUID AND ELECTROLYTE MOVEMENT

- ECF provides nourishment to each body cell and receives cell’s waste
products
- these exchanges are essential to life
1. OSMOSIS – through semipermeable membranes, water (pure solvent) is able to be transported through
cell walls
- major method of transporting body fluids
- through osmosis, water passes from an area of lesser solute concentration to an area of
greater solute concentration until equilibrium is established
- the greater the concentration of the two solutions, thegreater the osmotic pressure or drawing power of
water
osmolarity – concentration of particles in a solution, or its pulling, power
isotonic – solution that has about the same concentration of particles
(osmolarity) as plasma
- remains in intravascular compartment w/out any net flow across
semipermeable membrane
hypertonic – solution has greater osmolarity than plasma
- water moves out of cells and is drawn into intravascular
compartment, causing cells to shrink
hypotonic – solution has less osmolarity than plasma
- solution in intravascular space moves out and into intracellular fluid, causing cells to swell and possibly
burst
2.DIFFUSION – tendency of solutes to move freely throughout a solute;
“coasting downhill”
- moves from area of higher concentration to an area of lower
concentration until equilibrium is established
- gases move by diffusion
- oxygen and carbon dioxide exchange in the lung’s alveoli and capillaries by diffusion
3. ACTIVE TRANSPORT – process that requires energy for movement of substances through a cell
membrane from an area of lesser solute concentration to an area of higher concentration
- adenosine triphosphate makes it possible for certain substances to acquire energy needed
- energy requirements for active transport are affected by characteristics of cell membrane,
specific enzymes, and concentrations of ions
- “pumping uphill”
- substances include amino acids, glucose (in certain places only - -
kidneys, intestines), andions of sodium, chloride, potassium, hydrogen, phosphate,
calcium, and magnesium
4. FILTRATION – passage of fluid through permeable membrane from area of
high pressure to lower
colloid osmotic pressure (oncotic pressure) certain substances, such as plasma proteins, which have high
molecular weights on permeable membranes in the body
hydrostatic pressure – force exerted by fluid against container wall
- blood hydrostatic pressure is the pressure of plasma and blood cells in the capillaries - -depends
primarily on arterial blood pressure on arteriolar side of capillaries, and on venous blood pressure on
venular side of capillaries
- filtration pressure is the difference between colloid osmotic pressure and blood hydrostatic pressure
- these pressures are important in understanding how fluid leaves arterioles, enters interstitial
compartment, and eventually returns to venules
positive pressure in arterioles - - helping to force or filter
fluids into interstitial space
- negative pressure in venules - - helping fluid enter venules
D. FLUID BALANCE
- desirable amt of fluid intake and loss in adults ranges from 1500 – 3500 mL each 24 hrs., with most
people averaging 2500 mL/day
- individual’s health state as well as balance between actual intake and loss must be considered
- intake should normally be approx. balanced by output or fluid loss
- may not always occur in a single 24-hr. period but should be
achieved within 2 – 3 days
1. FLUID SOURCE
2. a. Ingested Liquids – makes up largest amt of water intake
- primarily regulated by thirst mechanism
- stimulated by intracellular dehydration and decreased blood volume
b. Water in Food – 2nd largest source of water - depends on diet
c. Water from Metabolic Oxidation – occurs during metabolism of food substances,
specifically,carbohydrates, fats, and proteins
3. - source varies among different types of nutrients
4. 2. FLUID LOSSES – through kidneys as urine, intestinal tract in feces, and skin as perspiration
(sensible
losses)
- insensible losses include ex. of invisible amt of water lost from skin constantly through evaporation
and from the lungs exhaled as breaths
- losses vary according to person and circumstances
- any deviations from normal ranges for a balanced water intakeand output should alert nurse to
potential imbalances