FLUID AND
ELECTROLYTE
IMBALANCE,ACID-BASE
BALANCE
AXSA ALEX
1ST YEAR MSC NURSING
INTRODUCTION
ELECTROLYTE IMBALANCE OR WATER ELECTROLYTE BALANCE,IS
AN ABNORMALITY IN THE CONCENTRATION OF ELECTROLYTES IN
THE BODY
ELECTROLYTES PALY A VITAL ROLE IN MAINTAINING
HOMEOSTASIS WITHIN THE BODY.
THEY HELP TO REGULATE HEART AND NEUROLOGICAL
FUNCTION ,FLUID BALANCE,OXYGEN DELIVERY,ACID BASE
BALANCE AND MUCH MORE.
HOMEOSTASIS
ELECTROLYTES PALY A VITAL ROLE IN MAINTAINING HOMEOSTASIS
WITHIN THE BODY.
HOMEOSTASIS IS THE ABILITY OF A SYSTEM OR LIVING ORGANIM TO
ADJUST ITS INTERNAL ENVIRONMENT TO MAINTAIN A STABLE
EQUILIBRIUM .
ELECTROLYTES ARE IMPORTANT BECAUSE THEY ARE WHAT CELLS USE
TO MAINTAIN VOLTAGES ACROSS THEIR CELL MEMBRANES AND TO
CARRY ELECTRICAL IMPULSES ACROSS THEMSELVES AND TO OTHER
CELLS
WATER CONTENT OF THE BODY
INTRACELLULAR FLUID-40% BODY WEIGHT
EXTRACELLULAR FLUID-20% BODY WEIGHT
INTERSTETIAL FLUID-15% BODY WEIGHT
PLASMA-5% BODY WEIGHT
ELECTROLYTES
A ELECTROLYTE IS A SUBSTANCE THAT PRODUCES AN
ELECTRICALLY CONDUCTING SOLUTION WHEN DISSOLVED INA
POLAR SOLVENT SUCH AS WATER.
IONS- ANION
CATION
CATIONS (POSITVE) - SODIUM,POTTASIUM,MAGNESIUM,HYDROGEN
IONS
ANIONS (NEGATIVE)-CHLORIDE,BICARBONATE,PHOSPHATE SULFATE
MECHANISMS CONTROLLING
FLUID ELECTROLYTE MOVEMENT
DIFFUSION
FACILITATED DIFFUSION
ACTIVE TRANSPORT
OSMOSIS
HYDROSTATIC PRESSURE
ONCOTIC PRESSURE
REGULATION OF WATER BALANCE
HYPOTHALAMIC REGULATION
PITUITARY REGULATUION
ADRENAL CORTICAL REGULATION
RENAL REGULATION
CARDIAC REGULATION
GASTRO-INTESTINAL REGULATION
ROUTES OF GAINS AND LOSSES
KIDNEY
SKIN
LUNGS
GI TRACT
FLUID VOLUME DISTURBANCES
HYPOVOLEMIA Fluid volume deficit
HYPERVOLEMIA: Fluid volume excess
ELECROLYTE IMBALANCES
THE MAIN ELECTROLYTE IMBALANCE ARE
SODIUM DEFICIT: HYPONATREMIA
EXCESS: HYPERNATREMIA
POTASSIUM DEFICIT: HYPOKALEMIA
EXCESS: HYPERKALEMIA
CALCIUM DEFICIT : HYPOCALCEMIA
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: diarrhoea, vomiting, Ng suction
RENAL LOSS: Diuretics, adrenal insufficiency, a wasting renal
diseases
SKIN LOSS: Burns, wound drainage
MEDICAL MANAGEMENT
Sodium replacement administration of sodium by mouth who eat
and drink.
Lactated ringers solution (0.9% sodium chloride) is prescribed
Serum sodium must not increase greater than 12meq/L in 24
hours to avoid neurological damages
HYPERNATREMIA
Hyper natremia is a higher than normal sodium level exceeding
(145meq/L)
CAUSES
Gain of sodium in excess of water
Inadequate water intake
Increased serum sodium concentration
MEDICAL 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
HYPERKALEMIA
It may be caused by a massive intake of potassium
CAUSES:
Excess potassium intake -excessive or rapid parenateral
administration -potassium containing drugs
Shift of potassium out of cell -acidosis, crush injury, tissue
catabolism(fever)
Failure to eliminate potassium -renal disease, adrenal
insufficiency, ACE inhibitors
MEDICAL MANGEMENT
Immediate ECG Should be obtained
Serum potassium level from vein without IV fluid infusion
Restriction of dietary potassium
Potassium containing diuretic
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
Shifts of potassium into cells
Lack of potassium intake
MEDICAL MANAGEMENT
t is treated with oral or IV replacement
Administer 40 to 80 mEq/ day 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
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
CHVOSTEKS SIGN
TROUSSEAUS SIGN
MEDICAL MANGEMENT
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
1,500mg/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]
MEDICAL MANGEMENT
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
ACID BASE BALANCE
The body normally maintains a steady balance between acid
produced during metabolism and bases that neutralize and
promote the excretion of the acid , many health problems lead to
acid base imbalance in addition to fluid and electrolyte imbalance
Patient with diabetes mellitus, chronic obstructive pulmonary
disease and kidney disease frequently develop acid-base
imbalance
HYDROGEN ION COCENTRATION
Acidity or alkalinity of a solution is determined by its
concentration of hydrogen ions (h+)
The unit used to describe acid base is PH
The PH scale ranges from 1-4. A neutral solution measures 7
Normal blood plasma is slightly alkaline and has a normal ph
range of 7.35-7.45
ACIDOSIS
It is the condition characterized by an excess of H ions or loss of
base ions/bicarbonate in ECF in which the PH falls bellow 7.35
ALKALOSIS
It occurs when there is a lack of H ions or a gain of based and the PH
exceeds 7.45
ACID BASE REGULATION
The body’s metabolic processes constantly produce acids.
These acids must be neutralized and excreted to maintain acid
base balance
Normally the body has three mechanisms by which it regulates
acid-base balance to maintain the arterial ph 7.35 and 7.45
BUFFER SYSTEM
THE RESPIRATORY SYSTEM
THE RENAL SYSTEM
The regulatory mechanisms react at different speeds.
BUFFER reacts immediately
THE RESPIRATORY SYSTEM responds in minutes and reaches
maximum effectiveness in hours
THE RENAL RESPONSE takes 2-3 days to responds maximally
ALTERATION IN ACID-BASE
BALANCE
The acid-base imbalance is produced when the ratio of 1:20
between acid and base content is altered
A primary disease or process may alter one side of the ratio
The compensatory process attempts to maintain the other side of
the ratio
When compensatory mechanism fails, an acid –base imbalance
occurs
CLASSIFICATION
Acid-base imbalances are classified as
RESPIRATORY IMBALANCE- It affects carbonic acid concentration
METABOLIC IMBALANCE- It affects the base bicarbonate
RESPIRATORY ACIDOSIS
Respiratory acidosis is a clinical disorder in which the PH is less
than 7.35 and the PaCo2 is greater than 42mmHg. It may either
acute and chronic
CAUSES
Elevated plasma level
Elevated carbonic acid
Acute pulmonary edema
Atelectasis
Impaired respiratory muscles
CLINICAL MANIFESTATIONS
Increased pulse
Increased respiratory rate
Increased blood pressure
Mental cloudiness
Cerebrovascular vasodilation
Increased intra cranial pressure
Papilledema
MANAGEMENT
Treatment is directed by improving ventilation
Pharmacologic agent
bronchodilators
anti biotic
anti coagulants
Pulmonary hygiene measures
adequate hydration
mechanical ventilation
RESPIRATORY ALKALOSIS
Respiratory alkalosis is a clinical condition in which the arterial ph
is greater than 7.45 and the paco2 is less than 38mmhg
CAUSES
Respiratory alkalosis is always due to hyperventilation
Anxiety
Hypoxemia
Chronic hypocapnia
Decreased serum bicarbonate levels
Chronic hepatic insufficiency and
cerebral tumors
CLINICAL MANIFESTATIONS
Light headedness due to
vasoconstriction
Decreased cerebral flow
Numbness tinnitus,
Loss of consciousness
Tachycardia
Ventricular and arterial dysrhythmias
MANAGEMENT
Treatment depends on the underlying cause respiratory alkalosis
Anxiety : patient is instructed to breath more slowly to allow co2
to accumulate
Sedative may be required to relieve hyperventilation in very
anxious patients
METABOLIC ACIDOSIS
Metabolic acidosis is a clinical disturbance characterized by a low
pH (increased hydrogen ions)and a low plasma bicarbonate
concentration
It can be produced by a gain of hydrogen ions or a loss of
bicarbonate
It can be divided clinically into two forms according to the values
of the serum anion gap
CLINICAL MANIFESTATIONS
Headache
Confusion
Drowsiness
Increased respiratory rate depth
Nausea and vomiting
Decreased blood pressure
Cold and clammy skin
Dysrhythmias
shock
Diagnostic evaluation
Arterial blood gas analysis
Change includes a low bicarbonate level (less than 22 meq/l)
Low ph (less than 7.35)
Calculation of anion gap is helpful
ECG will detect dysrhythmias caused by increased potassium
MANGEMENT
Treatment is directed at correcting the metabolic defect
If problem results from excessive intake of chloride, treatment is
aimed at eliminating the source of chloride
Bicarbonate is administered if the ph is less than 7.1
Serum potassium level is monitored closely and hypokalemia is
corrected as acidosis reversed
METABOLIC ALKALOSIS
Metabolic alkalosis is a clinical disturbance characterized by a
high ph (decreased H⁺ ions concentration) and a high plasma
bicarbonate concentration. It can be produced by a gain of
bicarbonate or a loss of H⁺ ions
CAUSES
Vomiting-WITH LOSS OF HYDROGEN AND CHLORIDE IONS
gastric suction
Pyloric stenosis
Diuretic therapy that promotes excretion of
potassium
Cystic fibrosis
Chronic ingestion of milk and calcium
carbonate
CLINICAL MANIFESTATIONS
Tingling of the fingers and toes
Dizziness
Symptoms of hypocalcemia is often the
symptoms of alkalosis
Ventricular disturbances (ph increase above7.6)
MEDICAL MANAGEMENT
Sufficient chloride must be supplied for kidney to absorb sodium
with chloride
Administering sodium chloride fluids
Histamine-2 receptor antagonists, such as cimetidin (tagamet).
Reduces the gastric hcl, thereby decreasing the metabolic
alkalosis associated with gastric suction
Input and output should be monitored
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