Care of Clients with Problems In Oxygenation, Fluids and Electrolytes, Metabolism and Endocrine (NCM103) Patients With Fluids

and Electrolytes (Renal) Alteration II

Topics Discussed Here Are: 1. Basic Concepts of Fluids and Electrolytes 2. Fluid Compartments 3. Major Common Fluid Imbalances

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Basic Concepts on Fluids and Electrolytes

A. Definition of Terms 1. Electrolytes Are compounds / substances which when placed in a solution would break up / dissociate in 2 electrically charged particles Can be an: 1. Ion Electrically charged particles 2. Cation / Anion 2. Fluid / Water Fluid More ENCOMPASSING Contains WATER and ELECTROLYTES Water Does not contain ELECTROLYTES FLUID is WATER, but WATER is NOT FLUID Body is made up of 60% - 70% WATER!! B. Factors That Determines the Amount of Water 1. Age (The younger more water! The older the less water) As we grow older, the LEAN portion of body (muscles), fatty tissues are replaced by ANHYDROUS (Contains no WATER) Babies have IMMATURE KIDNEYS. Therefore, they are at risk for DEHYDRATION (Kidneys cannot conserve water ) Body metabolism of newborn is HIGHER compared to an adult (As Age :Body Metabolism ) Body Metabolism, GREATER CONSUMPTION of WATER 2. Gender (Sex) Males: Water - Muscle Females - Water Fats (Anhydrous) However, the deposition of muscle on males and fats on females is only a secondary sex characteristic

3.

Body Size Thinner More WATER! Less FAT! Obese Less WATER More FAT! (Anhydrous)

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Normal Condition of Fluid Intake Normal intake of water is 2,600 mL Whatever we INTAKE, OUTPUT should be the same (2,600 mL) Where do we get the 2.6L of FLUID?? Water (1,300 mL) Food (1,000 mL) Oxidation of Food (300 mL) TOTAL: 2,600 mL Normal Conditions of Fluid Output Normal output of water is 2,600 mL Where do we get the 2.6 L of FLUID OUTPUT? Kidney (1,500 mL) GIT (200 mL) Lungs (300 mL) Skin (600 mL) TOTAL: 2,600 mL

LUNGS and SKIN are INSENSIBLE FLUID LOSS (900 mL) Fluid loss which are NOT within our control Fluid loss we CANNOT SEE SWEAT Sensible fluid loss!

Situation:
Inside the classroom with a teacher speaking and students listening Who has more insensible fluid loss through the lungs? Who has more sensible fluid loss through the lungs?

FLUID COMPARTMENTS :P
1.

2.

K, PO4, Na, Cl are all inside and outside the cell! Intracellular Fluid (ICF) Fluid inside the cell Composes 2/3 of the TOTAL BODY FLUID of the body Potassium Phosphate (Major ICF Electrolyte) Potassium (+) INSIDE and OUTSIDE THE CELL~ Phosphate () - There is a difference of concentration in Extracellular Fluid (ECF) the ICF and ECF Fluid outside the cell - The amount of ion in each compartment 1/3 of total body fluid will account for the osmolality~ Sodium Chloride (Major ECF Electrolyte) - If the amount of concentration is the Sodium (+) same both inside and outside the cell, Chloride () there is no SHIFTING of FLUID Divided into 3 Spaces~ a. Interstitial Fluid Compartment Fluid surrounding the cell or in between the cell Example: Lymph! 11 12 L of interstitial fluid b. Intravascular Fluid Compartment Fluid inside the blood vessel 5 6 L of intravascular space Plasma (3 L) RBC, WBC, Platelets (3 L) c. Transcellular Fluid Compartment Consists of bodys secretions and excretions
Urine, perspiration, saliva, GIT secretions, CSF, and synovial fluid

3.

3rd Space Fluid If in the event if the ICF/ECF escapes out/inside the cell respectively, the fluid does not go to the other compartment A special compartment wherein the fluid goes in the space, but the fluid is NOT used by the body (Ex. Peritoneum = Ascites) Total body fluid is the same!!

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We Are Aware with Fluid Imbalance!!

1. 2. 3. Thirst (1st Factor) Hypothalamus tells you if you are thirsty! Hormones a. ADH b. Aldosterone

Fluid intake

Thirst

LBM Px 6x Vomiting Water Reabsorption Urine Output Posterior Pituitary Gland Fluid Imbalance (FVD) Hypothalamus Pituitary Gland

Na

Reabsorption of Water Na, K Aldosterone

ADH

Anterior Pituitary Gland

Adrenal Cortex

ACTH

Major Common Fluid Imbalances

(Isotonic fluid referred to by body fluid and ECF, Ex. Blood, plasma, urine, perspiration) 1. Hypovolemia Fluid Volume Deficit (FVD) Isotonic Deficit Dehydration Causes: - Fluid Intake (People who cannot recognize thirst) - Fluid loss o Diarrhea, Polyuria, Bleeding, Burns, Excessive perspiration, excessive vomiting (Hyperemesis gravidarum), drainage (fistulas) Manifestations: - Sunken fontanels (Newborns) - Urine Output - Weight - Blood Pressure - CVP - Urinalysis: Dark yellow urine

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Management: a. Intravenous Therapy

ICF ECF Isotonic

Hypotonic

Hypertonic

1.

Isotonic = Concentration of fluid is same as blood; NO SHIFTING OF FLUID Used to maintain blood volume Examples: D5W 0.9 Saline Solution NSS LRS Give when patient is: BLEEDING Hypotonic = Concentration of fluid is in the blood than the concentration in the ICF Examples: D2.5W 0.45 Saline Solution Give when patient is: DEHYDRATED (Poor skin turgor) Hypertonic = Concentration of fluid is in the blood than the concentration in the ICF Examples: D10W D50W Mannitol Give when patient is/has: EDEMA! OSMOSIS Movement of FLUID from an area of LOW concentration to an area of HIGH concentration DIFFUSION (Gas / Particles) Movement of PARTICLES from a HIGHER CONCENTRATION to a LOWER CONCENTRATION Sea water is HYPERTONIC! SODA is also HYPERTONIC

2.

3.

b. Increase Oral Fluid Intake If fluid volume deficit is brought about by diarrhea, give anti diarrheal drug If vomiting, give antiemetic Give coagulant if bleeding Blood Transfusion Pack RBC Whole Blood Crystalloid Plasma Expander (Dextran) Burns

2.

Hypervolemia Fluid Volume Excess (FVE) Over hydration Intake: Output Causes: - Psychiatric patients (Obsessive Compulsive of Water

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Related to Diet o Increased Na diet o Rapid administration of IV Fluid Overuse of saline solution Associated with Disorders: o Cushings Syndrome ( Aldosterone) Na Retention, K Excretion Increased Na = Increased Water in body (Hypervolemia) Urine Output due to: o Renal Failure o Presence of Edema

Manifestations: 1. Weight is INCREASED 2. Periorbital Edema 3. Peripheral Edema (Sausage shaped fingers) 4. Ascites 5. BP Laboratory Findings: - Hemoglobin and Hematocrit is Decreased - Urinalysis o Dark Yellow Urine (Cant EXCRETE) Management: FLUID INTAKE Na Diet! SITUATION: (Management for each complication) Right Sided Heart Failure = Digitalis (Lanoxin) Renal Failure = Diuretic Severe Cases of Hypervolemia = Dialysis Liver Impairment Abdominal Paracentesis Aspiration of FLUID from PERITONEUM Inserted between the Umbilicus and Symphysis Pubis by 2 3 fingers IMPORTANT: Client MUST EMPTY the BLADDER To prevent damage to the bladder

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