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FLUID AND
ELECTROLYTE BALANCE
FLUID REQUIREMENTS
Sources Losses
Water 1500 ml Urine 1500 ml
RULE OF THIRDS
Intracellular: 2/3 (40% TBW)
Extracellular: 1/3 (20% TBW)
a. Interstitial + Lymph: 2/3 (15% TBW)
b. Intravascular: 1/3 (5% TBW)
ELECTROLYTES IN
BODY FLUID COMPARTMENTS
INTRACELLULAR EXTRACELLULAR
POTASSIUM SODIUM
MAGNESIUM CHLORIDE
PHOSPHOROUS BICARBONATE
IV FLUID DISTRIBUTION IN
BODY COMPARTMENTS
ICF ECF
Non-electrolytes
• Dextrose
• Urea
• Creatinine
Electrolytes
• Anions
• Cations
MAINTENANCE vs. REPLACEMENT
Maintenance:
• Provide normal daily requirements:
Water: 2.5 L
Sodium ½ or ¼ NS
KCl 40-60 meq/L
Example:
D5 ½ NS with KCL 20 meq/L running at
100 ml/hr
MAINTENANCE vs. REPLACEMENT
Replacement:
• Replace abnormal losses with a fluid
and electrolytes similar to that which
was lost.
OSMOLALITY
Intake
K Phos Mg
ICF ECF
Stomach
Intestine
Renal GI (stool)
Losses Losses
ELECTROLYE DISORDERS
POTASSIUM
Primary intracellular cation
Hypokalemia: Causes
1. Decreased dietary intake
2. Redistribution
Insulin
Metabolic Alkalosis
Dehydration
ELECTROLYE DISORDERS
POTASSIUM
Metabolic Alkalosis and Hypokalemia
Extracellular
Intracellular Fluid
Fluid
K+
H+
ELECTROLYE DISORDERS
POTASSIUM
Hypokalemia: Causes
Extracellular
Intracellular Fluid
Fluid
H+
K+
ELECTROLYE DISORDERS
POTASSIUM
Hyperkalemia: Treatment
2. Potassium Antagonist
Calcium Chloride
3. Redistribution
a. Insulin + Dextrose
b. Sodium Bicarbonate
4. Cationic Binding Resins
Kayexalate (Polystyrene Sulfonate)
6. Renal Elimination/Dialysis
ELECTROLYE DISORDERS
MAGNESIUM
Hypomagnesemia: Causes
2. Decreased Intake
Malnutrition
Alcoholism
3. Decreased Absorption
4. Increased Losses
GI losses
Renal losses
ELECTROLYE DISORDERS
MAGNESIUM
Drug Induced Hypomagnesemia
2. GI Losses
Laxatives
3. Renal Losses
Diuretics, Cisplatin, Aminoglycosides,
Amphotericin B
ELECTROLYE DISORDERS
MAGNESIUM
Hypomagnesemia: Treatment
2. IV Magnesium Sulfate
Replace over several days
Renal threshold for reabsorption of Mg
1 mEq/kg on day 1
0.5 mEq/kg on days x 3-5 days
3. Oral replacement
Mylanta
ELECTROLYE DISORDERS
MAGNESIUM
Hypermagnesemia: Causes
1. Exogenous ingestion
2. Impaired renal excretion
Treatment
Phosphate binders: Alternagel,
Amphojel, Calcium Supplements
ELECTROLYE DISORDERS
PHOSPHOROUS
M.T. is a 55 year-old female with a history of
chronic renal failure who is admitted to the
SICU following a motor vehicle accident. She is
started on a TPN solution with minimal K, no Mg
and no Phos. She also receives Mylanta II 30
ml per NG tube every four hours. Although her
baseline labs were normal on day six her labs
are as follows: