Fluid & Electrolyte

Basics
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www.pocketprofnursing.com

Homeostasis
Body fluids are in
constant motion
transporting nutrients,
electrolytes, and oxygen
to cells while carrying
away waste products
Many disease and
treatments affect this
balance

Water
More important to life than any other nutrient

Carries nutrients and waste products

Participates in metabolic reactions, food digestion
Solvent for minerals, vitamins, glucose
Lubricant and cushion for the joints, eyes, spinal
cord
Aids in regulation of body temp
Maintains blood volume

60% of an adults body weight (more in a

child, less in the elderly)
Found in foods (but not in alcohol)
Daily need is about 2000 mL
1 liter of water weighs 1 kg

Fluid Intake and Loss

Intake sources
Liquids (1500 mL/day)
Solid foods (800 mL/day)
Metabolism (300 mL/day)
Fluid loss routes
Kidney (1200-1500 mL/day)
Skin (500-600 mL/day)
Lungs (400 mL/day)
GI tract (100-200 mL/day)
Drainage from
fistulas/drains, GI suction,
salivation

Intake
Measurable

Output
Measurable

Oral fluid,
tube
feedings

Urine

Parenteral
fluid

Emesis

Enemas

Feces

Retained
irrigation
fluid

Drainage
from
body cavities

Not
Measurable

Not
Measurable

Solid foods

Sweating

Metabolism

Vaporization
through

Electrolytes
Chemicals dissolved in the body fluid,
distribution affects fluid balance
Regulated by intake, output, acid-base
balance, hormones, and cell integrity
Sodium
Major extracellular electrolyte
Controls and regulate water balance

Potassium
Major intracellular electrolyte
Helps maintain intracellular water balance
Transmit nerve impulses to muscles and
contract skeletal and smooth muscles

F&E Labs
Sodium (Na) 135-145
Determines whether water is retained, excreted, or
moved
Imbalances cause neuro problems
Potassium (K) 3.5-5.0
Increased with poor kidney function
Decreased with excessive urination, diarrhea, vomiting
Imbalances cause cardiac problems
Chloride (Cl) 96-106
Works with sodium to maintain osmotic pressure
Increased with poor kidney function
Decreased with excessive vomiting or diarrhea

F&E Labs
Calcium (Ca) 9.0-10.5
Transmission of nerve impulses, heart and muscle
contractions, blood clotting, formation of teeth and
bone
Requires Vit D for absorption
Phosphate (PO4) 3.0-4.5
Balance is intertwined with calcium
Other tests
BUN 6-20
Creatinine 0.6-1.3
Hematocrit 42-52% (males), 37-47% (females)
Total protein, albumin

Lab Normals Magic 4

Electrolyte

Range

Magic 4

Potassium

3.5 5.5

Chloride

98 106

104

Sodium

135 - 145

140

pH

7.35 7.45

7.4

pCO2

35 45

40

HCO3

22 26

24

FYI Hematocrit normal is 3 times the hemoglobin (1014 is normal)

Osmolarity and Osmolality

Indicates the water balance of the body
Serum osmo is 285 - 295 mOsm/kg
High is water deficit (concentrated)
Low is water excess (dilute)

Urine osmo is 50-1200 mOsm/kg (avg 500-800 mOsm/kg)

Together are used to determine what is
causing a sodium imbalance

Distribution of body fluids &

Electrolytes
Intracellular (2/3) K+, PO4 Extracellular (1/3) Na+, Cl Interstitial (lymph) and transcellular
(cerebrospinal, pleural, peritoneal,
synovial fluids)
Intravascular (blood plasma)

Regulation of Fluid & Electrolyte

Movement
Diffusi
on
Active
Transpor
t

Filtratio
n

Osmosi
s

Regulation of Water Balance

Fluid Spacing
First spacing
Normal

Second spacing
Edema

Third spacing
Ascites
Burn edema

IV Fluids
Isotonic
NS
D5W
LR

Hypertonic
3% NS
D51/2NS
D10W

Hypotonic
1/2NS

Plasma Expanders

Gerontologic considerations
Percent of body weight of water is decreased
Structural changes in the kidney and decreased
renal blood flow
Decreased GFR
Decreased creatinine clearance
Loss of ability to concentrate urine and thus
conserve water
Decrease in renin and aldosterone
Increase in ADH and ANP

Loss of subcutaneous tissue

Decrease in thirst mechanism
Musculoskeletal changes
Mental status changes
Incontinence

Assessment Considerations
History nutrition, I/Os, insensible losses,
use of diuretics/laxatives, weight changes,
kidney or endocrine disorders, LOC, mental
status, depression, eating disorders, alcohol
intake
Physical hydration status, skin turgor,
mucous membranes, I/Os
Dx tests electrolyte levels, BUN, glucose,
creatinine, pH, bicarb, osmolality, Hgb, Hct,
urine dipstick, urine pH, urine specific gravity

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Image Attribution

Slide 1 Flickr by Randy Le'Moine Photography, www.pixabay.com, no

attribution required
Slide 2 Flickr by TipsTimes, By Anna Frodesiak (Own work) [Public
domain or CC0], via Wikimedia Commons
Slide 3 www.pixabay.com no attribution required
Slide 10 - http://antranik.org/fluid-compartments-within-the-human-body/
Slide 13 By James Heilman, MD (Own work) [CC-BY-SA-3.0
(http://creativecommons.org/licenses/by-sa/3.0) or GFDL
(http://www.gnu.org/copyleft/fdl.html)], via Wikimedia Commons
Slide 14 - http://medxforum.com/vb/showthread.php?483-What-is-thename-of-This-sign-What-is-your-Differential-Diagnosis,
https://myspace.com/dancingsquids/photos/64974051
Slide 15 - "Photo by Chalmers Butterfield"." [CC-BY-2.5
(http://creativecommons.org/licenses/by/2.5), GFDL
(www.gnu.org/copyleft/fdl.html) or CC-BY-SA-3.0
(http://creativecommons.org/licenses/by-sa/3.0/)], from Wikimedia
Commons