Fluids Balance

Tanto H

Introduction
All

cells are bounded by a plasma

membrane.
This membrane is selectively permeable
allowing certain things in and out while
excluding others.
Useful substances like oxygen and
nutrients enter through the membrane,
while waste products like carbon dioxide
leave through it.

Selectively Permeable
1. These movements involve physical (passive)
processes such as:
1.

2.

3.

4.

Osmosiswater movement across a membrane

from an area of low concentration to an area of
high concentration
Diffusionmovement of molecules from an area
of high concentration to an area of low
concentration
Facilitative diffusion movement of molecules
from an area of high concentration to an area of
low concentration using a carrier cell to accelerate
diffusion
Filtrationselective allowance or blockage of
substances across a membrane, wherein
movement is infl uenced by a pressure gradient

Selectively Permeable
2. The movement of substances across a
membrane also includes physiologic (or active)
processes such as:
1. Active transportmolecules moving against a
concentration gradient with the assistance of energy.
2. Endocytosisplasma membrane surrounds the
substance being transported and takes the
substances into the cell with the assistance of ATP
3. Exocytosismanufactured substances are
packaged in secretory vesicles that fuse with the
plasma membrane and are released outside the cell

Fluid and electrolyte balance

Fluid

and electrolyte balance, therefore,

implies constancy, or homeostasis.
This means that the amount and
distribution of body fluids and
electrolytes are normal and constant.
For homeostasis to be maintained, the
water and electrolytes that enter (input)
the body must be relatively equal to the
amount that leaves (output).

Fluid and electrolyte inbalance

An imbalance of osmolality, the amount of
force of solute per volume of solvent
(measured in miliosmoles per kilogram
mOsm/kg or mmol/kg), of this medium can
lead to serious disorders or even death.

Self-regulating Systems
Fortunately,

the body maintains

homeostasis through a number of selfregulating systems, which include
hormones, the nervous system, fluid
electrolyte balance, and acidbase
systems.

Water is a critical medium

Water is a critical medium in the human body:
1. The chemical reactions that fuel the body occur in the
body fluids.
2. Fluid is the major element in blood plasma that is
used to transport nutrients, oxygen, and electrolytes
throughout the body.
3. Considering that the human body is composed of from
50 percent (adult females) to 60 percent (adult males)
to 75 percent (infants) fluids, it is easy to understand
that fluid must play an important role in maintaining
life.
4. Fluid intake should approximately equal fluid output
each day to maintain an overall balance.

Intake of fluids
Intake

of fluids and solid foods that

contain water accounts for nearly 90
percent of fluid intake.
Cellular metabolism, which results in the
production of hydrogen and oxygen
combinations (H2O), accounts for the
remaining 10 percent of water in the body

Intake of fluids
1.

Fluid intake comes from the following sources

(approximate percentages):
1.
2.
3.

2.

Fluid intake (50 percent)

Food intake (40 percent)
Metabolism (10 percent)

Solid foods are actually high in fluid content, for

example:
1.
2.

Lean meats70 percent fluid

Fruits and vegetables95 percent or more fluid

Loss of fluids
Fluid loss occurs from
1.
2.
3.
4.
5.

Urine (58 percent)

Stool (7.5 percent)
Insensible loss
Lungs (11.5 percent)
Skinsweat and evaporation (23 percent)

The major compartments

1.
2.

Intracellularthe area inside the cell

membrane, containing 65 percent of body fluids
Extracellularthe area in the body that is
outside the cell, containing 35 percent of body
fluids
1.
2.

Tissues or interstitial areacontains 25 percent of

body fluids
Blood plasma and lymphrepresents 8 percent of
body fluids
1.

3.

Blood plasma is contained in the intravascular spaces

Transcellular fluidincludes all other fluids and

represents 2 percent of Body fluids (e.g., Eye
humors, spinal fluid, synovial fluid, and peritoneal,
Pericardial, pleural, and other fluids in the body)

The ability of a solution to effect the flow of

intracellular fluid is called tonicity:
1.

2.

3.

Isotonic fluids have the same concentration of solutes

as cells, and thus no fluid is drawn out or moves into
the cell.
Hypertonic fluids have a higher concentration of
solutes (hyperosmolality) than is found inside the cells,
which causes fluid to flow out of the cells and into the
extracellular spaces. This causes cells to shrink.
Hypotonic fluids have a lower concentration of solutes
(hypo-osmolality) than is found inside the cells, which
causes fl uid to fl ow into cells and out of the
extracellular spaces. This causes cells to swell and
possibly burst

Opposite Response
The opposite response occurs when high
blood volume is noted.

Arteriole dilation results in increased blood

flow to the kidneys.
This results in increased urine output and fluid
elimination from the body.

Reninangiotensinaldosterone mechanism
The reninangiotensinaldosterone mechanism
also responds to changes in fluid volume:
If

blood volume is low, a low blood pressure results.

Cells in the kidneys stimulate the release of renin.
This results in the conversion of angiotensinogen to
angiotensin II.
This stimulates sodium reabsorption and results in
water reabsorption.

Atrial Natriuretic Peptide (ANP) mechanism

An additional mechanism for regulating
sodium reabsorption is the atrial natriuretic
peptide (ANP) mechanism:

When an increase in fluid volume is noted in

the atrium of the heart, ANP is secreted.
This decreases the absorption of sodium.
This results in sodium and water loss through
urine.

Fluid volume regulation is necessary to maintain life

Decreased

and inadequate fluid volume (i.e.,

hypovolemia) can result in decreased flow and
perfusion to the tissues.
Increased or excessive fluid volume (i.e.,
hypervolemia) can placed stress on the heart
and cause dilutional electrolyte imbalance.
It is clear that the renal system plays a vital role
in fluid management.
If the kidneys are not functioning fully, fluid
excretion and retention will not occur
appropriately in response to fluid adjustment
needs.

Osmoreceptor Mechanism
1.

2.

An increase in extracellular fluid osmolarity

(which in practical terms means an increase in
plasma sodium concentration) causes the
special nerve cells called osmoreceptor cells,
located in the anterior hypothalamus near the
supraoptic nuclei, to shrink.
Shrinkage of the osmoreceptor cells causes
them to fire, sending nerve signals to additional
nerve cells in the supraoptic nuclei, which then
relay these signals down the stalk of the
pituitary gland to the posterior pituitary.

Osmoreceptor Mechanism
3. These action potentials conducted to the
posterior pituitary stimulate the release of ADH,
which is stored in secretory granules (or
vesicles) in the nerve endings.
4. ADH enters the blood stream and is transported
to the kidneys, where it increases the water
permeability of the late distal tubules, cortical
collecting tubules, and medullary collecting
ducts.
5. The increased water permeability in the distal
nephron segments causes increased water
reabsorption and excretion of a small volume of
concentrated urine.

Osmoreceptor Mechanism
Retensi H2O
di ginjal

Retensi Na
di ginjal

Penurunan tekanan
darah 10% - 15%

TD
Vaso kontriksi
Retensi H2O
di ginjal

Aldosterone

Stimulasi baroreseptor

Renin-Angiotensin
Osmoreseptor
(hipothalamus)

Permeabilitas
tubulus me
Release ADH
N. Vagus
HR me

Osmolaritas me
Dehidrasi

Nursing Assessments for

Fluid Imbalance
SKIN AND MUCOUS MEMBRANES
Skin turgor, or the time it takes for the skin to
rebound once pinched together (particularly over
the forehead in an elderly patient), can reveal
the presence of dehydration.
Slow rebound of skin, that is, poor skin turgor, is
a sign of decreased tissue hydration, that is,
dehydration.
Skin also may feel dry to the touch if dehydration
is present.

Hypovolemia
Hypovolemia

also will be manifested in patients

by dry mucous membranes and possibly dry
lips and tongue.
Patients may complain of dry eyes capillary refill,
which is the time required for blood to return to
skin after pressure on the area (finger tips)
causes pallor.
Normal for capillary refill in 3 secs or less. Refill
time 75 secs indicates decreased tissue
hydration and perfusion.

Edema
Edema, which is a swelling of tissues owing
to the presence of excessive fluid, is noted
when the patient is experiencing fluid
overload or in some cases a fluid shift into
tissues owing to trauma, such as a burn
injury, or low protein levels in the blood, that
is, decreased osmotic pressure (resulting in
a fluid shift from hypoosmotic blood to
tissuesreview colloid osmotic and
hydrostatic pressure).

Common laboratory tests

The most common laboratory tests performed
to determine acidbase status include an
arterial blood-gas determinationpH, PCO 2,
and HCO3 levels, as well as PO2 because
hypoxia can result in lactic acidosis, venous
serum CO2, electrolytes because electrolyte
levels are affected by acid or base states, and
urine tests, including urinalysis, urine pH, and
litmus dipstick tests.

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