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Fluid and electrolyte balance

  1. 1. B A L A N C EB A L A N C E H+ cl- Na+ - HCO 3 DR faiyaz pgt su1
  2. 2. ContentsIntroduction Body Fluids Source Functions Composition Movements of Body Fluids Fluid Balance Regulation of Body Water Electrolytes Electrolyte balance Imbalance disorders conclusion
  3. 3. Introduction To achieve homeostasis, the body maintains strict control of water and electrolyte distribution and of acid-base balance.  This control is a function of the complex interplay of cellular membrane forces, specific organ activities and systemic and local hormone actions.
  4. 4. 4 Total body water (TBW)
  5. 5. • Water constitutes an average 50 to 70% of the total body weight. Young males - 60% of total body weight Older males – 52% Young females – 50% of total body weight Older females – 47% • Variation of ±15% in both groups is normal. • Obese have 25 to 30% less body water than lean people. • Infants 75 to 80% - gradual physiological loss of body water. - 65% at one year of age.
  6. 6. Sources of Body Fluids Preformed water represents about 2,300 ml/day of daily intake. Metabolic water is produced through the catabolic breakdown of nutrients occurring during cellular respiration. This amounts to about 200 ml/d. Combining preformed and metabolic water gives us total daily intake of 2,500 ml.
  7. 7. Functions 1 All chemical reactions occur in liquid medium. 2 It is crucial in regulating chemical and bioelectrical distributions within cells. 3 Transports substances such as hormones and nutrients. 4 O2 transport from lungs to body cells. 5 CO2 transport in the opposite direction. 6 Dilutes toxic substances and waste products and transports them to the kidneys and the liver. 7 Distributes heat around the body.
  8. 8. Composition of Body Fluids
  9. 9. Movement of BODY FLUIDSMovement of BODY FLUIDS Osmosis Diffusion Active Transport Filtration
  10. 10. Osmosis FluidFluid High SolutionHigh Solution Concentration,Concentration, Low FluidLow Fluid ConcentrationConcentration Low SoluteLow Solute Concentration,Concentration, High FluidHigh Fluid ConcentrationConcentration
  11. 11. DiffusionDiffusion High SoluteHigh Solute ConcentrationConcentration Low SoluteLow Solute ConcentrationConcentration FluidFluid Solutes
  12. 12. Active transportActive transport K +K + KK ++ KK ++ KK ++ KK ++ KK ++ KK ++ KK ++KK ++ KK ++ KK ++ KK ++ KK ++ KK ++ K +K + K +K + K +K +ATPATP ATPATP ATPATP ATPATP Na +Na + Na +Na + Na +Na + Na +Na + Na +Na + Na +Na + Na +Na + Na +Na + Na +Na + Na +Na + Na +Na + Na +Na + Na +Na + Na +Na + Na +Na + Na +Na + Na +Na + Na +Na + Na +Na + Na +Na + INTRACELLULAR FLUID EXTRACELLULAR FLUID
  13. 13. Filtration Filtration is the transport of water and dissolved materials through a membrane from an area of higher pressure to an area of lower pressure
  14. 14. Fluid Movement Among Compartments Compartmental exchange is regulated by osmotic and hydrostatic pressures. Net leakage of fluid from the blood is picked up by lymphatic vessels and returned to the bloodstream. Exchanges between interstitial and intracellular fluids are complex due to the selective permeability of the cellular membranes. Nutrients, respiratory gases, and wastes move unidirectionally. Plasma is the only fluid that circulates throughout the body and links external and internal environments. Osmolalities of all body fluids are equal; changes in solute concentrations are quickly followed by osmotic changes.
  15. 15. 17 Intake vs output
  16. 16. water requirements increase with: fever, sweating, burns, tachypnea, surgical drains, fistulae and sinuses, diarrhea, polyuria, or ongoing significant gastrointestinal losses.
  17. 17. Fluid balance Normally, there is a balance achieved between our total daily intake and output of water. Induction of Thirst is responsible for total water intake. Thirst center resides in hypothalamus which is activated either by increased osmotic pressure of the blood passing through this region or dryness of the oral mucosa.
  18. 18. Influence of ADH The amount of water reabsorbed in the renal collecting ducts is proportional to ADH release. When ADH levels are low, most water in the collecting ducts is not reabsorbed, resulting in large quantities of dilute urine. When ADH levels are high, filtered water is reabsorbed, resulting in a lower volume of concentrated urine. ADH secretion is promoted or inhibited by the hypothalamus in response to changes in solute concentration of extracellular fluid, large changes in blood volume or pressure, or vascular baroreceptors.
  19. 19. Problems of Fluid Balance Deficient fluid volume ◦Hypovolemia ◦Dehydration Excess fluid volume • Hypervolemia ◦Water intoxication Electrolyte imbalance ◦Deficit or excess of one or more electrolytes
  20. 20. Factors Affecting Fluid Balance Lifestyle factors ◦ Nutrition ◦ Exercise ◦ Stress Physiological factors ◦ Cardiovascular ◦ Respiratory ◦ Gastrointestinal ◦ Renal ◦ Integumentary ◦ Trauma Developmental factors ◦ Infants and children ◦ Adolescents and middle-aged adults ◦ Older adults Clinical factors ◦ Surgery ◦ Chemotherapy ◦ Medications ◦ Gastrointestinal intubation ◦ Intravenous therapy ELSEVIER ITEMS AND DERIVED ITEMS © 2007 BY SAUNDERS, AN IMPRINT OF ELSEVIER INC.
  22. 22. Electrolytes 25
  23. 23. Electrolyte balance Na + Predominant extracellular cation • 136 -145 mEq / L • Pairs with Cl- , HCO3 - to neutralize charge • Most important ion in water balance • Important in nerve and muscle function Reabsorption in renal tubule regulated by: • Aldosterone • Renin/angiotensin • Atrial Natriuretic Peptide (ANP)
  24. 24. Electrolyte balance K + Major intracellular cation • 150- 160 mEq/ L • Regulates resting membrane potential • Regulates fluid, ion balance inside cell Regulation in kidney through: • Aldosterone • Insulin
  25. 25. Electrolyte balance Cl ˉ (Chloride) • Major extracellular anion • 105 mEq/ L • Regulates tonicity • Reabsorbed in the kidney with sodium Regulation in kidney through: • Reabsorption with sodium • Reciprocal relationship with bicarbonate
  26. 26. SODIUM HOMEOSTASIS Normal dietary intake is 6-15g/day. Sodium is excreted in urine, stool, and sweat. Urinary losses are tightly regulated by renal mechanisms.
  27. 27. Sodium abnormalities Hypernatremia: Defined as a serum sodium concentration that exceeds 150mEq/L. Always accompanied by hyperosmolarity.
  28. 28. Etiology Excessive salt intake Excessive water loss Reduced salt excretion Reduced water intake Administration of loop diuretics Gastrointestinal losses
  29. 29. Treatment: Restore circulating volume with isotonic saline solution After intravascular vol. correction hypernatremia is corrected using free water.
  30. 30. Hyponatremia Serum sodium concentration less than 135mEq/L . ◦ Renal losses caused by diuretic excess, osmotic diuresis, salt-wasting nephropathy, adrenal insufficiency, proximal renal tubular acidosis, metabolic alkalosis, and pseudohypoaldosteronism result in a urine sodium concentration greater than 20 mEq/L ◦ Extrarenal losses caused by vomiting, diarrhea, sweat, and third spacing result in a urine sodium concentration less than 20 mEq/L
  31. 31. Treatment of Hyponatremia Correct serum Na by 1mEq/L/hr Use 3% saline in severe hyponatremia. Goal is serum Na 130. 34
  32. 32. Hyperkalemia Serum K+ > 5.5 mEq / L CAUSES trauma, burns, surgical procedures, destruction of tumor cells or red blood cells, and. rhabdomyolysis 35
  33. 33. Hyperkalemia Management 10% Calcium Gluconate or Calcium Chloride Insulin (0.1U/kg/hr) and IV Glucose Lasix 1mg/kg (if renal function is normal)
  34. 34. Hypokalemia Hypokalemia: Serum potassium level<3.5mEq/L Etiology: GI losses from vomiting, diarrhea, or fistula and use of diuretics
  35. 35. management Treatment: Correction of the underlying condition K should be given orally unless severe(<2.5mEq/L), patient is symptomatic or the enteral route is contraindicated Oral K supplements (60-80mEq/L) coupled with normal diet is sufficient. ECG monitoring along with frequent assessment of serum K level is reqiured
  36. 36. Electrolyte Disorders Signs and Symptoms ElectrolyteElectrolyte ExcessExcess DeficitDeficit Sodium (Na)Sodium (Na) •HypernatremiaHypernatremia •ThirstThirst •CNS deteriorationCNS deterioration •Increased interstitial fluidIncreased interstitial fluid •HyponatremiaHyponatremia •CNS deteriorationCNS deterioration Potassium (K)Potassium (K) •HyperkalemiaHyperkalemia •Ventricular fibrillationVentricular fibrillation •ECG changesECG changes •CNS changesCNS changes •HypokalemiaHypokalemia •BradycardiaBradycardia •ECG changesECG changes •CNS changesCNS changes
  37. 37. Electrolyte Disorders Signs and Symptoms ElectrolyteElectrolyte ExcessExcess DeficitDeficit Calcium (Ca)Calcium (Ca) •HypercalcemiaHypercalcemia •ThirstThirst •CNS deteriorationCNS deterioration •Increased interstitial fluidIncreased interstitial fluid •HypocalcemiaHypocalcemia •TetanyTetany •Chvostek’s, Trousseau’sChvostek’s, Trousseau’s signssigns •Muscle twitchingMuscle twitching •CNS changesCNS changes •ECG changesECG changes Magnesium (Mg)Magnesium (Mg) • HypermagnesemiaHypermagnesemia • Loss of deep tendonLoss of deep tendon reflexes (DTRs)reflexes (DTRs) • Depression of CNSDepression of CNS • Depression ofDepression of neuromuscular functionneuromuscular function •HypomagnesemiaHypomagnesemia •Hyperactive DTRsHyperactive DTRs •CNS changesCNS changes
  38. 38. Conclusion • Fluid movements in the body and Fluid – electrolyte balance are the inevitable process for normal body function. • Assessment of body fluid is important to determine causes of imbalance disorders.
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