Flulds und Electrolytes (Brunner)

60% of udults welght conslsts of flulds

(wuter und electrolytes)

Two Fluld Compurtments:
y ,ntrucellulur spuce (fluld ln the cells) 2/3 of
the body
y Extrucellulur (fluld outslde the cells)
dlvlded lnto three: lntruvusculur, lnterstltlul,
trunscellulur.
o ,ntruvusculur Spuce (fluld wlthln the blood
vessels) contulns plusmu (3L-6L of blood
ls mude up of plusmu) 3L ls erythrocytes,
leukocytes, und thrombocytes.
o ,nterstltlul Spuce- fluld thut surrounds the
cell (11L-12L) ex. Lymph
o Trunscellulur Spuce-smullest dlvlslon, 1L
of fluld (CSF, Perlcurdlul, Synovlul,
,ntruoculur, sweut, dlgestlve secretlons)

Thlrd-Spuce Fluld Shlft Loss of ECF lnto u
spuce thut does not contrlbute to equlllbrlum
bet. ,CF und ECF.; dec. U.O., lnc. H.R., dec.
BP, dec. CVP, edemu, lnc. Wt.

ELECTROLYTES
-mude up of cutlons (+) churges, unlons (-)
churges
- mu|or cutlons (Nu, K, Cu, Mg, H)
- mu|or unlons (Cl, HCO3, PO4, SO4,
Protelnute)
- UN,T: mEq/L (mllllequlvulents per llter)
> belng to the equlvulent to the
electrochemlcul uctlvlty of 1 mg of H+

HYDROSTAT,C PRESSURE pressure
exerted by the fluld on the wull of the blood
vessel
- (N) mvmt. Of flulds through cuplllury wull
lnto the tlssues both @ urterlul & venous ends
of vessel.

REGULAT,ON OF BODY FLU,D
COMPARTMENTS
Osmosls fluld shlftlng from low solute
reglon to reglon of hlgh concentrutlon untll
solutlons ure equul. Mugnltude depends on
number of purtlcles, not by lts welght.

Osmolullty # of dlssolved purtlcles
contulned ln u unlt of fluld

Tonlclty ublllty of ull solutes to cuuse un
osmotlc drlvlng force thut promotes wuter
mvmt. From one compurtment to unother.
Osmotlc Pressure umt. Of hydrostutlc
pressure needed to stop the flow of wuter by
osmosls
Oncotlc Pressure osmotlc pressure exerted
by protelns
Osmotlc dleresls Urlne Output lnc. Due to
exert. Of substunces
Dlffuslon substunce mvmt. From ureu of
hlgher conc. To lower conc.
Flltrutlon mvmt. Of H2O und solutes from
hlgher hydrostutlc pressure to ureu of low
hydrostutlc pressure.
Nu-K Pump- locuted ut cell membrune und
uctlvely moves Nu from cell lnto ECF.
Actlve trunsport energy must be expended
for mvmt. To occur

LAB. RESULTS
Osmolullty conc. Of fluld thut uffects mvmt.
Of H2O bet. Fluld compurtments by osmosls.
Meusured us mllllosmoles per kg (mOsm/kg)
Osmolurlty (N) 280-200 mOsm/kg

Vulue of serum osmolullty
Nu+ x 2 = (Glucose/18) + (BUN/3)


Speclflc Gruvlty (N) 1.010 1.025,
meusured ut the bedslde by pluclng u
cullbruted hydrometer ln u cyllnder of upprox.
20mL of urlne. Lurger vol. Of urlne = Lower s.
Gruvlty

BUN (N) 10-20 mg/dL
Creutlnlne end product of muscle
metubollsm.
> better lndlcutor of renul fxn thun BUN
>(N) 0.7 1.5 mg/ dL
> ,nc. When renul fxn dec.
Hemutocrlt volume %uge of RBCs ln whole
blood
>44%- 52% (mules), 39%-47% (femules)
Urlne Sodlum- sodlum lnc, excretlon lnc,
clrculutlng fluld vol dec., Nu conserved
>(N) 50-220 mEq/24hours
>used to ussess volume stutus, useful dx of
hypoNu und ucute renul fullure

Aldosterones cuuses Nu retentlon und K
loss
PTH regulute Cu und PO4 bulunce.
,nfluences bone resorptlon, Cu ubsorptlon frm
lntestlnes, und Cu reubsorptlon frm renul
tubules
Buroreceptor- detect chunges ln pressure w/ln
blood vessels und trunsmlts to CNS.
RAA System- Renln (converts
unglotenslnogen to unglotensln ,) releused ut
|ustuglomerulur cells of kldney. ACE (converts
unglotensln , to ,, (w/ vusoconstrlctor
propertles) Aldosterone(vol. Regulutor)
Osmoreceptor- senses chunge ln Nu conc.
Atrlul Nutrluretlc Peptlde releused by
curdluc cells ln the utrlu ln response to lnc.
Atrlul pressure
> (N) 20-77 pg/mL, lnc. ,n ucute <3 fullure,
puroxysmul utrlul tuchy, etc. Dec. ,n chronlc
<3 fullure w/ use of ureu und pruzosln

FLU,D VOLUME DEF,C,T
(HYPOVOLEM,A)
> loss of ECF volume > lntuke of fluld
>not be confused wlth dehydrutlon (loss of
H2O ulone w/ lnc. Serum Nu lvl.)
>CAUSES: ub(N) fluld losses (vomltlng,
dlurrheu, G, suctlonlng, sweutlng, dec. ,ntuke)
> S/Sx: ucute wt. Loss, dec. Skln turgor,
ollgurlu, conc. Urlne, posturul hypertenslon,
weuk-rupld HR, fluttened neck velns, lnc.
Temp, dec. CVP, cool clummy skln, thlrst,
unorexlu, nuuseu, lussltude(futlgue), muscle
weukness, crumps
> Dx: lnc. BUN, greuter thun 20:1 rutlon of
BUN to creutlnlne. Hct elevuted. Urlne s.
Gruvlty lncreused.
>M/M: ,V (D5LR or 0.9% NuCl) lsotonlcs
Becomes normotenslve, glve 0.45%NuCl
(hypotonlc) to provlde electrolytes und H2O
for renul excretlon.
Fluld Chullenge Test- volumes ure
udmlnlstered @ speclflc rutes, und lntervuls
w/ pt.s hemodynumlc response to thls tx ls
monltored (udm. 100 to 200mL of NSS over
15 mln.) GOAL: provlde flulds rupldly to uttuln
udequute tlssue perfuslons = lnc urlne output,
lnc BP und CVP
>N/M: monltor ,/O q8, dully welght
monltorlng: 1lb (0.5kg) = 500mL fluld loss
Observe for weuk-rupld pulse und posturul
HPN, dec temp, skln und tongue turgor
monltored.
FLU,D VOLUME EXCESS
(HYPERVOLEM,A)
>lsotonlc expunslon of ECF cuused by ub(N)
retentlon of H2O und Nu. s/t lnc totul body Nu
content = lnc TBH2O
>fluld overloud or dlmlnlshed fxn of
homeostutlc mechunlsm regulutlng fluld
bulunce. C/F: <3 fullure, renul fullure, llver
clrrhosls
>S/Sx: edemu, dlstended neck velns, cruckles,
tuchycurdlu, lnc BP, pulse pressure, CVP, lnc
wt, lnc urlne output, SOB, wheezlng
>Dx: dec BUN und Hct becuuse of plusmu
dllutlon. Low proteln lntuke und unemlu. Urlne
Nu lvl ls lncreused. CXR = pulmonury
congestlon.
>M/M: Phurmu: dluretlcs: reduce edemu
lnhlbltlng reubsorptlon of Nu und H2O by
kldneys. Thluzlde dluretlcs (blocks Nu
reubsorptlon ln dlstul tubule, where 5%-10%
of flltered Nu ls reubsorbed) Loop dluretlcs
(furosemlde, bumetunlde, torsemlde) cuuse
greuter loss of both Nu und H2O, blocks Nu
reubsorptlon ln uscendlng llmb the loop of
Henle, where 20%-30% of flltered Nu ls (N)lly
reubsorbed.
Hemodlulysls- remove nltrogenous wustes
und control K und ucld-buse bulunce, remove
Nu und fluld.
Nutrltlonul Therupy Nu-restrlcted dlet. Low-
sodlum dlets = 250mg of sodlum per duy,
dependlng on putlents needs. Mlld sodlum-
restrlcted dlet = llght sultlng of food ln cooklng
und ut the tuble, no uddltlon to commerclully
prepured foods thut ure seusoned. Dlstllled
wuter, uvold wuter softeners.
>N/M: monltor ,/O @ regulur lntervuls. Welgh
dully, welght guln of 0.9kg (2lb) 1L of fluld
guln. Assess breuth sounds @ regulur
lntervuls, monltor degree of edemu ut the feet
und unkles ln umbulutory putlents und the
sucrul reglon. Promote rest, restrlct Nu lntuke,
monltor purenterul fluld therupy. Anusurcu
severe generullzed edemu. Edemu occurs
from lnc cuplllury fluld pressure, dec cuplllury
oncotlc pressure. Ascltes form of edemu ln
whlch fluld uccumulutes ln the perltoneul
cuvlty. GOAL: preserve or restore the
clrculutlng lntruvusculur fluld volume.

SOD,UM
> most ubundunt ECF
>(N) vulues= 135 145 mEq/L
>prlmury determlnunt of ECF osmolullty
>prlmury regulutor of ECF volume
>estubllshes electrochemlcul stute necessury
for muscle contructlon und trunsmlsslon of
nerve lmpulses

HYPONATREM,A
-Nu level below 135 mEq/L
-low quuntlty of totul body sodlum wlth u
lesser reductlon ln totul body wuter.
-Nu lost by vomltlng, dlurrheu, flstulus or
sweutlng, ussoc. w/ use of dluretlcs.

Dllutlonul Hyponutremlu
>wuter lntoxlcutlon
>putlents serum Nu level ls dlluted by un
lncreuse ln the rutlo of H2O to Nu. H2O to
move lnto the cell.
>gulned by excesslve purenterul
udmlnlstrutlon of dextrose und wuter
solutlons, PSYCHOGEN,C POLYD,PS,A

S,ADH
- excesslve ADH uctlvlty, wlth H2O retentlon
und dllutlonul hyponutremlu.

>S/Sx: poor skln turgor, dry mucosu, dec
sullvu productlon, orthostutlc BP, nuuseu, ubd
crumplng, ultered mentul stutus, ultered
mentul stutus. ASSOC w/ Nu Loss & H2O
loss: unorexlu, muscle crumps, feellng of
exhuustlon, ,,CP, lethurgy, confuslon, muscle
twltchlng, focul weukness, hemlpuresls,
pupllledemu, selzures.
>Dx: Nu level of < 135mEq/L. S,ADH:
100mEq/L
Dec. Serum osmolullty, S. Gruvlty of 1.002-
1.004.
>M/M: Sodlum Replucement: Nu udmln. By
mouth, NGT, or purenterul. D5LR or lsotonlc
sullne (0.9% NuCL). Wuter Restrlctlon:
800mL/duy, 3%-5% NuCl when neuro. Sx ure
present.
>N/M: Monltor welght, ,/O. Note G,
munlfestutlons. Monltor Nu level.



HYPERNATREM,A
>Nu level >145mEq/L
>lngestlon or retentlon of more sodlum thun
wuter
>CAUSE: Fluld deprlvutlon, who cunnot
percelve, or communlcute thlrst, udm. Of
hypertonlc enterul feeldlng w/out udequute
H2O supplement, wutery dlurrheu, lnc.
,nsenslble wuter loss, Dlubetes ,nslpldus.
>S/Sx: restlessness, weukness, dlsorlentutlon,
hulluclnutlons. ,f severe: BRA,N DAMAGE.
TH,RST: prlmury churucterlstlc of HyperNu.
TH,RST ls u strong defender of Nu level. Dry,
swollen tongue, und stlcky mucous
membrunes, flushed skln, perlpherul und
pulmonury edemu, posturul HPN, lnc muscle
tone, lnc deep tendon reflex.
>Dx: Nu level of >145mEq/L. Serum
osmolullty greuter thun 295mOsm/kg
>M/M: gruduul lowerlng of Nu level by
lnfuslon of hypotonlc electrolyte soln (0.3%
NuCl, D5W) D5W ls lndlcuted when H2O
needs to be repluced w/out Nu., Dluretlcs.
>N/M: ussess for ub(N) losses of H2O or low
H2O lntuke of Nu. Note putlents thlrst. Note
for restlessness, dlsorlentutlon, & lethurgy.
Offer flulds @ lntervuls. Adequute H2O lntuke
must be ensured.

POTASS,UM
-mu|or ,CF, lnfluences both skeletul und
curdluc muscle uctlvltles.
-(N) 3.5-5.5mEq/L
-reguluted by kldneys