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OUTCOMES OBJECTIVES: BODY FLUIDS AND

COMPARTMENTS
• C OGNITIVE

FLUIDS AND •

•
Identify the major fluid compartments in the body.

List functions of water in the body.

ELECTROLYTES •
•
Describe how fluids and electrolytes move through the body.
Describe how body mechanisms regulate fluids and electrolytes balance.
• Identify key assessment elements associated with body fluids. (Safe and Quality Nursing
Care.)
BALANCE AND • P SYCHOMOTOR

DISTURBANCES •

•
List different functions of water in the body.

A FFECTIVE
• Appreciate the importance of fluids and electrolytes in the body.

OUTCOMES OBJECTIVES: MAJOR FLUIDS AND OUTCOMES OBJECTIVES: MAJOR FLUIDS AND
ELECTROLYTES ELECTROLYTES
• C OGNITIVE • P SYCHOMOTOR
• Identify major electrolytes in the body. • Create a table differentiating the signs and symptoms of fluid/electrolytes imbalances.
• Identify electrolytes according to their normal values, imbalances, functions, dietary • Given a scenario (any of the imbalances) , develop a comprehensive nursing care plan for
sources, and effects to the human body. a patient.
• Compare and contrast the pathophysiology, clinical presentation, patient needs, and
• A FFECTIVE
management approaches of life-threatening electrolyte imbalances.
• Identify primary goals and common nursing interventions for clients with alterations in • Write/Analyze summary of electrolytes according to normal/abnormal values, functions,
Fluids and Electrolytes. (Safe and Quality Nursing Care) dietary sources, and effects to the human body.

• List examples of Nursing Diagnoses related to fluids and electrolytes imbalance.

• Recognize safe medical and pharmacologic treatment for the imbalances and its
considerations. (Safe and Quality Nursing Care)
• Identify topics for patient teaching/health education. (Health Education)

OUTCOMES OBJECTIVES: ACID-BASE BALANCE

• COGNITIVE
• Identify the body’s mechanisms for maintaining acid-base balance.
• Describe the role of the lungs and kidneys in regulating acid-base balance.
• Identify conditions which produce acid-base imbalances.
• Differentiate the four respiratory and metabolic acid-base imbalances.
• Identify proper medical, pharmacologic, and nursing care for the patient with acid-base
imbalances. (Safe and Quality Nursing Care)
• PSYCHOMOTOR
• Follow the steps in ABG interpretation.
• AFFECTIVE
• Read in advance primary concepts and principles about acid-base balance.
• Interpret ABG results
I. BASICS

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BODY FLUID is composed of: HOMEOSTASIS

WATER ELECTROLYTES

Normal volume, composition, distribution and pH

of body fluids reflects homeostasis.

BODY WATER ACCORDING TO LEMONE 195

The picture can't be displayed.

1. Provides a medium for the transport

and exchange of nutrients and other
substances
2. Provides a medium for metabolic
reactions
3. Regulation of body temperature
4. Provides form for body structure; acts
as a shock absorber
5. Provides insulation
6. Acts as a lubricant

TOTAL BODY FLUID

60% of Total Body Weight

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AGE
THREE FACTORS INFLUENCING
AMOUNT OF BODY WATER

BODY FAT
GENDER

ELECTROLYTES

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ELECTROLYTES FUNCTIONS:

DIVIDED INTO: 1. Assists in regulating water

balance
CATIONS
2. Help regulate and maintain
(+) charged molecules
acid-base balance
3. Contribute to enzyme reactions
ANIONS
4. Essential for neuromuscular
(-) charged molecules
activity

Intracellular Fluid/Compartment ELECTROLYTES

• K is the most abundant cation
• PO4 is the most abundant anion Expressed in terms of mEq/L
a measure of the ions chemical activity or its
power.
Extracellular Fluid/Compartment
• Na is the most abundant cation Normal Values:
• Cl is the most abundant anion

MAJOR ELECTROLYTES IN THE BODY

C EXTRACELLULAR C INTRACELLULAR
A A
T Na 135-145mEq/l T Na 10-14mEq/L
I K 3.5-5.0mEq/L I K 140-150mEq/L
O O
N Ca 8.6-10.2mg/dL N Mg 40mEq/kg
S S Ca <1mEq/L
Mg 1.3-2.3mg/dL

A Bicarbonate 22-26mEq/L A Bicarbonate 7-10mEq/L

N Chloride 97-107mEq/L N Chloride 3-4mEq/L
I Phosphate 2.5-4.5mg/dL I Phosphate 4mEq/kg
O Proteins 16mEq/L O Proteins 54mEq/L
N Other anions 8mEq/L N Other anions 31-86mEq/L
S S
BODY FLUID
COMPARTMENTS

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TWO MAJOR FLUID COMPARTMENTS

INTRACELLULAR FLUID
Intracellular Space
Makes up of two-thirds (2/3) of body’s
v water or 40% of body weight

Extracellular Space Located primarily in the skeletal

v muscles mass

EXTRACELLULAR FLUID
EXTRACELLULAR FLUID
20% of total body weight DIVIDED INTO:
Rich in Electrolytes Intravascular (5%)
(eg. Na, Cl, and Bicarbonate etc) Interstitial Space (15%)
It is the transport medium that carries Transcellular (nearly 1%)
oxygen and nutrients to and waste
products from the cells

INTERSTITIAL SPACES

INTRACELLULAR

INTRAVASCULAR
SPACE

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• KIDNEYS
• SKIN
• LUNGS
• GASTROINTESTINAL TRACT

ROUTES OF GAINS AND LOSSES

Daily Intake and Output of Water (ml/day)

Normal Prolonged,Heavy Exercise

Intake
Fluids ingested 2100 ?
From metabolism 200 200
Total intake 2300 ?

Output
Insensible—skin 350 350
Insensible—lungs 350 650
Sweat 100 5000
Feces 100 100
Urine 1400 500
Total output 2300 6600

ACTIVE TRANSPORT
REGULATION OF
Na – K Pump
BODY FLUID COMPARTMENTS
POTASSIUM levels LOW and POTASSIUM
SODIUM levels HIGH levels HIGH
outside the cell and SODIUM
levels LOW
inside the cell
ACTIVE TRANSPORT
PASSIVE TRANSPORT

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ACTIVE TRANSPORT

ATP
• Primary source of
energy for moving
compounds in and
out of the cell.

PASSIVE TRANSPORT

Osmosis
The distribution of water from a lesser
area of solute concentration to a higher
area of solute concentration

THE CONCENTRATION OF A SOLUTION

MAYBE EXPRESSED AS: TONICITY
• Ability of all the solutes to cause an
OSMOLARITY OSMOLALITY osmotic driving force that promotes
• Refers to the amount • Refers to the number water mov’t from one compartment to
of solutes per liter of of solutes per kilogram another
solution (by volume) of water (by weight)
• Its control determines the normal state
• mOsm/L • mOsm/Kg
of cellular hydration and cell size

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1.Isotonic solution 1.Isotonic solution

2.Hypertonic solution 2.Hypertonic solution
3.Hypotonic solution 3.Hypotonic solution

1.Isotonic solution 1.Isotonic solution

2.Hypertonic solution 2.Hypertonic solution
3.Hypotonic solution 3.Hypotonic solution

PASSIVE TRANSPORT
SCENARIO:
• The patient’s labs revealed an increase in Diffusion
Na concentration in the blood.
It is the movement of solutes from an
• As a nurse, you know that such condition area of higher concentration to an area
may cause the cells to SHRINK or of lower concentration.
SWELL?
• What kind of solution will you prepare?

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FILTRATION

• Hydrostatic Pressure
• Osmotic Pressure

Hydrostatic Osmotic Pressure

Pressure
• Pulling fluid in
• Pushing fluid out • Force supplied by
• Pressure made by proteins that are
the pumping action too large to pass
of the heart. the capillary walls.

BARORECEPTORS
• Located in left atrium and the carotid
and aortic arches
• Responds to changes in circulating
blood volume and regulate SNS and
PSNS activities
FLUID HOMEOSTASIS/
HOMEOSTATIC MECHANISMS

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OSMORECEPTORS AND
THIRST MECHANISM
ANTIDIURETIC HORMONE
• Also known as VASOPRESSIN
The sensation of
• ADH is secreted in conditions causing
thirst occurs when the
osmoreceptors located increased osmolality and decreased blood
near the thirst center of volume
the hypothalamus are
• The presence or absence of this hormone is the
stimulated due to an
most significant factor in determining whether
increased osmolality.
the urine that is excreted is concentrated and
diluted.

RENIN-ANGIOTENSIN-ALDOSTERONE
SYSTEM
RENIN
• Is released by the juxtaglomerular cells of the
kidneys in response to decreased renal tissue
perfusion

• An enzyme that converts angiotensinogen (an

inactive substance formed by the liver) into
angiotensin I.

ALDOSTERONE
• Is a mineralocorticoid released by the adrenal
gland which regulates sodium balance

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ATRIAL NATRIURETIC PEPTIDE

RELEASE
A peptide • Increased atrial
pressure
synthesized, • Angiotensin II
stored and • Endothelin
released by atrial • SNS stimulation
muscles in • Conditions resulting to
response to: volume expansion

LABORATORY TESTS

Urine Studies
• Urine Osmolality/Osmolarity
• Urine Specific Gravity

LABORATORY TEST FOR

EVALUATING FLUID STATUS

LABORATORY TESTS
URINE STUDIES
Urine Osmolality
• Provides clinically useful information about water
and dissolved particles across fluid compartment
membranes
Blood Studies
Urine Specific Gravity • BUN/Creatinine
• Hematocrit
• It is the reflection of the concentration ability of
• Electrolytes
the kidneys; ability to excrete/conserve water

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BLOOD STUDIES BLOOD STUDIES

BUN Serum Osmolality

• BUN reflects the balance between urea -primarily reflects concentration of sodium
production and excretion -normal: 280-300mOsm/kg
• normal: 10-120mg/dL (3.6-7.2mmol/L)
Serum Creatinine Hematocrit
• Creatinine reflects Glomerular Filtration Rate • Measures the volume % of Red Blood Cells in
whole blood
• normal: 0.7-1.4mg/dL (62-124mmol/L)
• 42-52% (male); 35-47%(female)

FLUID VOLUME DEFICIT:

PREDISPOSING FACTORS

Inadequate Replacement Excessive Fluid Loss

§ Decreased/Poor Oral Intake § Gastro-Intestinal Tract

§ Inadequate IV Fluids § Renal
§ Metabolic Disturbances
§ Inability to gain access to § Skin
HYPOVOLEMIA fluids § Third Spaces
§ Bleeding
FLUID VOLUME DEFICIT

FLUID VOLUME DEFICIT FLUID VOLUME DEFICIT

CLINICAL MANIFESTATIONS CLINICAL MANIFESTATIONS

üAcute Weight Loss üFlattened Neck Veins

üDecreased Skin Turgor üIncreased/Decreased

Temperature; Pale
üOliguria, Concentrated
Urine üThirst

üPostural Hypotension üDelayed Capillary Refill

üWeak, Rapid Heart üMuscle

Rate Weakness/Cramps
üDecreased LOC

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A PATIENT WITH CVP MANOMETER

FLUID VOLUME DEFICIT

NURSING/MEDICAL MANAGEMENT
DIAGNOSTIC TESTS
MILD
• Urine Specific Gravity
and osmolality
• Encourage clients to increase Fluid
Intake/Give oral fluids
• BUN
• Hct Hgb • Carbohydrate/Electrolyte Solutions:
• Electrolytes or
sports drink, gingerale, rehydrating soln.
• CVP Observe patients for untoward symptoms.

FLUID VOLUME DEFICIT

SPECIAL CONSIDERATIONS
FLUID VOLUME DEFICIT
FLUID CHALLENGE TEST

Oral Discomfort / Reluctant to Drink Volumes of fluid are

Nauseated and Vomiting administered at specific
rates and intervals while
Cannot eat or drink hemodynamic response
is monitored

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NSG DIAGNOSIS: FLUID VOLUME DEFICIT NSG DIAGNOSIS: FLUID VOLUME DEFICIT

SEVERE/ACUTE Check for vital signs

• Initiate IV fluids administration (Weak/Rapid Pulse, Postural Hypotension,

Decreased Temperature, Breath Sounds)
• Use isotonic Fluids to expand plasma vol.
Record Intake and Output (I and O) every shift/every
Educate client on reducing intake of tea and hour
coffee
Weigh the patient.
Monitor laboratory results (urine and
Monitor CVP if present
electrolytes etc)

NSG DIAGNOSIS: INEFFECTIVE TISSUE PERFUSION NSG DIAGNOSIS: RISK FOR INJURY RELATED TO
(RENAL,CEREBRAL,PERIPHERAL) DIZZINESS/LOSS OF BALANCE

Check Level of Consciousness and/or mental Institute safety precautions (position changes,
function. lower bed, side rails)
Check for peripheral perfusion. Measures to prevent orthostatic hypotension
Check for Skin turgor and color.
Check for oral membrane moisture (dry mouth)
Turn every 2 hours to prevent skin breakdown

FLUID VOLUME EXCESS:

PREDISPOSING FACTORS

Excess Intake Inadequate Output

• IV Fluids, Blood Use • Heart Failure

• Increased Na Intake • Nephrotic Syndrome
• Liver Cirrhosis
• Water Intoxication
• Decreased Dietary Protein
• Remobilization of edema • Steroid Use
HYPERVOLEMIA • Stress conditions
FLUID VOLUME EXCESS

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FLUID VOLUME EXCESS FLUID VOLUME EXCESS

CLINICAL MANIFESTATIONS CLINICAL MANIFESTATIONS

üEdema üTachycardia; full

bounding pulse
üWeight gain
üDistended Neck and üIncreased BP
peripheral Veins üIncreased CVP
üCrackles, Dyspnea, üAltered mental status r/t
SOB, Orthopnea cerebtal edema
üIncreased Urine Output

FLUID VOLUME EXCESS

NSG/MEDICAL MANAGEMENT
DIAGNOSTIC TESTS Fluid management/restriction
Subtract requisite fluids (IV fluids;
• Urine Specific Gravity fluids used to dilute meds)
• BUN
Divide remaining fluid allowance:
• Hgb/Hct
Day: 50% of total
• Electrolytes or
Evening: 25-30% of total
• Chest X-Rays
• Renal and Liver Functions
Night: Remainder

FLUID VOLUME EXCESS FLUID VOLUME EXCESS

NSG/MEDICAL MANAGEMENT NSG/MEDICAL MANAGEMENT
Dietary management/restriction
Fluid management/restriction • Restrict Sodium in the diet
• Identify patient preferred fluids • Read food labels to identify “hidden” sodium
• Choose fresh and frozen food items
• Use small glasses (perceived as full) • Select unsalted snacks and broths. If using canned,
observe labels carefully.
• Offer ice chips • Use dairy products that are fat free or low fat and low
• Offer mouth care sodium
• Ask for your dish to be prepared without salt when dining
• Sugarless gum (lessen thirst sensation) out.
• Use spices, herbs or lemon juice to enhance the taste of
food

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NSG DIAGNOSIS: FLUID VOLUME EXCESS

Pharmacologic D – iet (hig
h
I – and O in potassium)
Assess VS,CVP; Measure I and O Therapy U – ndesir
able Effec
Weigh Daily a.Diuretics (electrolyte ts
imbalance
R – eview )
Monitor for degree of edema §Thiazide Diuretics E – lders: B: eHR, BP, Electrolytes
T – ak careful
Instruct about Sodium restricted diet; Fluid Restriction
§Loop Diuretics I – incree drugs am/afternoon
Promote rest; Semi Fowler’s position ase risk o
C – ancel f hypotens
§Potassium alcohol ion
Monitor parental fluid therapy: regulate flow rate
Sparing Diuretics
Administer appropriate medications

NSG DIAGNOSIS: RISK FOR IMPAIRED SKIN INTEGRITY NSG DIAGNOSIS: IMPAIRED GAS EXCHANGE

Assess skin, note pressure areas and bony Auscultate lungs. Note presence of crackles
prominences or decreased breath sounds
Reposition every 2 hours Position patient to fowler’s posiiton
Provide egg crate mattress if possible Check ABG results

1. Populations at risk for dehydration include: 2. Checking for orthostatic hypotension

allows the nurse to detect early signs of:
a. Infants
b. Adolescents a. Hypovolemia

c. Patients with SIADH b. Low serum osmolality

d. Young Adults c. High serum osmolality
d. Hypervolemia

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3. Of the following options, the first step you 4. One sign of hypervolemia is:
should take for a patient with hypovolemic
shock is to: a. Increased urine output
b. Clear, watery sputum
a. Assess for dehydration c. Severe hypertension
b. Administer IV fluids d. A rapid, bounding pulse.
c. Insert a urinary catheter
d. Prepare for surgery

FLUID VOLUME ASSESSMENT

When assessing a client with fluid volume
Parameter Fluid Deficit Fluid Excess
deficit, the nurse would expect to find:
Weight

Pulse
a.Increased pulse rate and blood pressure
b.Dyspnea and respiratory crackles Blood Pressure

c. Headache and muscle cramps Mucous Membrane

d.Orthostatic hypotension and flat neck veins Skin Turgor

Jugular / Peripheral
Veins

EDEMA

DEFINITION
• Presence of excess fluid in the
interstitial space
• Mainly occurs in the extracellular fluid
compartment than in the intracellular
fluid compartment.
EDEMA

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INTRACELLULAR EDEMA EXTRACELLULAR EDEMA

Cause:
• Inflammation

1. INCREASED CAPILLARY PRESSURE 2. DECREASED PLASMA PROTEINS

• Loss of proteins in the urine

• Excessive kidney retention of Na and H20
• Loss of proteins in the denuded areas/skin
• High venous pressure and constriction
• Failure to produce proteins
• Decreased arteriolar resistance

3. INCREASED CAPILLARY PERMEABILITY 4. BLOCKAGE OF LYMPHATICS

• Immune reactions/release of histamine • Cancer

• Toxins • Infection
• Bacterial infections • Surgery
• Vitamin deficiency esp. Vitamins C
• Congenital anomalies of lymphatics
• Prolonged ischemia

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EDEMA
Localized

Generalized

The picture can't be displayed.

PITTING EDEMA

The picture can't be displayed.

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WHAT IS THE DIFFERENCE?

E
Third d
Spacing e
and
m
a THIRD SPACING

Potential Spaces:
Accumulation a.Pericardial
and sequestration
of trapped b.Pleural
extracellular fluid c.Peritoneal
in an actual or
d.Joint cavities
potential body
space as a result of e.Bowel
a disease or injury. f. abdomen ELECTROLYTES

ELECTROLYTES
FUNCTIONS:
DIVIDED INTO:
1. Assists in regulating water balance
CATIONS 2. Help regulate and maintain acid-base
balance
(+) charged molecules
3. Contribute to enzyme reactions
ANIONS
4. Essential for neuromuscular activity
(-) charged molecules

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Intracellular Fluid ELECTROLYTES

• K is the most abundant cation
• PO4 is the most abundant anion Expressed in terms of mEq/L
a measure of the ions chemical activity or its
power.
Extracellular Fluid
• Na is the most abundant cation
• Cl is the most abundant anion Normal Values:
(See your handouts)

MAJOR ELECTROLYTES IN THE BODY

C EXTRACELLULAR C INTRACELLULAR
A A
T Na 135-145mEq/l T Na 10-14mEq/L
I K 3.5-5.0mEq/L I K 140-150mEq/L
O O
N Ca 8.6-10.2mg/dL N Mg 40mEq/kg
S S Ca <1mEq/L
Mg 1.3-2.3mg/dL

A Bicarbonate 22-26mEq/L A Bicarbonate 7-10mEq/L

N Chloride 3-4mEq/L
N
I
O
Chloride
Phosphate
Proteins
97-107mEq/L
2.5-4.5mg/dL
16mEq/L
I
O
Phosphate
Proteins
4mEq/kg
54mEq/L
NORMAL AND ABNORMAL
N Other anions 8mEq/L N Other anions 31-86mEq/L
S
S
ELECTROLYTES

What is the Normal?

UNDERSTANDING THE
ELECTROLYTE MAZE

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What is the Normal? What is the Normal?

What is the What is the

Imbalance? Imbalance?

What causes the

Imbalance?

What is the Normal? What is the Normal?

What is the What is the appropriate What is the

Imbalance? clinical nursing care? Imbalance?

What are the signs What causes the What are the signs What causes the
and symptoms? Imbalance? and symptoms? Imbalance?

SODIUM SODIUM
What is Normal?

ü Normal Level
135 – 145
ü Function/s mEq/L
It is the primary regulator of ECF
Osmolality, Volume and Distribution

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SODIUM
…Regulation
What is Normal?
Regulated by the kidneys
Also by the Aldosterone and ADH
ü Normal Level
ü Function/s Excreted through the GI Tract and
ü Dietary Sources skin through sweat in small amount
ü Regulation
2,300mg of salt in a day

WHAT IS THE IMBALANCE?

HYPONATREMIA HYPERNATREMIA

Hyponatremia
• Indicates • Indicates
<135mEq/L DECREASED INCREASED
osmolality of blood osmolality of blood
• The imbalance may • The imbalance may
Hypernatremia be called WATER be called WATER
>145mEq/L INTOXICATION DEPLETION

WHAT CAUSES THE IMBALANCE? WHAT CAUSES THE IMBALANCE?

HYPONATREMIA HYPERNATREMIA HYPONATREMIA HYPERNATREMIA

• Loss of Sodium • Loss of Sodium • Water deprivation r/t

altered mental status/
• Kidneys • Kidneys
physical disability
• GIT • GIT
• Excess water loss r/t
• Skin • Skin watery diarrhea,DI,
• Water Gains • Water Gains insensible loss
• Decreased Intake • Decreased Intake • Excess Na+ intake r/t
diet, IV fluids

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What are the signs and symptoms? What are the appropriate clinical nursing care?
HYPONATREMIA HYPERNATREMIA HYPONATREMIA

• Brain cells swells • Brain cells shrink Medical Management

• Muscle cramps, • Thirst • Sodium Replacement
weakness, fatigue Ø Careful administration of Na by mouth,
• Muscle weakness/
NGT, IV route
• N/V,anorexia,diarrhea Twitching
Ø Slow infusion of hypertonic saline
• Headache • Confusion, Lethargy
solution which causes fluid shift out of
• Confusion/Lethargy • Convulsions, Coma cells
• Convulsions, Coma

What are the appropriate clinical nursing care? What are the appropriate clinical nursing care?
HYPONATREMIA
Medical Management
Medical Management
• Water Restriction
Ø to 800-1000ml in 24 hours
• Pharmacology
ØDiuretics: Furosemide
• If edema exists alone, Sodium is restricted
If edema and hyponatremia exists, both
Water and Sodium are restricted

What are the appropriate clinical nursing care? What are the appropriate clinical nursing care?
HYPERNATREMIA

Nursing Management
Medical Management
1. Identify patients at risk; Monitor for LOC
• If caused by decreased water in the body:
2. Monitor I and O; daily weight; note symptoms
3. For abnormal losses: Oral fluid replacement
• Encourage patient to eat food/fluids with high • Gradual infusion of hypotonic solution
Na content (over 48 hours)
4. If the primary problem is water retention - • Restrict Sodium intake
• Restrict fluids- to a total of 800ml in 24 hours. • Diuretics to increase Na+ excretion

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A PATIENT WHO WANTS TO REDUCE SODIUM IN HER DIET

What are the appropriate clinical nursing care? CAME TO YOU, AS A NURSE YOU SHOULD TELL YOUR
PATIENT TO:
HYPERNATREMIA

Nursing Management • Choose fresh and frozen

food items
• Monitor Intake and Output; Weigh daily
• Select unsalted snacks
• Obtain medication history for medications with and broths.
high Na content
• If using canned, observe
• Note patient’s thirst
labels carefully.
• Provide a safe environment. Check LOC

• Use dairy products that

are fat free or low fat and WHY DO SYMPTOMS OF HEADACHE, LETHARGY,
low sodium AND CONFUSION OCCUR WITH HYPONATREMIA?
• Ask for your dish to be
prepared without salt
when dining out.
• Do not add salt in the
diet. Answer?
• Use spices, herbs or
lemon juice to enhance
the taste of food

POTASSIUM
WHICH AMONG THE FOLLOWING IS THE BEST NURSING
INTERVENTION THE NURSE SHOULD PROVIDE TO A
CLIENT WITH SEVERE HYPONATREMIA?

a. Assess muscle strength and tone

b. Maintain a quiet environment
c. Continuously monitor for the results of
sodium levels in the blood
d. Report abnormal electrolyte results to the
physician

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POTASSIUM POTASSIUM
What is Normal? What is Normal?

ü Normal Level ü Normal Level

3.5 – 5.0 mEq/L ü Function/s
It influences both the skeletal and
cardiac muscle activities

POTASSIUM
…DIETARY SOURCES
What is Normal?
• Fruits (oranges, banana )
• Dried fruits
ü Normal Level
• Vegetables (carrots, mushroom, tomatoes,
ü Function/s
potatoes)
ü Dietary Sources
• Nuts/Seeds
50 – 100 mEq in a day
• Chocolate
• Meat

POTASSIUM
…Regulation
What is Normal?
§ Regulated and primarily excreted by
the kidneys
ü Normal Level
ü Function/s § Regulated also by Aldosterone
ü Dietary Sources § Excreted through the GI Tract
ü Regulation (bowel) and skin (sweat)

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WHAT CAUSES THE IMBALANCE?

HYPOKALEMIA HYPERKALEMIA

• Inadequate K+ intake
Hypokalemia • K+ loss through
<3.5mEq/L • Kidneys
• GIT
• Alkalosis
Hyperkalemia • Rapid tissue repair
>5.0mEq/L • Excess insulin; Stress

What are the signs and symptoms?

WHAT CAUSES THE IMBALANCE?
HYPOKALEMIA HYPERKALEMIA
HYPOKALEMIA HYPERKALEMIA
• Muscle weakness/ cramps, • Muscle weakness/
• Increased K+ intake Ascending paralysis
• Impaired urinary excretion
• GI: diminished bowel • GI: abdominal cramping,
of K+
function, constipation nausea and diarrhea
• Rapid IV administration of
K+ • Cardio: Dysrrythmias, Risk • Cardio: Bradycardia,
• Transfusion of aged blood of Digitalis toxicity Heart Block, Cardiac
• Acidosis • ECG: Flat/Inverted T Wave; Arrest
• Severe tissue trauma ST segment depression, • ECG: Peaked T Wave
• Pseudohyperkalemia presence of U wave

What are the appropriate clinical nursing care? What are the appropriate clinical nursing care?
HYPOKALEMIA HYPOKALEMIA

Medical Management Medical Management

• Encourage increased intake of K in the diet • IV KCl
• Prepare to administer Oral or Intravenous Don’t add to a hanging container.
replacement therapy Use infusion device.
• Oral K+ supplements can produce small Never administer by push/bolus.
bowel lesions-assess and caution about Watch IV site for complications
abdominal pain/bleeding/cramps.

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What are the appropriate clinical nursing care? What are the appropriate clinical nursing care?
HYPOKALEMIA HYPERKALEMIA

Nursing Management Medical Management

• Immediate ECG readings, check K+ serum
• Monitor vital signs.
levels.
• Check heart rate and ECG tracings.
• Mild Cases-Loop Diuretics; Low K+ Diet
• Assess respiratory rate and pattern. • Moderate to Severe-
• Encourage increase K+ in the diet Emergency Measures
• Teach about abuse of laxatives and 10%Calcium gluconate/Calcium Chloride
diuretics

What are the appropriate clinical nursing care? What are the appropriate clinical nursing care?
HYPERKALEMIA HYPERKALEMIA

Medical Management Nursing Management

• Acidosis • Assess vitals signs and anticipate cardiac
IV sodium bicarbonate (50mEq)
monitoring.
• Others
• Monitor patient’s intake and output/ food.
Dextrose with insulin; Dialysis
Na Polystrene Sulfonate (Kayexalate) • Monitor for bowel sounds-hyperactive.
Dialysis • Implement safety measures for muscle
weakness.

WHEN A LABORATORY TEST RESULT INDICATES A PATIENT’S SERUM POTASSIUM LEVEL RESULT
THAT YOUR PATIENT HAS A HIGH POTASSIUM IS 6.2MEQ/L. AS A NURSE, YOU ANTICIPATE
LEVEL, AND THE RESULT DOESN’T SEEM TRUE THAT THE DOCTOR WILL ORDER WHAT SPECIFIC
AND THE SAME WITH THE PATIENTS CONDITION, MEDICATION/S?
WHAT WOULD BE THE BEST THING TO DO?

a. Osmotic diuretics
b. Insulin and glucose
c. Potassium supplement
d. Sodium Bicarbonate

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POTASSIUM IS PRIMARILY EXCRETED FROM THE CALCIUM

BODY THROUGH:

a. Cellular exchange
b. GI Tract
c. Kidneys
d. Lungs

CALCIUM CALCIUM
What is Normal? What is Normal?

ü Normal Level (Total) ü Normal Level (Ionized)

8.6 – 10.2 mg/dL or 4.5 – 5.1 mg/dL or
2.2 – 2.6 mmol/L 1.1 – 1.3 mmol/L

CALCIUM
CALCIUM
What is Normal?
• Stabilizing cell membranes
• Regulating muscle contractions and
ü Normal Level relaxations
ü Function/s • Maintaining cardiac function
Formation and structure of • Blood Clotting
bones/teeth

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CALCIUM
CALCIUM – DIETARY SOURCES
What is Normal?
• Dairy Products
• Green Leafy Vegetables
ü Normal Level
ü Function/s
ü Dietary Sources
800-1,200 mg in a day **Requirements vary for children, pregnant,
with osteoporosis

CALCIUM
…Regulation
What is Normal?
• Calcium in the blood is controlled by
PTH, Calcitonin, Vit D, Phosphorus
ü Normal Level Level, Blood pH level
ü Function/s
• Absorbed by the small intestines and
ü Dietary Sources
excreted through the feces/urine
ü Regulation

WHAT CAUSES THE IMBALANCE?

HYPOCALCEMIA HYPERCALCEMIA

Hypocalcemia • Risk Fxs: Elderly, lactose

intolerance, alcoholism
8.6 mg/dL • Parathyroidectomy
• Hypoparathyroidism
• Alkalosis
• Renal Failure
Hypercalcemia • Massive Blood transfusion
• Acute pancreatitis
>10.2mg/dL
• Drugs

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WHAT CAUSES THE IMBALANCE? WHAT ARE THE SIGNS AND SYMPTOMS?
HYPOCALCEMIA HYPERCALCEMIA HYPOCALCEMIA HYPERCALCEMIA

• Hyperparathyroidism • Increased muscle • Decreased muscle

• Malignancies/Cancer contraction and contraction and excitability
• Prolonged Immobility excitability • Cardio:
• Increased GI absorption • GI:
• Cardio:
• Renal Failure • Urinary: Stone Formation
• Acidosis • Neuro: Personality/
• Drugs: behavioral changes

What are the appropriate clinical nursing care? What are the appropriate clinical nursing care?
HYPOCALCEMIA HYPOCALCEMIA

Medical Management Nursing Management

• Oral Calcium Supplements • Check history for thyroid surgeries or massive BT.
• Teach patients on foods rich in Calcium
• Parenteral administration of
• Take precautions for seizures.
10% Calcium Ca Gluconate or Calcium Chloride
• Vitamin D therapy to increase absorption in the
GI Tract

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What are the appropriate clinical nursing care? What are the appropriate clinical nursing care?
HYPERCALCEMIA HYPERCALCEMIA

Medical Management Nursing Management

• IV fluids with loop diuretics • Increase fluids to dilute Ca+
• Advise mobility if possible
• Calcitonin
• Watch out for mental changes
• Administration of Biphosphates and • Assess for cardiac rate/rhythm
Mithramycin r/t malignancies/bone resorption • Handle patients gently to prevent fractures
• Rapid Effect: Na PO4/ K PO4 (calcium binds • Increase Fiber in the diet; Low Ca+ diet
with phosphorus

WHAT CAN BE THE SOURCE OF CALCIUM FOR

WHAT TYPE OF FOOD SOURCES SUPPLY CALCIUM? LACTOSE INTOLERANT OR FOR THOSE WHO CHOSE
NOT TO EAT ANIMAL PRODUCTS?

• Tofu
• Canned salmon, sardines
Answer? • Brocolli, Cabbage, Malunggay
• Almonds and other nuts
• Calcium fortified fruit juices and drinks
• Cereals

A PATIENT HAS A POSITIVE CHVOSTEK’S SIGN IF MAGNESIUM

THERE’S:

a. Spasm of the carpals when an inflated

BP cuff is applied
b. Contraction of the facial muscles
following a tap on the facial nerve
c. Hypotension and ventricular
dysrhythmias
d. Respiratory arrest due to laryngospasm

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MAGNESIUM MAGNESIUM
What is Normal? What is Normal?

ü Normal Level (Total) ü Normal Level

1.3 – 2.3 mg/dL or ü Function/s
0.62 – 0.95 mmol/L Essential for neuromuscular
transmission and cardiovascular
function

MAGNESIUM MAGNESIUM
What is Normal?
• Vital to many intracellular processes
• Promotes enzyme reactions within the cell
during carbohydrate metabolism ü Normal Level
• Takes part in DNA and protein synthesis ü Function/s
• Aids in transmission and hormone-receptor ü Dietary Sources
binding
• The physiologic effects of Mg+ are affected by 30 - 350 mg in a day
both K+ and Ca+ levels

MAGNESIUM
MAGNESIUM – DIETARY SOURCES
• Seafood/Meat What is Normal?
• Dried beans, whole grains, nuts and seed
• Chocolate, Peanut butter, Raisins ü Normal Level
• Potatoes, Rice,Oatmeal ü Function/s
• Fruit
ü Dietary Sources
ü Regulation
• Milk
• Vegetables: peas,green leafy, brocolli

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…Regulation
• Absorbed through the intestine Hypomagnesemia
• Elimination is through the urine and 1.3mg/dL
feces

Hypermagnesemia
>2.3mg/dL

WHAT CAUSES THE IMBALANCE? WHAT ARE THE SIGNS AND SYMPTOMS?
HYPOMAGNESEMIA HYPERMAGNESEMIA HYPOMAGNESEMIA HYPERMAGNESEMIA

ØNEUROMUSCULAR:
• Decreased intake • Increased intake;
muscle weakness, tremors,
decreased loss or
• Increased loss or hyperactive DTR, Tetany,
excretion excretion
paresthesia, Confusion,
• Kidney: • Increased intake of mood changes, seizures
antacids with Mg+
• GIT: ØCARDIO: Tachycardia,
• Increased Mg IV/IM use dysrhythmias, hypertension
• Impaired absorption
• Renal failure • GIT: n/v, diarrhea,
• Chronic alcoholsim
abdominal distension

WHAT ARE THE SIGNS AND SYMPTOMS? What are the appropriate clinical nursing care?
HYPOMAGNESEMIA
HYPOMAGNESEMIA HYPERMAGNESEMIA

MILD
• Nausea, vomiting, hypotension,
Medical Management
flushing, feeling of warmth,
sweating • Mild: Diet
ØSEVERE • Moderate: Oral Supplements
• CNS Depression-weakness,
lethargy, absent DTR
• Severe: Mg IV/IM
Respiratory dep, Coma Antedote:________
• CARDIO – Heart block,
cardiac arrest

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What are the appropriate clinical nursing care? What are the appropriate clinical nursing care?
HYPOMAGNESEMIA HYPERMAGNESEMIA

• Nursing Management
Medical Management
• Check vital signs; WOF respiratory distress
• Check UO: Urine output should be monitored at • Increase fluids with diuretics
least every 4 hours. • Switch to different antacids/laxatives
• Patient Teaching; abstinence from alcohol. • Ca Gluconate: antedote
• Institute seizure precautions. • Ventilatory support
• Hemodialysis

PHOSPHORUS
What are the appropriate clinical nursing care?
HYPERMAGNESEMIA

Nursing Management
• Identify patients at risk
• Check vital signs, hypotension and shallow
respiration
• Check for patellar reflexes and changes in
level of consciousness

PHOSPHORUS PHOSPHORUS
What is Normal? What is Normal?

ü Normal Level (Total) ü Normal Level

2.5 – 4.5 mg/dL or ü Function/s
0.8 – 1.45 mmol/L Structural support for teeth and
bones

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PHOSPHORUS
PHOSPHORUS
What is Normal?
•Production of ATP
•Essential in the normal function of muscle activity ü Normal Level
and nerves and RBC ü Function/s
•Metabolism of fats, protein and carb ü Dietary Sources
30 - 350 mg in a day

PHOSPHORUS – PHOSPHORUS
DIETARY SOURCES
• Organ meats (brain, liver) What is Normal?
• Fish
• Poultry ü Normal Level
• Milk and Milk Products ü Function/s
• Whole grains, nuts
ü Dietary Sources
ü Regulation
• Eggs
• Dried Beans

REGULATION

• Absorbed through the intestine under

the influence of Vitamin D and Hypophosphatemia
parathyroid hormone. <2.5 mg/dL
• Elimination is through the urine by the
kidneys.
• Greater in children Hyperphosphatemia
>4.5mg/dL

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WHAT CAUSES THE IMBALANCE? WHAT ARE THE SIGNS AND SYMPTOMS?
HYPOPHOSPHATEMIA HYPERPHOSPHATEMIA HYPOPHOSPHATEMIA HYPERPHOSPHATEMIA

• Decreased intake/absorption• Increased intake /absorption • CNS: • Muscle cramps and

• Increased loss or excretion • Impaired excretion pain, paresthesia,
• Poor intake; Alcoholism • Hypoparathryodism • Musculo:
tingling around mouth,
• IATROGENIC CAUSE r/t • Shift of PO4 from ICS to • Hematologic:
treatment ECS cellular destruction: muscle spasm, tetany
Refeeding syndrome chemotherapy, trauma • Respiratory: • Calcification of soft
Medications sepsis, hypothermia
• Hyperventilation/Respiratory•
• Cardio: tissues
Renal Failure
Alkalosis • GIT:

What are the appropriate clinical nursing care? What are the appropriate clinical nursing care?
HYPOPHOSPHATEMIA HYPOPHOSPHATEMIA

• Nursing Management/Medical Management • Monitor vital signs (Resp failure,low BP,T)

• Assess for decreased muscle strength
• Gradually introduce parenteral nutrition • Assist patient with activities and ambulation.
• Oral Phosphate supplement: Neutra Phos • Report signs of infection
• IV administration of phosphorus • Encourage intake of Phosphorus rich food
• Document and report early signs of
hypophosphatemia

What are the appropriate clinical nursing care? What are the appropriate clinical nursing care?
HYPERPHOSPHATEMIA HYPERPHOSPHATEMIA

Nursing and Medical Management Nursing and Medical Management

• Vitamin D preparation • Monitor for laboratory data (High PO4,Low
• Volume Replacement (I and O):PNSS Ca+)
• Diuretics • Low phosphorus diet
• Agents that bind with PO4 in the GIT: • Restrict diet rich in organ meats, milk and
milk products
Ca-containing antacids
• Avoid phosphorus containing substances
• Dialysis like laxatives/enemas

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CHLORIDE CHLORIDE
What is Normal?

Most abundant
96-106mEq/L anion in ECF

CHLORIDE –
DIETARY SOURCES (750MG/DAY)
• Fruits
• Helps maintain osmolality and water balance
• Vegetables
• Digestion and enzyme reaction
• Table Salt
• Maintain acid-base balance
• Salty Food
• Processed and Canned Food

REGULATION

• Produced mainly in stomach to HCl.

Hypochloremia
• Absorbed through the intestines
<97 mEq/L
• Reabsorbed and excreted in kidneys.
• Eliminated small portions through
feces. Hyperchloremia
>107 mEq/L

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WHAT CAUSES THE IMBALANCE? WHAT ARE THE SIGNS AND SYMPTOMS?
HYPOCHLOREMIA HYPERCHLOREMIA HYPOCHLOREMIA HYPERCHLOREMIA

• Increased intake and • Symptoms of Alkalosis; Low • Symptoms of Acidosis

• Decreased
absorption Na & K (DOB, Decreased LOC,
intake/absorption
• Associated with • Tetany, hyperactive DTR, Weakness; Lethargy)
• Increased loss or
Hypernatremia hypertonicity • Untreated: arrythmias,
excretion
• Muscle cramps, twitching, coma, low cardiac output
• Renal Failure
• Diuretics; Bicarbonate, weakness, irritable • Symptoms of hypernatremia
Laxatives • Increased water loss;DHN and Hypervolemia : DOB,
• DANGER SIGNS:
arrythmias, seizures, coma, Increased HR and BP,
and respiratory arrest edema

What are the appropriate clinical nursing care? What are the appropriate clinical nursing care?
HYPOCHLOREMIA HYPOCHLOREMIA

• Nursing Management/Medical Management • Nursing Management/Medical Management

• Monitor LOC, muscle strength and movt • Insert IV line for fluids/electrolyte
• Monitor vital signs (RR and HR) replacement (NSS/ Ammonium Chloride)
• Monitor electrolytes and ABG • Intake and output
• Offer food high in chloride • Provide safe and quiet environment
• Oral Chloride replacement (salty broth)

What are the appropriate clinical nursing care? Complete the following sentences:
HYPERCHLOREMIA
• I believe…
Nursing and Medical Management • I learned…
• Monitor vital signs including cardiac rhythm • I hope…
• Continually assess patient: neurologic, cardiac and
respiratory changes • I wish…
• Administer IV and medication as ordered (sodium • I confirm…
bicarbonate)
• Restrict fluids,sodium and chloride • I appreciate…
• Monitor and record electrloytes and ABG • I conclude…
• Monitor and record intake and output.

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UNDERSTANDING PH

The plasma pH is an indicator of hydrogen

ion (H+) concentration

The amount of acid or base in body fluid is

reflected in the pH.
ACID – BASE BALANCE

TERMINOLOGIES: HYDROGEN ION

HYDROGEN ION – is an acid needed for maintenance The greater the amount, the more acidic
of cellular membranes and enzyme reactions, and The smaller the amount, the more basic
minor alterations may affect metabolism and essential
body functions. pH is based on a negative logarithm
INCREASED H+ CONCENTRATION=pH Value is DECREASED
ACID- a molecule that can contribute a hydrogen ion DECREASED H+ CONCENTRATION-pH Value is INCREASED =

or
BASE- a molecule that can accept or remove a
increased H+ Concentration = ACIDOSIS=LOW pH
hydrogen ion
Decreased H+ Concentration = ALKALOSIS =HIGH pH

BUFFER SYSTEM
3 SYSTEMS TO HELP MAINTAIN
ACID-BASE HOMEOSTASIS Prevents major changes in the pH of body fluids
by removing or releasing H+
1.Buffer Systems
It is the fastest acting system and the primary
regulator of acid-base balance

They change strong acids to weaker acids and

neutralize them.

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BUFFER SYSTEM
BICARBONATE-CARBONIC ACID BUFFER SYSTEM
3 TYPES OF BUFFER SYSTEM

• This system is capable of readjusting the pH

• The BICARBONATE-CARBONIC ACID BUFFER within seconds.
SYSTEM
• The PHOSPHATE AND AMMONIA BUFFER • Normal ratio is :
SYSTEM
20 bicarbonate is to 1 carbonic acid
• The PROTEIN BUFFERS

BUFFER SYSTEM
BUFFER SYSTEM PROTEIN BUFFER
PHOSPHATE AND AMMONIA BUFFER SYSTEM

• Found in hemoglobin, plasma proteins and

• Important in buffering fluids in the kidney
intracellular proteins
tubules.
• H+ combine with this buffering system, and
are excreted in the urine • They buffer H+ and CO2 when they diffuse
across the cell membrane of the cell.

• Lungs work by adjusting the ventilation in

3 SYSTEMS TO HELP MAINTAIN ACID-BASE HOMEOSTASIS
response to the amount of the CO2 in the
blood.
1.Buffer Systems
• Increase partial pressure of carbon dioxide
2.Respiratory System
in the arterial blood (PaCO2) is a powerful
3.Renal System stimulant to respiration.
• The only way the respiratory system can
remove acid is through the elimination of
CO2

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In a state of ACIDOSIS, the respiratory

Increased amounts of H+ or acids cause an system attempts to decrease the increased
increase in respirations, resulting to greater acid through HYPERVENTILATION
elimination of CO2.

In a state of ALKALOSIS, the respiratory

Decreased amount of H+ or acids result to system decreases the increased base
decreased respirations, causing CO2 to be through HYPOVENTILATION.
retained

3 SYSTEMS TO HELP MAINTAIN ACID-BASE HOMEOSTASIS • Regulates bicarbonate in the ECF.

1.Buffer Systems • Kidneys can regenerate Bicarbonate ions

2.Respiratory System as well as reabsorb them from the renal
3.Renal System tubular cells.

• Renal compensation for imbalances is

relatively slow. (a matter of hours or days)

ALTERATIONS IN ACID – BASE BALANCE

Bicarbonate and CO2/Carbonic Acid

Ratio is no longer maintained

ACID-BASE IMBALANCE ASSESSMENT OF

ACID-BASE BALANCE

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ABG ARE ANALYZED TO:

• Arterial Pressure is preferred because its
• To identify acid-base disorders and cause
pressure is higher than the venous ends.
• Extent of the imbalance • Drawing blood requires specialized training
• To monitor treatment
by RN’s, RT’s, and Med Techs

ALLEN’S TEST
• Post Procedure Care:
Apply firm pressure to the puncture site.

COMPONENTS COMPONENTS
PaCO2/PCO2
pH
Pressure exerted by the dissolved CO2 in the
blood
• Acidosis occurs when Hydrogen ions is
above normal Reflect the respiratory component of the acid-
• Alkalosis occurs when Hydrogen ions is base balance and is regulated by the lungs
below normal
Normal: 35-45 mmHg

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RESPIRATORY COMPONENT/DISORDERS COMPONENTS

HCO3
• The primary change is in the concentration
of Carbonic Acid Renal regulation of acid-base balance
• Respiratory acidosis –
CO2 is retained, high CO2 levels Reflect the metabolic component of the acid-
base balance and is regulated by the kidneys
• Respiratory alkalosis –
CO2 blown off, low levels of CO2
Normal: 22-26 mEq/L

METABOLIC COMPONENT/DISORDERS PaO2

• The primary change is in the concentration
of Bicarbonate. • Normal: 80-100mmHg
• Metabolic acidosis – • Measure of pressure exerted by O2 that is
dissolved in plamsma
low HCO3 levels in relation to the
amount of acid in the body. • Valuable in evaluating respiratory function,
but is not used as a primary measurement
• Metabolic alkalosis – in determining acid-base status
high HCO3 levels in relation to the
amount of acid in the body

ACID – BASE DISORDERS

FURTHER DEFINED AS:

• PRIMARY
Primary/Simple disorders due to one cause

• MIXED
Combination of respiratory/metabolic disturbances 5 STEPS IN EVALUATING
Example: Cardiac Arrest ARTERIAL BLOOD GAS VALUES

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STEP # 1 Note the pH EXAMPLE:

pH > 7.4 (alkalosis) • pH – 7.34

pH = 7.4 (normal) • pH – 7.46
pH < 7.4 (acidosis) • pH – 7.20
• pH – 7.54

EXAMPLE
STEP # 2
DETERMINE THE PRIMARY CAUSE OF THE IMBALANCE
• PaCO2 – 33
a.PaCO2 (Respiratory) • PaCO2 - 46
Normal: 35 – 45 • PaCO2 – 44
<35 : ALKALOSIS • PaCO2 - 35
>45 : ACIDOSIS

EXAMPLE
STEP # 3
DETERMINE THE PRIMARY CAUSE OF THE IMBALANCE
• HCO3 – 24
a.HCO3 (Metabolic) • HCO3 – 28
Normal: 22 – 26 • HCO3 – 20
<22 : ACIDOSIS • HCO3 – 22
>26 : ALKALOSIS

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STEP # 4
DETERMINE IF THE CO2 OR THE HCO3 MATCHES THE STEP # 5
ACID OR BASE ALTERATION OF THE PH DETERMINE IF THE COMPENSATION HAS BEGUN.

Example:
pH is acidosis; CO2 is alkalosis; HCO3 is acidosis

Since pH and HCO3 goes in the same direction,

the interpretation is METABOLIC ACIDOSIS

EXERCISES: EXERCISES:

1.pH – 7.34; CO2 – 50 ; HCO3 – 25 1.pH – 7.34; CO2 – 50 ; HCO3 – 25

2.pH = 7.60; CO2 = 30; HCO3- =22 2.pH = 7.60; CO2 = 30; HCO3- =22
1
3.pH = 7.55; CO2- = 40; HCO3- = 30
4.pH = 7.34; CO2= 45; HCO3- = 21 3.pH = 7.55; CO2- = 40; HCO3- = 30
5.pH = 7.20; CO2= 49; HCO3= 19 4.pH = 7.34; CO2= 45; HCO3- = 21 2

INTERPRET AND GIVE AT LEAST 1 CAUSE INTERPRET

• pH- 7.37; PCO2-34; HCO3-21 • pH- 7.37; PCO2-34; HCO3-21
• pH-7.47; PCO2-34; HCO3-19 • pH-7.47; PCO2-34; HCO3-19
1
• pH-7.43; PCO2-46; HCO3-27
• pH-7.39; PCO2-46; HCO3-31 • pH-7.43; PCO2-46; HCO3-27
• pH-7.39; PCO2-46; HCO3-31
2

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INTERPRET INTERPRET
• pH- 7.37; PCO2-34; HCO3-21
• pH-7.47; PCO2-34; HCO3-19 1 • pH-7.43; PCO2-46; HCO3-27
• pH-7.39; PCO2-46; HCO3-31

METABOLIC ACIDOSIS

METABOLIC ACIDOSIS METABOLIC ACIDOSIS

PRIMARY IMBALANCE: CAUSES:

Direct Loss of Bicarbonate Others:

A.Diarrhea • Ketoacidosis
pH B.Lower intestinal • Lactic acidosis
fistulas
C.Ureterostomies • ASA overdose
Bicarbonate (HCO3) D.Use of diuretics, • Uremia (CRF)
early renal
insufficiencies
E.Hyperchloremia

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METABOLIC ACIDOSIS
METABOLIC ACIDOSIS
MANIFESTATIONS:
TREATMENT:
Musculoskeletal Malaise, Weakness, Fatigue, AIM: Restore the Fluid and Electrolyte loss and correction
of the underlying cause.
Neuro Stupor,coma
a. For Hyperchloremia – eliminate the source of Chloride
Integumentary Vasodilation, Warm , flushed skin
b. Hyperkalemia – serum Potassium is monitored
Gastrointestinal Nausea, Vomiting, anorexia,
c. Alkalinizing agent – Sodium Bicarbonate
d. DKA-IV insulin
Cardiac Decreased cardiac contractility, CO,
Dysrrythmias, Cardiac Arrest, Shock e. Diarrhea-Fluid Replacement

Respiratory DOB/SOB/Kussmaul’s breathing f. Hemodialysis or Peritoneal Dialysis

METABOLIC ALKALOSIS
PRIMARY IMBALANCE:

pH

Bicarbonate (HCO3)
METABOLIC ALKALOSIS

METABOLIC ALKALOSIS METABOLIC ALKALOSIS

CAUSES: MANIFESTATIONS:

Decreased Ca Hypocalcemia; numbness, tingling

A.Vomiting and Gastric Suction ( Most common) Ionization around mouth, fingers/toes, tetany,
muscle spasm
B.Hypokalemia Neurological Dizziness
• Increased renal excretion of Hydrogen ion as
kidneys try to conserve K+.K out+, H+ in.
Respiratory Decreased respirations, respiratory
failure
C.Alkali ingestion (Increased, Antacids)

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METABOLIC ALKALOSIS
TREATMENT:

A. GI Loss: Monitor patients fluid intake and

output
B. Restore normal fluid volume;
Administration of NaCl fluids
C. Hypokalemia: Potassium Chloride
D. Treat underlying cause of Alkalosis

RESPIRATORY ACIDOSIS
PRIMARY IMBALANCE:

pH

PaCO2
RESPIRATORY ACIDOSIS

RESPIRATORY ACIDOSIS RESPIRATORY ACIDOSIS

CAUSES: MANIFESTATIONS:
Inadequate ventilation and excretion of CO2
Neurological Headache, Blurred Vision, mental
A. Acute cloudiness,vertigo, irritability,
• Trauma/Chest injury/Brains stem damage disorientation, lethargy, coma
• Bronchial Asthma, Pulmonary edema, drug Cardiac Tachycardia, Dysrythmias
overdose, airway obstruction
Integumentary Warm, flushed
B. Chronic
• COPD-Emphysema Respiratory Initial: Hyperventilation
Late: Hypoventilation

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RESPIRATORY ACIDOSIS
TREATMENT:

A. Adequate hydration to moisten mucous membrane’

B. Supplemental oxygen
C. Bronchodilators, Antibiotics
D. Narcotic Antagonists
E. Mechanical Ventilator for support
F. Semi Fowler’s Position RESPIRATORY ALKALOSIS

RESPIRATORY ALKALOSIS RESPIRATORY ALKALOSIS

PRIMARY IMBALANCE: CAUSES:

Excessive “blowing off” of CO2

pH A. Hyperventilation
B. Extreme anxiety
C. ASA overdose (early onset)
PaCO2 D. Cerebral Tumors
E. Pain and Fever

RESPIRATORY ALKALOSIS RESPIRATORY ALKALOSIS

MANIFESTATIONS: TREATMENT:

Muscular Numbness/Tingling, AIM:

Cramps/Carpopedal spasm
Treat the underlying cause and to increase
Neurological Decreased cerebral blood flow
CO2 levels
Light headedness, dizziness,seizure, A. Anxiety:
Decreased LOC patient is instructed to breathe more slowly
Cardio/ Respi Palpitation, have client breathe into a paper bag
Air Hunger B. Sedative
C. Adjust ventilator setting

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EXERCISES: Interpret each and give

at least one predisposing factor for
each acid-base imbalance
INTRAVENOUS FLUID AND
1. pH- 7.37; PCO2-34; HCO3-21 ELECTROLYTE REPLACEMENT
2. pH-7.47; PCO2-34; HCO3-19
1. pH-7.43; PCO2-46; HCO3-27
2. pH-7.39; PCO2-46; HCO3-31

PURPOSE: NURSE’S RESPONSIBILITIES:

• To provide water, electrolytes and

• Monitors patient response to the fluids being
nutrients to meet daily requirements
administered and considers the ff:
• To replace water and correct electrolyte
1. Fluid volume
deficit
2. Content of the fluids
• To administer medications and blood
3. Patient’s clinical status

TYPES OF INTRAVENOUS SOLUTIONS: TYPES OF INTRAVENOUS SOLUTIONS:

CRYSTALLOIDS COLLOIDS CRYSTALLOIDS COLLOIDS
• Hypotonic • Albumin/Plasma • Hypotonic • Albumin/Plasma
• Isotonic Proteins • Isotonic Proteins
• Hypertonic • Dextran • Hypertonic • Dextran
• Hetastarch • Hetastarch

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CRYSTALLOIDS-ISOTONIC SOLUTIONS CRYSTALLOIDS-ISOTONIC SOLUTIONS

• Isotonic fluids have same osmolality to that Examples

of ECF • Normal Saline Solution / 0.9% Sodium Chloride
• Do not cause RBCs to shrink or swell • Dextrose 5% in Water / D5W
• It has the ability of expanding ECF volume/ • Lactated Ringer’s / Plain LR
intravascular space

CRYSTALLOIDS-HYPOTONIC SOLUTIONS CRYSTALLOIDS-HYPOTONIC SOLUTIONS

• One of its purpose is to replace cellular Example

fluid • 0.45% Sodium Chloride
• Used to treat hypernatremia and other (Half-normal saline solution)
hyperosmolar conditions

CRYSTALLOIDS-HYPERTONIC SOLUTIONS CRYSTALLOIDS-HYPERTONIC SOLUTIONS

• These solutions draw water from the Examples

ICF to the ECF • Dextrose 5% in lactated Ringer’s Solution
• cause cells to shrink. • Dextrose 5% in half-normal saline solution
• Not to be administered rapidly for this • Dextrose 5% in normal saline solution
may cause extracellular volume excess • Dextrose 10% in water

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COLLOIDS COLLOIDS

• Also known as Plasma Expanders Examples

• Given to patients who doesn’t improve with • Albumin
crystalloids. • Dextran
• Colloids pull fluid into the bloodstream and the
effects last several days.
• Patients need to be closely monitored for increase
blood pressure, dyspnea, and bounding pulse

OTHER INTRAVENOUS SUBSTANCES

oWhole Blood
oPacked RBC
oPlatelets
oCryoprecipitate

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