FLUID AND ELECTROLYTE BALANCE THIRD SPACE FLUID SHIFT

 dynamic process that is crucial for life

1. Loss of Extracellular Fluid into a space
and homeostasis
 unavailable for use by either the
ICF or ECF
2. Accumulates membrane
Solution
 peritoneal cavity
 mixture of solute and solvent
 pleural space
3. Examples
Solvent
 ascites – fluid in peritoneal space
 fluid medium
 pleural effusion
o plasma
 pericardial effusion
 angioedema – fluid accumulation
Solute
 particles
o proteins (mainly albumin)
ELECTROLTES
o glucose
o lipoprotein
 Elective lights
o mineral oils (electrolytes)
o light up your body/active
chemicals
 ions that are found in body fluids
BODY FLUIDS
o help to conduct electricity and
energy
 “bodily fluids” “biofluids”
o help control body fluids
 lipids within the body of an organism
o maintain homeostasis in the body
o helps in transporting nutrients
o expel waste from human cells
TYPES
 60 % fluids
o H2O and electrolytes
1. Cations
 2000-3000 ml of water per day
 carry positive charges
 Na, K, Ca, Mg, H ions
2. Anions
FLUID COMPARTMENTS
 carry negative charges
 Cl bicarbonate, phosphate,
1. Intracellular Fluid (ICF)
sulphate and proteinate ions
a) 2/3 of body fluid

2. Extracellular Fluid (ECF)

a) 1/3 of body fluid
ICF ECF
 intravascular space (mmol/l) (mmol/l)
o 3 L of the average 6 L of
blood Na 10 140 145
o plasma – ½ of blood K 155 3.7 3.8
b) interstitial space – between cells Cl 3 102 115
 11-12 L in adult HCO3 10 28 30
 lymph Ca (ionized) <0.01 1.2 1.2
c) transcellular space Mg 10 0.8 0.8
Phosphate 105 1.1 1.0
 “Salty” SODIUM (135-145 mEq/L)
“K+ing” POTASSIUM (3.5-5.0 mEq/L)
 Na+ = edema and chronic kidney
disease  K = cause death;
 Major cation to extracellular fluid  K = erratic heart; leads to arrythmia
o always followed by H2O paparazzi  Major cation in intracellular fluid (95 %)
o where Na+ goes, H2O flows  Functions:
o keeps each muscle cells charged
 Sources:  cardiac rhythm
o salty foods, processed foods, fast o affects nerve impulse transmission
foods, meats and cheese  Sources:
o fruits and green leafy veggies
 Absorbed in small intestine  Absorbed in small intestine
 Excreted in kidneys  Excreted in kidneys (80%), sweat and
 Functions: bowels
o regulate body fluid  Nursing intervention: Monitor the
o maintain fluid and electrolyte condition of the heart and kidney.
balance
o maintain blood volume and blood “Magnum” MAGNESIUM (1.5-2.5 mEq/L)
pressure
o impulse transmission  Mg = calm
 nerve and muscle fibers  Mg = erratic
o keep acid-base balance  Functions:
o maintain normal pH level (7.35- o keep law and order in the muscles
7.45) o protein synthesis
 Regulated by: o nerve functions
o ADH (antidiuretic hormone) o blood sugar control
o “vasopressin” o helps Na and K ions across the cell
o aldosterone (produced in adrenal membrane
gland) o promotes enzyme reaction
 holds Na+ in the body o helps produce ATP
o production of parathyroid
hormone
“4 Eyed” Chloride (95-105 mEq/L)  Sources:
o spinach, almonds and yogurt
 Most abundant anion in ECF  Absorbed in small intestine
o always follow her sister salty Na  Excreted in kidneys
 Sources:  Mg++ and Ca++ are BFF
o table salt, sea salt, seaweed, o Mg++ stimulate parathyroid
tomatoes, olives and others hormone which regulates Ca++
 Absorbed in small intestine o Mg++ is required in Ca++ and
 Excreted in kidneys vitamin D absorption which fights
 Functions: tooth decay by binding Ca ++ to
o maintain blood volume tooth enamel
o maintain blood pressure
o keep pH balance
o CO2 transport in RBC
 “Cocky” Calcium (8.5-10.5 mEq/L) SUMMARY

 Most abundant cation in the body ELECTROLYTES

o 99% found in bone K 3.5-4.0 mEq/L
 Sources: Na 135-145 mEq/L
o green veggies, fruits, almonds and Cl 95-105 mEq/L
dairy products Mg 1.5-2.5 mEq/L
 Absorbed in small intestine Ca 8.5-10.5 mEq/L
 Excreted in kidneys PO4 3.0-4.5 mEq/L
 Function
o make things strong
o strong beats (heart beats) ELECTROLYTE FOOD SOURCES
 very important in heart K green leafy veggies (spinach),
construction banana, avocado, apricot, orange
o strong bones and teeth juice, raisins
o strong blood (clotting factors) Na canned foods, processed foods,
o muscle contractions and nerve cheese, fast foods
Mg green leafy veggies, spinach,
signals
almond, yogurt
 Regulated by 3 main hormones
Ca green leafy veggies, almond, dairy
o Parathyroid hormones
products (tofu)
 Ca++ in the blood PO4 dairy meat and beans
o Calcitonin hormone Cl salt and salt substitutes
 Ca++; oppresses cations of
parathyroid hormones
o Calcitriol ELECTROLYTE DEPLETION CAUSES
 controls blood Ca++ by vomiting NGT suctioning
stopping calcitonin pooping diarrhea, stoma drainage
 Vitamin D enhances Ca++ absorption (colostomy or ileostomy)
 Ca++ and Mg++ are BFF peeing urinary test
o If Mg++ is low, Ca++ fills the role of sweating exercise, diaphoresis (fever, stress,
heat exhaustion)
Mg++
burn high risk for fluid loss
patients
“Punk” Phosphate (3.0-4.5 mEq/L)
Sample Question:
 Most abundant anion in the ICF  Diagnosis: constipation
 Sources:  Intervention for maintaining normal
o meat, poultry, fish, nuts, beans bowel function: Assessing dietary intake
and dairy products  Prevention for constipation: Instruct to
 Functions: fill a 2 L of water
o bone and teeth formation  high roughage = high fiber
o repair cell tissues
 regulated by parathyroid hormone which
regulates Ca++ too
 Calcium worst enemy
o works inversely
o If Ca++ is , phosphate is (vice
versa)
  cisplatin
ELECTROLYTE IMBALANCE  Signs and Symptoms:
1. Heart – low and slow
 flat/inverted/shallow T waves
HYPOKALEMIA
 ST segment depression
 prominent U wave
 low level of K in the blood
 dysrhythmias
 lower than 3.5 mEq/L
2. Muscular – low and slow
 Causes:
 muscle cramping, low/absent DTR
1. GI loss – vomiting, diarrhea,
 flaccid paralysis (paralyzed limbs)
fistulas
 rhabdomyolysis
2. wound drainage
3. GI – low and slow
3. kidney disease
 low GI motility
4. metabolic alkalosis = pH
 hypoactive to absent bowel sounds
 K shift to intracellular space
 constipation
due to H+ movement
 abdominal distention
5. severe diaphoresis
6. hyperaldosteronism
 Nursing Interventions
 adrenal glands (regulates
o If K+ is < 2.5 mEq/L, give K+ as an
Na) secrete high levels of
infusion for almost 4 hours
aldosterone
o Assess first the kidney function
 cushing syndrome –
(Urine output – 230 ml/h
hyperactive adrenal glands
o Best route: Oral
7. nasogastric suctioning
8. transcellular shift o Give with 4 oz of juice
 insulin, albuterol o K Dur tablet, K tab
o pushes K+ from o Signs and symptoms: nausea
intravascular into the and vomiting
cell o Do not take with an empty
o ex: burn patients stomach.
9. poor dietary intake of K+ o Use infusion pump if IV then KVO
o piggyback – infuse over 1
 Drugs: hour
1. Thiazides and loop diuretics o does not exceed 40 mEq/L
 chlorothiazide, chlorothalidone o burning redness during
 hydrochlorothiazide infusion
 furosemide, bumetanide & o Do not give through IV, SQ. M
torsemide because it will kill the patient.
2. Osmosis diuresis o Monitor HR, RR, GI and renal status
 mannitol, contrast agents o Attach cardiac monitor and watch
 sorbitol for EKG changes
3. Other meds o BUN and Creatinine, ABG test
 corticosteroids, insulin o Watch for Mg++ , glucose, Na+ level
 laxatives, antibiotics o Hold K+ wasting diuretics (Lasix,
 epinephrine or albuterol thiazides)
4. Certain antibiotics o Monitor HR if taking digoxin.
 aminoglycosides, penicillin o High risk for digoxin/digitalis
5. Antineoplastic agent (cancer toxicity
medicine)
o Signs and Symptoms: BAD
o Bradycardia/tachycardia
o Anorexia
o Diarrhea due to GI upset (most
common)

o K+ sparring diuretics per MD order

o Spironolactone (Aldactone)
o