FLUIDS & ELECTROLYTES
Adult body: 40L water, 60% body weight
2/3 intracellular
1/3 extracellular (80% interstitial, 20% intravascular)
Infant: 70-80% water
Elderly: 40-50% water
Extracellular fluid – divided into interstitial & intravascular
substances that dissolve in other substances form a solution
solute – the substance dissolved
solvent – substance in which the solute is dissolved
- usually water (universal solvent)
molar solution (M) - # of gram-molecular weights of solute per liter of solution
osmolality – concentration of solute per kg of water
normal range = 275-295 mOsm/kg of water
osmolarity – concentration of solute per L of solution
* since 1kg=1L, & water is the solvent of the human body, osmolarity & osmolality are
used interchangeably
electrolyte - any of various ions, such as sodium, potassium, or chloride, required by cells to
regulate the electric charge and flow of water molecules across the cell membrane.
Ions – electrically charged particles
Hydrostatic pressure -pushes fluid out of vessels into tissue space; higher to lower pressure
– due to water volume in vessels; greater in arterial end
– swelling: varicose veins, fluid overload, kidney failure & CHF
Osmotic pressure -pulls fluid into vessels; from weaker concentration to stronger
concentration
- from plasma proteins; greater in venous end
- swelling: liver problems, nephrotic syndrome
Active transport – use of energy to move ions across a semipermeable membrane against a
concentration, chemical or electrical gradient
Diffusion – particles in a fluid move across a semipermeable membrane from an area of
greater to lesser concentration
Acid - yields hydrogen ions
- HCl, carbonic acid, acetic acid (vinegar), lactic acid
Base – yields OH; binds with H ions
- magnesium & aluminum hydroxide (antacids), ammonium hydroxide (household
cleaner)
Fluid Balance Regulation
Thirst reflex triggered by:
1. decreased salivation & dry mouth
2. increased osmotic pressure stimulates osmoreceptors in the hypothalamus
3. decreased blood volume activates the renin/angiontensin pathway, which simulates
the thirst center in hypothalamus
Renin-Angiotensin
1. drop in blood volume in kidneys = renin released
2. renin = acts on plasma protein angiotensin (released by the liver) to form angiotensin
I
3. ACE = converts Angiotensin I to Angiotensin II in the lungs
4. Angiotensin II = vasoconstriction & aldosterone release
ADH – produced by hypothalamus, released by posterior pituitary when osmoreceptor or
baroreceptor is triggered in hypothalamus
Aldosterone – produced by adrenal cortex; promotes Na & water reabsorption
Sensible & Insensible Fluid Loss
Sensible: urine, vomiting, suctioned secretions
Insensible: lungs (400ml/day)
Skin (400ml/day evaporation, 200ml/day sweat)
GI (100ml/day)
IV Fluids
Isotonic LR
PNSS (0.9%NSS)
NM
Hypotonic D5W
- isotonic in bag
- dextrose=quickly metabolized=hypotonic
D2.5W
0.45% NSS
0.3% NSS
0.2% NSS
Hypertonic D50W
D10W
D5NSS
D5LR
3%NSS
Colloids (usually CHONs) & Plasma expanders
Albumin
Plasma – for hypoalbuminemia, volume-depleted patients
- has protein, including CF (I to IX)
Dextran – synthetic polysaccharide, glucose solution
- increase concentration of blood, improving blood volume up to 24 hrs
- contraindicated: heart failure, pulmonary edema, cardiogenic shock, and renal failure
Hetastarch – like Dextran, but longer-acting
- expensive
- derived from corn starch
Composition of Fluids
Saline solutions – water, Na, Cl
Dextrose solutions – water or saline, calories
Lactated Ringer’s – water, Na, Cl, K, Ca, lactate
Plasma expanders – albumin, dextran, plasma protein (plasmanate)
- increases oncotic pressure, pulling fluids into circulation
Parenteral hyperalimentation – fluid, electrolytes, amino acids, calories
Fluid Volume Deficit
Hypertonic: some diuretics, Diabetes insipidus, Diabetes Mellitus, infections, fever, decreased
water intake, salt tablet/salt water intake, watery diarrhea
Hypotonic: diuretics, salt-wasting renal diseases, Addison’s disease
Isotonic: diuretics, diarrhea, vomiting, blood loss, third-spacing
S/S: thirst
Dry skin, mucous membranes
Increased temp, flushed skin
Rapid, thready pulse
Increased Hct, specific gravity, etc.
Late: hypotension
decreased UO
adult – 30ml/hr
children – 1-2ml/kg/hr
kids: depressed fontanels
Fluid Volume Excess
Hypertonic: cause - hypertonic IV fluids, hyperaldosteronism
May lead to: CHF, edema etc
Hypotonic: increased water intake, tap water enemas/irrigations, SIADH
Isotonic: renal failure, corticosteroids
S/S CHF-like
weight gain, edema, ascites
crackles, dyspnea
distended neck veins
bounding pulse
confusion, weakness
increased CVP
Decreased Hct, BUN etc
Kids: bulging fontanels
Old vs. infants
Body water & regulation:
Old – 40-50%
- kidneys cannon concentrate or dilute urine as efficiently
- diminished thirst mechanism
Infant – up to 80% (90% if premature)
- kidneys immature until age 2
- larger body surface area for size
- higher metabolic rate requires more water
Skin turgor:
Old – use sternum, forehead, inner thigh, top of hip bone
Infant – abdomen, inner thighs