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![-Primary controller of the body’s carbonic acid
supply
-Carbon dioxide constantly produced by cellular
metabolism (Carbonic acid[H2CO3] yields CO2and
H2O), is excreted by exhalation.](https://image.slidesharecdn.com/fluidandelectrolyteimbalance-180131131237/75/Fluid-and-electrolyte-imbalance-26-2048.jpg)
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Fluid and electrolyte imbalance
This document discusses fluid, electrolyte and acid-base balance in the human body. It covers the following key points: 1. Approximately 60% of adult weight consists of fluid that is regulated by various systems like the kidneys and lungs. Fluid is divided into intracellular and extracellular compartments. 2. Electrolytes like sodium, potassium, calcium and chloride are important for various body processes and their levels are regulated. Imbalances can cause issues in different organ systems. 3. The kidneys, lungs, skin and other organs help maintain fluid and electrolyte balance through processes like filtration, diffusion and active transport between compartments. Hormonal factors also play a role in homeostasis.
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Similar to Fluid and electrolyte imbalance
Fluid and electrolyte imbalance
- 1. MR.J.G SAMBAD IKDRC COLLEGEOF NURSING
- 2. Fluid, electrolyteand acid base balance within the body are necessary to maintain the health and function in all the body systems. These balance are maintain by the intake and output of the water and electrolyte and regulation by the renal and pulmonary systems.
- 3. Approximately 60%ofadult weight consist of fluid (i.e. water ad electrolyte) Factors that influence the amount of body fluid are age, gender and body fat.
- 4. 4 Intracellular fluids (ICF) Extracellularfluids (ECF) 2/3 (65%) of TBW is intracellular (ICF) 1/3 extra cellular water -ECF is divided into small compartments 25 % interstitial fluid (ISF) 5- 8 % in plasma (IVF intravascular fluid) 1- 2 % in Tran cellular fluids – CSF, intraocular fluids, serous membranes, and in GI, respiratory, urinary tracts and synovial fluid
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- 7. Electrolytes Two typesof electrolytes are Cations e.g. Na+, K+, Ca+, H+ Anions e.g. Cl-, HCO3-,SO4-, P- The unit of these ions are expressed in terms of Milliequivalent (mEq/l)
- 8. Fluids andelectrolytes constantly shift from compartment to compartment to facilitate body process such as tissue oxygenation, acid base balance and urine formation. Route for transporting materials to and from intracellular compartments Osmosis, Diffusion, Active transport and Filtration.
- 9. Osmosis isthe movement of a pure solvent, such as water through a semipermeable membrane from an area of lesser solute concentration to an area of greater concentration
- 10. Osmotic pressure- it is the amount of the hydrostatic pressure needed to stop the flow of water by osmosis Oncotic pressure Osmotic diuresis
- 11. It isthe movement of a solute (gas or substance) in a solution across a semi permeable membrane from an area of higher concentration to lower concentration. FILTRATION It is a process by which water and diffusible substance move together in response to fluid pressure, moving from an area of higher pressure to lower pressure.
- 12. It isa process that requires energy for the movement of a substance through a cell membrane from an area of lesser solute concentration to higher concentration.
- 13. Kidneys Skins Lungs G. I. tract.
- 14. Ingested liquids Water in food water in metabolic oxidation
- 16. The physiologicalbalance of the body fluid are regulated by fluid intake , hormonal controls, and fluid output is known as Homeostatic. Organs involved in homeostasis include the Kidneys, Heart, Lungs, adrenal glands, parathyroid glands and pituitary glands
- 17. Regulation ofECF volume and osmolarity by selective retention and excretion of body fluids Regulation of Ph of the ECF by retention of H+ HEART AND BLOOD VESSELS - The pumping action of the heart circulates blood through the kidney under sufficient pressure to allow for urine formation _ Failure of this pumping action interferes with renal perfusion and hypovolemia by stimulating with retention
- 18. To correctmetabolic acid base disturbance regulates H+ concentration (pH) by controlling the level of CO2 in the ECF PITUITARY GLANDS - Stores and release the antidiuretic hormone (ADH) which makes the body retain water ADRENAL GLANDS - Regulate blood volume and Na and K balance by secreting ALDOSTERONE - Increase aldosterone secretion causes Na retention and K loss
- 19. Regulate Caand PO4balance by means of parathyroid hormone (PTH) PTH influence bone reabsorption Ca absorption Increase secretion of PTH causes A) elevated serum Ca concentration B) lower serum po4 concentration
- 20. Inhibits andstimulates mechanism influencing fluid balance, regulate Na and water intake and excretion Regulates oral intake by acting at thirst centre located in hypothalamus ADH AND THIRST - Maintaining Na concentration and oral intake of fluid - Oral intake is controlled by the thirst centre located in hypothalamus
- 21. Osmoresceptors aresensitive to change in the concentration of ECF Sending appropriate impulses to the pituitary to release ADH
- 22. Acid - Anacid is a substance containing H+ that can be liberated or release Base -A base is a substance that can accept or trap H+
- 23. Buffer system, Respiratory mechanism and Renal mechanism -A buffer is a substance that can absorbed or released H+ to correct an acid-base imbalance.
- 24. 1.Carbonic acid-sodium bicarbonate buffersup to 90% of the H+ of (ECF) Acts like a base and binds free hydrogen ions. 2.Phosphate Buffer System Active in intracellular fluid It converts alkaline sodium phosphate (Na2HPO4) a week base to acid sodium phosphate(NaH2PO4) in the kidneys.
- 25. It isa mixture of the plasma protein and the globins portion of the hemoglobin in RBC. It can combine with or liberate hydrogen ions that tends to minimize change in PH and serves as excellent buffering agent.
- 26. -Primary controller ofthe body’s carbonic acid supply -Carbon dioxide constantly produced by cellular metabolism (Carbonic acid[H2CO3] yields CO2and H2O), is excreted by exhalation.
- 27. The concentrationof bicarbonate in the plasma is regulated by kidneys. Kidneys excrete or retain H+ and form or excrete bicarbonate ion is responsible to the pH of the blood.
- 28. Electrolyte imbalances: Sodium Hypernatremia (high levels of sodium) Plasma Na+ > 145 mEq / L Due to ↑ Na+ or ↓ water Water moves from ICF → ECF Cells dehydrate 28
- 29. Hypertonic IVsoln. Oversecretion of aldosterone Loss of pure water Long term sweating with chronic fever Respiratory infection → water vapor loss Diabetes – polyuria Insufficient intake of water (hypodipsia) 29
- 30. Thirst Lethargy Neurological dysfunction due to dehydration of brain cells Decreased vascular volume 30
- 31. Lower serumNa+ Isotonic salt-free IV fluid Oral solutions preferable 31
- 32. Overall decreasein Na+ in ECF Two types: depletional and dilutional Depletional Hyponatremia Na+ loss: diuretics, chronic vomiting Chronic diarrhea Decreased aldosterone Decreased Na+ intake 32
- 33. Dilutional Hyponatremia: Renal dysfunction with ↑ intake of hypotonic fluids Excessive sweating→ increased thirst → intake of excessive amounts of pure water Syndrome of Inappropriate ADH (SIADH) or oliguric renal failure, severe congestive heart failure, cirrhosis all lead to: Impaired renal excretion of water Hyperglycemia – attracts water 33
- 34. Neurological symptoms Lethargy, headache, confusion, apprehension, depressed reflexes, seizures and coma Muscle symptoms Cramps, weakness, fatigue Gastrointestinal symptoms Nausea, vomiting, abdominal cramps, and diarrhea Tx – limit water intake or discontinue meds 34
- 35. Serum K+ <3.5 mEq /L Beware if diabetic Insulin gets K+ into cell Ketoacidosis – H+ replaces K+ , which is lost in urine β – adrenergic drugs or epinephrine 35
- 36. Decreased intakeof K+ Increased K+ loss Chronic diuretics Trauma and stress Increased aldosterone 36
- 37. Neuromuscular disorders Weakness, flaccid paralysis, respiratory arrest, constipation Dysrhythmias, Postural hypotension Cardiac arrest Treatment- Increase K+ intake, but slowly, preferably by foods 37
- 38. Serum K+ >5.5 mEq / L Check for renal disease Massive cellular trauma Insulin deficiency Addison’s disease Potassium sparing diuretics Decreased blood pH Exercise causes K+ to move out of cells 38
- 39. Early –hyperactive muscles , paresthesia Late - Muscle weakness, flaccid paralysis Change in ECG pattern Dysrhythmias Bradycardia , heart block, cardiac arrest 39
- 40. If time,decrease intake and increase renal excretion Insulin + glucose Bicarbonate Ca++ counters effect on heart 40
- 41. Most inECF Regulated by: Parathyroid hormone ↑Blood Ca++ by stimulating osteoclasts ↑GI absorption and renal retention Calcitonin from the thyroid gland Promotes bone formation ↑ renal excretion 41
- 42. Results from: Hyperparathyroidism Hypothyroid states Renal disease Excessive intake of vitamin D Malignant tumors – hypercalcemia of malignancy Tumor products promote bone breakdown Tumor growth in bone causing Ca++ release 42
- 43. Effects: Manynonspecific – fatigue, weakness, lethargy Increases formation of kidney stones and pancreatic stones Muscle cramps Bradycardia, cardiac arrest Pain GI activity also common Nausea, abdominal cramps Diarrhea / constipation Metastatic calcification 43
- 44. Hyperactive neuromuscularreflexes and tetany differentiate it from hypercalcemia Convulsions in severe cases Caused by: Lack of vitamin D Suppression of parathyroid function Hypersecretion of calcitonin Malabsorption states Widespread infection or peritoneal inflammation Pancreatitis – produce fatty acid that combine with calcium , iron decreasing serum Ca level 44
- 45. Diagnosis: Chvostek’ssign Trousseau’s sign Treatment IV calcium for acute Oral calcium and vitamin D for chronic 45
- 46. It refersto a magnesium excess. It depress the skeletal muscles and nerve function. The depression of acetylcholine leads to a sedative effect, which can lead to bradycardia, cardiac arrhythmia, and decreased respiratory rate and depth. Occurs in end stage renal failure. 46
- 47. 47 Renal failure. Excess oral or parenteral intake of magnesium. SIGN and SYMPTOMS: Hypoactive deep tendon reflexes Decrease depth and rate of respiration, Hypotension and flushing. LAB FINDINGS Serum magnesium level > 2.5 mEq/L
- 48. Magnesium deficit. Occurs with malnutrition and malasorption disease and sign and symptoms related to neuromuscular disorders. CAUSES Inadequate intake: malnutrition and alcoholism. Inadequate absorption: diarrhea, vomiting, fistulas, disease of small intestine. Aldosterone excess Polyuria. 48
- 49. Muscular tremor, Hyperactive deep tendon reflexes, Confusion and disorientation, Dysrhythmia and positive chvosliks and Trousseasis sign. LAB FINDINGS Srrum magnesium level < 1.5 mEq/L 49
- 50. ISOTONIC IMBALANCE : i)Fluid volume deficit (Hypovolemia) ii) Fluid volume excess (Hypervolemia) OSMOLAR IMBALANCE : i) Hyper osmolar imbalance (Dehydration) ii) Hypoosmolar imbalance (Water excess) 50
- 51. Diarrhea Vomiting Drainage from fistula and tubes. Loss of plasma or whole blood eg. Burns and hemorrhage Excessive perspiration Decreased oral intake of fluids Fever Use of diuretics. 51
- 52. Postural hypotention Tachycardia Dry mucous membranes Poor skin turgor, thirst Confusion, lethargy Rapid weight loss and weak pulse LAB FINDINGS Urine sepecific gravity >1.030 Increased hematocrit level and BUN level
- 53. FVE refersto an isotonic expansion of ECF caused by the abnormal retention of water and sodium near normal proportion which are normally exist in ECF. CAUSES Congestive heart failure Renal failure Increased serum aldosterone and steroid level Excessive sodium intake or administration.
- 54. Rapid weightgain, edema Hypertension and polyuria Neck vein distention Increased venous pressure LAB FINDINGS Decreased hematocrit level
- 55. HYPEROSMOLAR IMBALANCE (DEHYDRATION) Itrefers only to a decreased volume of water alone with increased serum sodium level. CAUSES: Diabetic ketoacidosis Osmotic diuresis Administration of hypertonic parenteral fluid .
- 56. Dry andsticky mucous membranes Flushed and dry skins Thirst and irritability Elevated body temperature Convulsion and coma. LAB FINDINGS Increased serum sodium level above 145mEq/L
- 57. It refersonly to above normal amounts of water in extracellular space. CAUSES: Excess water intake Malfunction of the kidneys causing inability to excrete the excesses. SIGNS AND SYMPTOMS: Decreased level of consciousness Edema around eyes, fingers, ankles .
- 58. Decreased serumsodium level below 135mEq/L. ACID-BASE IMBALANCE Acid base imbalances occur when the carbonic acid or bicarbonate levels become disproportionate. FOUR MAIN TYPES OF ACID BASE IMBALANCE Respiratory acidosis Respiratory alkalosis Metabolic acidosis Metabolic alkalosis
- 59. Respiratory acidosisis a clinical disorder in which the pH is less than 7.35 and the PaCO2 is greater then 42 mmHg. Respiratory acidosis = high PaCO2 because of alveolar hypoventilation.
- 60. Respiratory alkalosisis a clinical condition in which the arterial pH is greater than 7.45 and the PaCO2 is less than 38 mmHg. Respiratory alkalosis = low PaCO2 because of alveolar hyperventilation.
- 61. Metabolic acidosisis a clinical disturbance characterized by a low pH ( increased H+ concentration) and a low bicarbonate concentration. It can be produced by again of hydrogen ion or a loss of bicarbonate. Metabolic acidosis = low bicarbonate or HCO3 - is loss in similar amount. ABG<7.35 Paco2 <35 mm of Hg.
- 62. Metabolic alkalosisis a clinical disturbance characterized by a high pH ( decreased H+ concentration) and a high bicarbonate concentration. Metabolic alkalosis = high bicarbonate. ABG>7.45 Paco2>45mm of Hg.
- 63. 3 TYPES OFIV FLUIDS i) Isotonic fluids ii) Hypotonic fluids iii) Hypertonic fluids
- 67.