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Fluid and electrolytes balance. Terry White, MBA, BSN. Body fluid and electrolyte: About 46 to 6o % of the average adult weight is water. Water may serve as:. Medium of metabolic reaction with cells. Transporter for nutrients, waste products, and other substance. A lubricant.

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Fluid and electrolytes balance

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Fluid and electrolytes balance

Fluid and electrolytes balance

Terry White, MBA, BSN

Fluid and electrolytes balance

Body fluid and electrolyte:

  • About 46 to 6o % of the average adult weight is water.

Water may serve as

Water may serve as:

  • Medium of metabolic reaction with cells.

  • Transporter for nutrients, waste products, and other substance.

  • A lubricant.

  • Shock absorber.

  • Regulate and maintain body temperature.

Fluid and electrolytes balance

  • The proportion of water decreases with aging because fat, age and sex effect of total body water.

  • (Infant 70 – 80%).

Distribution of body fluids

Distribution of body fluids:

  • The body fluid divided in two major compartments:

    A) Intracellular fluid (ICF):

  • Is found in the cells of the body. its constitute 2/3 of the total body fluid in the adult.

Fluid and electrolytes balance

b) Extracelluar fluid (ECF):

  • is found out side of cell and account 1/3 of the total body fluid.

  • it’s subdivided into three compartments:

    1) Intravascular fluid or plasma: is found within vascular system.

    2) Interstitial fluid: is found surrounding the cell and includes lymph.

    3) Transcellular: includes cerebrospinal fluid, pleural, peritoneal and synovial fluid.

Fluid and electrolytes balance













Composition of Fluids

Fluid and electrolytes balance

  • Function of ICF & ECF:

  • ICF: is vital to normal cell function, its contain solutes such as oxygen, electrolytes and glucose. It provides a medium to metabolic process.

  • ECF: it is the transport system that carries nutrients and waste product from the cell.

Movement of body fluid and electrolyte

Movement of body fluid and electrolyte:

1. Osmosis:

  • Is the movement of water across cell membranes, from the less concentrated solution to more concentrated solution. In other word water move toward higher concentration.

Fluid and electrolytes balance

  • Solutes are substance dissolved in liquid.

  • Crystalloid: salts that dissolved readily in to true solution.

  • Colloids: substance such as large protein molecules that do not dissolved in true solution.

  • Sodium is the major determinant of serum osmolality.

  • Fluid and electrolytes balance

    2. Diffusion:

    • Is the continual intermingling of molecules in liquid, gases by random movement of the molecules.

    Fluid and electrolytes balance

    3. Filtration:

    • Is the process where by fluid and solutes moved together across a membrane from one compartment to another.

    Fluid and electrolytes balance

    4. Active transport:

    • substance can move across cell membranes from a less concentrated solution to amore concentrated one by active transport.

    Fluid and electrolytes balance

    Regulating body fluid:

    • The average adult drinks about 1500ml per day, but need to 2500ml per day, this added volume is acquired by the food.

    • The thirst center is located in the brain, this center trigger by osmotic pressure and angiotensin II .

    Hormonal regulation

    Hormonal regulation

    Regulation of ecf

    Regulation of ECF

    Fluid out put

    Fluid out put:

    • Urine: normal urine out put 1500ml per 24hrs or at least 30ml per hours.

    • Insensible loss: through the skin as perspiration and through the lung a water vapor in the expired air.

    • Loss through the intestine (feces)

    Fluid and electrolytes balance

    • Obligatory losses: approximately 500ml of fluid must be exerted through the kidney to eliminate metabolic waste product and feces, respiration and perspiration to maintain body temperature.

    • The average daily fluid out put for an adult 2500ml/ day.

    Client at risk for fluid and electrolyte imbalance

    Client at risk for fluid and electrolyte imbalance:

    • Post operative client.

    • Client with sever trauma or burn.

    • Client with chronic disease as congestive heart failure.

    • Client who are NPO.

    • Client with intravenous infusion.

    • Client with special drainage.

    • Client who receiving diuretic

    Factor effecting fluid and electrolyte balance

    Factor effecting fluid and electrolyte balance:

    • Age: infant have greater water need and greater loss due to greater metabolic rate.

    • Environment: excess heat stimulates the sympathetic nervous system and cause person to sweat.

    Fluid and electrolytes balance

    • Diet: in nutritional deficiency, the body preserved the protein by breaking down the fat and glycogen.

    • Stress: water retention and increase the production antiduritic hormone.

    • Illness: burn, renal disorder

    Fluid and electrolytes balance

    Disturbances in fluid and electrolyte:

    • Hypovolemia: decrease blood volume

    • Hypovolemic shock when intravascular fluid is depleted.

    • Hypervolimia: increase blood volume.

    Fluid and electrolytes balance

    Edema: is collection of fluids in the tissue.

    Type of edema:

    • Dependent edma: found in the lowest part body.

    • Pitting edma: edema that leaves a depression or pit after finger pressure is applied on the swollen area.

    Pitting odema

    Pitting odema

    Fluid and electrolytes balance

    • Sodium (Na):

    • Is the most abundant cation in the extracelluar fluid and major contributor to serum osmolality.

    • Function of sodium:

    • controlling and regulating water balance.

    • Maintaining blood volume

    • Transmitted nerve impulses.

    Fluid and electrolytes balance

    • Normal level is 135 – 145 mg/dl.

    • Hyponatremia: sodium deficit in the blood.

    • Hypernatremia: sodium excess in the blood.

    • Sodium is found in many foods, such as processed cheese, table salt.

    Fluid and electrolytes balance


    • Is the major cation in intracellular fluid.

    • Function of potassium:

    • Maintain ICF osmolality.

    • Transmitting nerve impulses.

    • Regulate cardiac impulses.

    • Skeletal and smooth muscle function.

    • Regulate acid base balance

    Fluid and electrolytes balance

    • Potassium is found in many fruits and vegetables, meat, fish, milk.

    • Normal level of potassium is 3.5 – 5.3meq/l.

    • Hypokalemia: potassium deficit in the blood.

    • Hyperkalemia: potassium excess in the blood.

    Fluid and electrolytes balance

    • Hypocalcemia: calcium deficit in the blood.

    • Hypercalcemia: calcium excess in the blood.

    Loss of water and electrolyte

    Loss of water and electrolyte:

    • Vomiting.

    • Diarrhea.

    • Excessive sweating.

    • Ployuria.

    • Fever.

    • Nasogastric suction.

    • Abnormal drainage.

    • Anorexia.

    • Nausea

    • Impaired swallowing.

    Finding associated with fluid and electrolyte imbalance

    Finding associated with fluid and electrolyte imbalance:

    • Skin: dry pale, cool skin, reduce skin Turgor.

    • Oral cavity: dry mucous membrane, absence of salivation.

    • Weak rapid pulse.

    • Decreased blood pressure.

    • Decreased central venous pressure

    Fluid and electrolytes balance

    • Decreased urine out put.

    • Increased hematocrit.

    • Thirst.

    • Flat neck vein.

    Fluid volume excess

    Fluid volume excess:

    • Excess intake of sodium – containing intravenous fluid.

    • Excess of ingestion of sodium in diet.

    • Heart failure.

    • Renal failure.

    • Liver cirrhosis.

    Clinical manifestation

    Clinical manifestation:

    • Weight gain.

    • Fluid intake greater than out put.

    • Moist mucous membrane.

    • Tachycardia.

    • Increased blood pressure.

    • Distended neck vein.

    • Dyspnea and crackles.

    • Mental confusion.

    Acid base balance

    Acid – Base Balance

    Nursing care plan

    Nursing care plan

    • Assessment:

      • Nursing history:

    • Date include fluid and food intake, output.

    • Recent fluid losses.

    • Sign of fluid deficit.

    • Common sign of electrolyte disturbance.

    • Medication.

    Fluid and electrolytes balance

    Clinical measurement:

    • Daily weights, vital sign, fluid intake and output (I&O), serum electrolyte, complete blood count (CBC). Serum osmolality, urine specific gravity.

    Nursing diagnosis

    Nursing diagnosis:

    • Fluid volume deficit related to dehydration.

    • Fluid volume excess related to heart failure.

    • Altered oral mucous membrane related to fluid volume defects.

    • Impaired skin integrity related to dehydration

    • Decreased cardiac output related to hypovolemia.

    • Altered tissue perfusion related to decreased cardiac output.



    • Assess clinical manifestation of hypo or Hypervolimia.

    • Provide fluid and electrolyte orally.

    • Foods.

    • Intravenous therapy can prescribed for those reason

    • Provide salts if needed.

    • Provide glucose for metabolism.

    • Provide water soluble vitamins

    Fluid and electrolytes balance

    • Monitor intake & output.

    • Monitor lapratory finding.

    • Provide frequent oral care.

    • Monitor weight.

    • Assess for edma.

    • Place patient in fowler position.

    • Assess breathing sound, inspiration and expiration (crackles).

    • Provide safety for client

    Fluid and electrolytes balance

    The End

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