Fluid and electrolyte – 60% of body weight b.

Chloride – cation; affects pH; maintains acid -

base
Sensible loss – can be measured; urinating,
bleeding, defecating Bicarbonate – regulate acid base

Insensible loss – non- visible; respiration;

perspiration
FACTORS THAT AFFECT FLUID AND
Hypothalamus – thirst mechanism ELECTROLYTE BALANCE

Fluid Compartments: * Gender

a. Extracellular – outside the cell 1. Males – 60% - more muscle – 80% water

i. Intravascular – fluid within the 2. Females – 50% - more adipose tissue – 15%
vascular system; blood water
plasma
* Age
ii. interstitial – fluid that surrounds the
1. Infants – 80%
cell
2. Elderly – less muscle: thirst center diminished
iii. transcellular fluid – all other fluids;
synovial ** both risk for fluid electrolyte imbalance
b. Intracellular – fluids that are found within the
cells of the body
FLUID SHIFTING
Electrolytes – allows fluid movement from one
compartment to the other Diffusion – solutes move – higher to lower

Major Electrolyte in the ICF
a. Potassium – nerve impulses, regular cell
excitability
b. Magnesium - leading ICF cation; protein
synthesis; affect neuromuscular
processes
c. Calcium – action in teeth and bones; help to
adhere to one another; muscular
contraction; blood coagulation
Active transport – use of energy – solutes lower
to higher
Osmosis – movement of solvent – low to high
concentration; passive
SOLUTE - solids; diluted in solvent
SOLVENT – liquids
1 kg = 1 liter

d. Phosphorous - ICF anion - Hydrogen buffer;

promotes energy storage

Major Electrolyte in ECF

a. Sodium – cation; governs normal osmolality;

activates the nerve and muscles
Kidneys – 20 ml of urine = 500 ml/day Atrial – natriuretic peptide (ANP)

Normal is 30 ml - reducing intravascular blood volume

ADH – anti – diuretic hormone – pituitary gland - diuresis is promoted

- its presence or absence whether the - decreases blood pressure and volume
urine that is excreted id concentrated or dilute.
- Opposite of RAAS

Thirst –
RAAS – Renin – Angiotensin –Aldosterone –
Dehydration – too much body loss
System
Hypervolemia – fluid water loss
Renin – enzyme that converts angiotensin, an
inactive substance formed by the liver, into Diuretic
angiotensin I and angiotensin II. Renin is
released in response to decreased renal
perfusion. An enzyme released within the lung Fluid balance – to maintain homeostasis
capillaries converts angiotensin I to angiotensin
II. Angiotensin II with its vasoconstrictor a. Fluid balance = I=O
properties, increased arterial perfusion pressure i. GIT – oral route
and stimulates thirst. As the sympathetic
nervous system is stimulated, aldosterone is ii. Parenteral – intravenous fluids,
released in response to an increased release of subcutaneous injection, enteral
renin. Aldosterone is a volume regulator feeding
(controls fluid balance) and is also released as
iii. Pulmonary – O2 therapy through
serum potassium increases, serum sodium
mists
decreases, or adrenocorticotropic hormone
increases. iv. Irrigation – gavage –body
cavities/orifice
** RAAS controls fluid volume
b. Fluid Distribution – fluid shifting; osmosis
Aldosterone – fluid balance – decreased fluid
ICF; ECF
↓
c. Fluid Excretion – sensible (urination,
Then renin is released from juxtaglomerular cell
perspiration; insensible (respiration)
in the liver
i. Kidneys – 1 – 2 L in an adult
↓
ii. GIT – 100 – 200 mL / day ; diarrhea
Angiotensin I – lungs – Angiotensin II 500mL

↓ iii. Skin – perspiration ; sodium,

chloride, potassium
Aldosterone – help regulate fluid balance
iv. Lungs – insensible 400mL/day

v. DHn Losses – emesis, fistula, suction

tube, hemorrhage
Tonicity – ability of all the solutes to cause an
osmotic driving force that promotes water
movement from one compartment to another
1. Isotonic – same solute and solvent
Urea – can pass through semi permeable
membrane
Glucose, albumin – cannot through semi
permeable membrane

- equal concentration to one Chemical Regulation – help maintain

homeostasis
- ECF =ICF
Buffer System – vasoreceptor
- no shifting of liquids
ADH – anti – diuretic hormones synthesize
-e.g PNSS; plain lactated ringer’s; plain
hypothalamus – posterior pituitary gland –
normal saline solution;
regulate water
2. Hypertonic - solutions high solute
Prolonged fever/vomiting/diarrhea
concentration
Excessive perspiration, severe blood loss, septic
- can lead to cell shrinkage
shock
- ICF – ECF
↓
- cell to blood stream (intravascular);
↓ BP, ↓ Blood Volume , ↑ Blood osmolality
volume expander
↓
- e.g 3% - 5% saline solution; dextrose
solution greater than 5%; osmotic Osmoreceptor in hypothalamus
diuretics; dextran; albumin
Stimulate posterior pituitary gland, to secrete or
3. Hypotonic – lower solute concentration release ADH

- use to prevent cellular ↓

dehydration
ADH stimulates renal tubules to ↑ reabsorption
- e.g D5H20; .45% - .33% saline of water
solution
↓
- extracellular to intracellular
Scant urine (concentrated)
- intravascular, blood vessles
↑ BP ↑BV ↓ blood osmolality
Osmolality – concentration of solute of 1 kg of
H20 = m0sm/kg of water
Angiotensin – vasoconstrictor – increase blood
Osmolarity – concentration of solute of 1 L of
pressure as it passed blood vessels
H20 = m0sm/L water or solution
Aldosterone – it retains water – blood vessel
- to prevent intracranial pressure; edema
become narrower
Osmosis – fluid
- renin – angiotensin
Diffusion – balance homeostasis
ACE – amgiotensin converting enzyme – arterial
pressure; stimulates thirst mechanism
Cardiac output – pump by the blood of the - ↑ Na diet ↑Na result ; poor
heart excretion

Perfusion – oxygen supply to the kidneys ABG – Arterial Blood Gases

How to evaluate fluid status through  NORMAL BLOOD PH (potential

assessment hydrogen): 7.35 – 7.45
↓acidosis ↑alkalosis
Skin turgor – resiliency of the skin once it is
 PCO2 – 35 – 45 mmHg
pinched
↓alkalosis↑acidosis
BUN – Blood Urea Nitrogen  PO2 – 80 – 100 mmHg
> 100 more than adequate
- by product of CHON 80 -100 – still adequate o2
(protein)metabolism 70 – 79 – mild hypoxia
- N = 10 -20 mg/dL (3.6 – 7.2 mmol/L) 50 -69 – moderate hypoxia
Below 50 – severe hypoxia
↓ (↓renal fxn, GI bleeding,  Bicarbonate – 22 – 26
DHN , ↑ CHON intake, fever, ↓acidosis ↑alkalosis
sepsis = hindi nafifiltrate ng
kidney

↑ (low CHON diet,

starvation, pregnancy

Creatinine – end product of muscle metabolism

- N = .7 – 1.4 mg/dL (62-124 mmol/L)

↓ when renal function is ↓

Hematocrit – volume of % of blood particularly

RBC, WBC, plasma

N= 42 – 52% Male

= 35-47% Female

↑ DHN, polycythemia,↑ number

of RBC

↓ overhydration, anemia - ↓
RBC, diluted blood component

Urine Na – N = 5 – 200 mEq/24

(75- 200 mmol/24°)

- fluid volume, depending fluid

intake, excretion of Na intake