Fluid & Electrolyte Balance Dr Grace Ann Varghese

1. Fluid & Electrolyte Balance Dr Grace Ann Varghese Submitted by Aiswaria Varghese

2. BODY FLUID Body fluid refers to the body water and its dissolved substance

3. DISTRIBUTION OF BODY FLUIDS & ELECTROLYTES • Adult man- 60% body weight • Adult women-50% body weight • Infants-70% body weight • Total body water varies with body fat , sex &age • Fat cell- less water • Women<men…..(fluid)

4. DISTRIBUTION FLUID Intracellular fluid (ICF) Extracellular fluid(ECF) intravascular fluid interstitial fluid (btwn cell/tissue)

6. DISTRIBUTION • Body fluid = water + electrolytes • Electrolyte- substance that develop electric charge when dissolved in water • They are Cations – develop +ve charge Anions – develop –ve charge

7. List of cations & anions • .

8. Homeostatic mechanism • Kidney • Heart & ANF • Lungs • Pituitary gland • Adrenal gland • parathyroid gland

9. kidney • Vital to regulate fluid & electrolyte balance • Filter-180 l plasma/day • Excrete-1.8 l urine/day Major functions • Regulation of ECF volume & osmolarity • Regulation of electrolyte levels • Regulation of acid-base • Excretion of metabolic waste

10. Renal blood flow Blood volume Blood pressure -ve Secretion of renin angiotensinogen angiotensin 1 BP ANTINATRIURETIC angiotensin 2 HORMONE vasoconstriction Sodium retained by kidney Blood Na level kidney

11. Heart & anf HEART • Pumping action provide circulation thro kidney under sufficient pressure for urine to form ANF • Atrial natriuretic factor-released in right atrium • This hormone causes diuresis of Na+ & water by acting on kidney , thus decreases the intravascular volume

12. lungs • Vital in maintaining homeostasis • Under the control of medulla the lung act to correct metabolic acid-base disturbance by regulating the levels of CO2 in ECF. • (CO2- a potential acid) • To compensate alkalosis , the lung hypoventilate to retain CO2,the increased acidity helps correct excess alkalinity of the body fluid • To compensate for metabolic acidosis , the lung hyperventilate to remove CO2,thus helps excess acidity • Lung remove-300 L water/day thro’ exhalation

13. Pituitary gland • Specialized cell-hypothalamus manufacture a substance- ADH-stored in posterior lobe of pituitary gland • ADH helps body retain water- WATER CONSERVING HORMONE ADH renal water retension ADH renal water retension & urinary output

14. Pituitary gland Blood osmotic pressure -ve +ve Osmoreceptors in hypothalamus Stimulates posterior pituitary gland • secretion of ADH Re absorption of H2o by kidney Blood osmotic pressure lowered

16. ADRENAL GLAND • Primary adrenocortical hormone in influence of fluid balance is ALDOSTERONE • Promote Na + retention in exchange for K+ & H+ ions • Causes Na + retension & excretion of K+ • Primary regulator for aldosterone secretion-ANGIOTENSIN II • Na + con/ K+ con stimulate aldosterone • CORTISOL, another adrenocortical hormone, produce Na+ in large amt & K+ deficit

17. Parathyroid gland • Regulate Ca2+ & phosphate balance by parathyroid hormone (PTH) • A receprocal relationship exists between Ca2+ & phosphate level. • CALCITONIN- action on Ca2+ is opposite to PTH. • Reduces Ca2+ concentration increased Ca ions Stimulate PTH secretion Depress PTH secretion Ca2+ releases No Ca2+ releases from bone into ECF from bone into ECF

19. FUNCTIONS OF ELECTROLYTES • Maintenance of acid base balance • Maintain proper osmolarity and volume of body fluids • Determine specific physiologic function • Maintenance of electroneutrality • Initiate the production of energy • In impulse transmission

20. FLUID IMBALANCES • Soduim • Potassium • Calcium • Magnesium • Phosphorus

22. Sodium imbalance

23. Sodium imbalance • Most plentiful electrolyte in ECF • Normal value : 135 – 145 mEq/L • 95% bodys active Na + is present in ECF, in ICF – small • Distribution across membrane requires ATP pump….providing energy • The salt intake per day : 50-90 mEq as NaCL

24. SODIUM IMBALANCE HYPONATREMIA • Low Na+ LEVEL • Diluted ECF • Water drawn Into cells HYPERNATREMIA • High serum Na + level • Concentrated ECF • Water pulled out of cells

26. Hyponatremia • Refers to reduced serum sodium level below 135 mEq/l • Most frequent electrolyte disorder • In Marked hyperlipidemia/hypoproteinemia….serum Na+ may appear to be lower than the actual value---PSEUDOHYPONATREMIA

27. ETIOLOGY • GI LOSS • ADRENAL INSUFFICIENCY • SWEATING • SALT LOSING NEPHRITIS

28. SINGS & SYMPTOMS • Anorexia • Nausea • Vomiting • Lethargy • Confusion • Muscle twitching • Seizures • coma

29. TREATMENT WATER RESTRICTION • Chronic asymptomatic hyponatremia-water restriction • Attempts made to increase water excretion • Administration of loop diuretics in conjuntion with Na+ & K+ SODIUM REPLACEMENT • Accomplished by nasogastric tube/parenteral route. • Patients able to eat/drink Na+ replacement easy coz Na+is plenty in diet. • If plasma vol is below normal ,lactated ringers solution can be used

30. HYPERNATREMIA • Refers to greater than normal serum concentration of 145mEq/l • Non hospitalized patients-condition seen in elderly. • Hospitalized patients-condition seen in all ages • Mortality rate ranges : 40-60%

31. ETIOLOGY • Water deprivation • Insensible water loss • Water diarrhoea • Excessive sodium intake • Diabetes insipidus

32. SIGNS & SYMPTOMS • Thirst • Fever • Disorientation • Hallucination • Lethargy • Irritability • Seizures • coma

33. TREATMENT • By addition of water or by removal of sodium depending on imbalance • Children & adult- fluid replacement therapy • Chronic hypernatremia should not be corrected faster than 0.7mEq/l • Acute hypernatremia ,sodium level in serum may be reduced to 6-8 mEq/l in first 3-4 hrs,then decline should not be more than 1mE/l • Std treatment- ADH replacement by means of vasopressin administration

35. MAGNESIUM IMBALANCE • Normal value – 1.3 – 2.1 mEq/L • 2/3 rd located in skeleton , 1/3 rd in ICF & 1% in ECF • Involved in enzymatic reaction • In production & utilization of ATP • In neuronal control • In NM transmission • In CV tone • Kidney – primary route of excretion

36. HYPOMAGNESIA • Total serum Mg level lower than 1.3mEq/L • Common in both ambulatory & hospitalized patients

37. ETIOLOGY • GI Loses • Alcohol • Re feeding after starvation • Drugs disrupting Mg homeostasis

38. Signs & symptoms

39. TREATMENT • Mg replacement • Dietary source of Mg – encouraged • Mg orally administered • Mg – tablet form (diarrhea – side effect) • Given IV/ intramuscular • Mg sulfate - IV

40. HYPERMAGNESEMIA • Total serum Mg level > 2.1 mEq/L • Less common than hypomagnesemia • Occur more frequently • Cause – iatrogenic

41. ETIOLOGY • Renal failure • Mg administered for therapeutic purpose

42. SIGNS & SYMPTOMS • Peripheral vasodilation with facial flushing, sense of warmth, tendency for hypotension, nausea & vomiting • Drowsiness , muscle weakness • Hypotension • Bradycardia • Respiratory depression • Paralysis • Coma • Cardiac arrest

43. TREATMENT • Tx – prevention • Avoid administration of Mg salts –patients with renal failure • Mg oral / IV – patient with hypermagnesemia / deep tendon reflexes • neuromuscular & cardiac toxicity of hypermagnesemia – IV administration of Ca gluconate • Dialysis

44. Potassium imbalance

45. Potassium imbalance • Major IC electrolyte • 98% in ICF • 2% IN ECF • Normal renal function is needed for maintaining potassium balance • 80% excreted through kidney • 20% excreted – bowel &sweat glands • Potassium distribution requires Na+/K+pump • Normal value : 3.5-5mE/l

46. HYPOKALEMIA • Refers to below normal serum K+ concentration • Mild hypokalemia : 3-3.5mEq/l • Moderate hypokalemia : 2.5-3mEq/l • Severe hypokalemia : 2..5mEq/l or less

47. ETIOLOGY • Renal losses • GI loses • Shift into cells • Sweat loses

48. Signs & symptoms

49. TREATMENT • Best treatment– prevention • Hypokalemia due to alkalosis be given KCL • Loop & thiazide diuretics+ potassium sparing diuretics • K+ given thro oral / IV route • Potassium acetate –patients with acidosis • Potassium phosphate used whn patient deficit in potassium & phosphate

50. hyperkalemia • Refers to greater than normal serum potassium level • Often due to iatrogenic causes • More dangerous coz associated with cardiac arrest