ELECTROLYTES
by Guiomar Goransson, RN, CHPN
©2008

FLUID/WATER - The body holds water/fluid in 2 basic areas or compartments --- inside cells and outside them. Sixty-five percent (65%) of body is water/fluid.

EXTRACELLULAR fluid -found OUTSIDE cells.

  • INTERSITIAL fluid - extracellular fluid that fills spaces between most of the cells of body and provides substantial portion of liquid of the body.

  • INTRAVASCULAR fluid - found INSIDE blood vessel (it’s blood)



INTRACELLULAR fluid - found INSIDE cells. Cells are mostly water.

TRANSCELLULAR fluid comprises about 8% and includes:

    • digestive juices
    • intraocular fluid
    • cerebrospinal fluid
    • bladder and renal tubles
    • synovial fluid


FUNCTIONS OF WATER/FLUID


INTRACELLULAR FUNCTION OF WATER: it’s a medium for cellular chemical function. The main need for water is at a CELLULAR LEVEL - perfusion of tissue.

EXTRACELLULAR FUNCTION OF WATER: maintains blood volume, transports nutrients and wastes to and from cells, cushions and lubricates. Water also takes CO
2 from cells.

TRANSCELLULAR
FUNCTION OF WATER:
hydrolyzes food in digestive system lubcates structures of eye & keeps configuration of eyeball
medium for filtration, secretion, reabsorption & excretion of waste in renal system cushions and protects brain & spinal cord
cushions & lubricates joints medium for nourishment of neurons



ELECTROLYTES

ELECTROLYTES - are elements or compounds that when melted or dissolved in water or another solvent, dissociates into ions and is able to produce an electric current. Eg. tabled salt mixed in water are now sodium or chloride and carry an electrical charge.

MOST IMPORTANT POSITIVELY CHARGED ELECTROLYTES (cat-ions) are:

POSITIVE: SO CALCulate the magnesium in the HY-PO

**************

MOST IMPORTANT NEGATIVELY CHARGED ELECTROLYTES (anions) are:
When water evaporates, sodium and chloride come together because of AFFINITY. NEED TO KNOW hydrogen and bicarbonate go together.

PRECISE CONCENTRATIONS of ELECTROLYTES are VITAL to BODY FUNCTION

MEASURE ELECTROLYTES by mEQ/L
MEASURE CALCIUM by mg/L

Concentration at neutral balance is maintained in all compartments.
Fluids contain equal quantities (mEqs) of anions and cations

LAB NORMS FOR ELECTROLYTES

FUNCTIONS OF ELECTROLYTES:

*ADH (anti-diuretic) is a hormone that restores blood volume by reducing peeing and increasing water retention. Also called VASOPRESSIN.

WITH SEVERE FLUID & ELECTROLYTE IMBALANCE.....

PREVENT IMBALANCE OF FLUIDS & ELECTROLYTES!

WHO IS AT RISK?
WHAT CONDITIONS ARE RISKS FOR IMBALANCE?
  • Acute MI
  • Dehydration
  • Liver Disease
  • Addison’s
  • Diabetes
  • Low Sodium Diet
  • Bone Disease
  • Diarrhea
  • Panacreatis
  • Burns (intra- and extracellular fluid loss)
  • Eating Disorder...
  • anorexia, bulimia
  • Renal Failure
  • CHF
  • Excessive GI fluid loss
  • Respiratory Failure
  • COPD (always at risk!)
  • Exposure to cold
  • Trauma Hemorrhage
  • Corticosteroids (retains water by hoarding sugar)and diuretics
  • Gastrointestinal Surgery*
  • Vomiting
  • Cushing’s
  • Heat stroke
 


*With GASTROINTESTINAL SURGERY, esp at risk are: Preps (laxatives & enemas); NPO status; Gastric suction; Delayed peristalsis. In hospital, esp. w/gastric suction of hydrochloric acid, pt at risk for alkalosis.

IF SUCTION TUBE IS IN INTESTINE, loss will be of HCO3- (bicarbonate) and risk will be acidosis.

NOTES: K+ (potassium) is MAJOR abundant intracellular electrolyte. Sodium is major extracellular. When K+ moves into a cell, sodium moves out (or vice versa). Electrical charge happens.

TPN -
TOTAL PARENTAL NUTRITION or HYPERAILAMENTATION will increase osmolarity and will pull water from tissue.

TRANSFUSIONS - preserved with citrate which removes calcium from body.

CIRCULATORY OVERLOAD --- if pt already has heart problem and IV, they can overload on fluid. Forty year old man is not at risk like 90 y/o man. Need to watch infusion rate!

WHAT QUESTIONS TO ASK:
WHAT ARE SIGNS & SYMPTOMS OF OVERHYDRATION?

WHAT ARE SIGNS & SYMPTOMS OF DEHYDRATION?


WHAT ARE SIGNS & SYMPTOMS OF CIRCULATORY OVERLOAD?

ASSESSMENT: PALPATE for edema, peripheral pulses, fontanel (infants)
When assessing for edema, take thumbs and push in along tibia around ankle bones. In ANASARCA you can actually see fluid seep out of tissue!

ASSESSMENT: AUSCULTATION for blood pressure, apical pulse rate and rhythm (high risk for dysrhythmias), lung sounds - be sure to listen to lungs sitting up.
DIAGNOSTIC DATA

PREVENTION, TREATMENT & EVALUATION


Electrolytes ©2008 Guiomar Goransson, RN, CHPN