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Fluid and Electrolytes Balance & Imbalances nursing study guide

Hassan Magdy
Water is the primary body component, it measures 50% to 60% of adult body weight. However, these percentages vary with gender, body mass, and age.
  1. Water weight is greater in men than in women due to higher lean body mass.
  2. The more fat weight in the body, the less water weight.
  3. Elderly body water content averages 45% to 55% of body weight. They're at higher risk for dehydration.

Body Fluid Compartments

The two fluid compartments in the body are:
fluid body compartments
Visit source.
  1. Intracellular space ICF (inside the cells: two thirds of the body water / 40% of body weight of an adult)
  2. Extracellular space ECF (outside the cells: one third of the body water / 20% of body weight), consists of:
    1. interstitial fluid (the fluid in the spaces between cells: 70% of ECF)
    2. plasma / intravascular fluid (the liquid part of blood: 20% of ECF)
    3. transcellular fluid (a very small amount of fluid, totals about 1 L and contained within specialized cavities: cerebrospinal fluid; fluid in the gastrointestinal (GI) tract; and pleural, synovial, peritoneal, intraocular, and pericardial fluid.)
  3. 3 to 6 L of fluid is secreted into and reabsorbed from the GI tract every day, Therefore loss of this fluid from vomiting or diarrhea can produce serious fluid and electrolyte imbalances.

Calculation of Fluid Gain or Loss

It's important to understand the following:
  1. One liter of water weighs 2.2 lb (1 kg).
  2. if a patient drinks 240 mL of fluid, weight gain will be 0.5 lb (0.23 kg).
  3. A patient receiving diuretic therapy who loses 4.4 lb (2 kg) in 24 hours has experienced a fluid loss of approximately 2 L.
  4. An adult patient who is fasting might lose 1 to 2 lb/day. A weight loss exceeding this is likely due to loss of body fluid.

Homeostasis

Homeostasis: is the stable environment of the body, a condition in which human body is maintained in a more-or-less steady state. (Wakim & Grewal, 2021).
Furthermore, homeostasis is the job of every part of the body to keep many variables within narrow ranges. homeostasis requires:
  1. monitoring of the internal environment
  2. frequently making adjustments to keep balance.

Normal Range Maintenance

For any given variable, such as vital signs, there is a physiological optimum normal range. The rang fluctuates in a normal way (no extreme fluctuations).

Homeostasis is normally maintained in the human body by a complex system. Homeostasis requires at least four interacting components:
  • Stimulus: the value of the variable has left the normal range.
  • Sensor: monitors the values of the variable and sends data on it to the control center.
  • Control center: matches the data with normal values and sends a signal to the effector
  • Effector: an organ, gland, muscle, or other structure that acts on the signal to move the variable back to normal range.
Body fluids are in constant motion:
  1. moving nutrients, electrolytes, and oxygen to cells.
  2. bringing waste products from cells.
Homeostatic control mechanisms by the body are keeping the composition & volume of fluids and electrolytes in narrow normal limits in effort to maintain homeostasis.

They maintain a constant internal environment to ensure that a balance between fluid gain and fluid loss is maintained. such as anti-diuretic hormone (vasopressin) and aldosterone, we will mention that later in details.

Positive Feedback

Is a loop serves to intensify a response up to reaching an endpoint. Blood clotting and childbirth are processes controlled by positive feedback.
 
When a wound causes bleeding, the body responds with a positive feedback loop to clot the blood and stop blood loss. The positive feedback Intensifies the process of clotting until the clot is sufficent to stop the bleeding.

Negative Feedback

Is a loop serves to reduce an excessive response. Processes controlled by negative feedback include regulation and control of blood glucose, and body temperature regulation which involves negative feedback whether it lowers the temperature or raises it 

Fluid and eletrolytes Imbalance

Many pathological conditions and treatments may affect fluid and electrolyte balance. this includes:
  • Metastatic breast or lung cancer may develop hypercalcemia because of bone destruction from tumor invasion.
  • Chemotherapy may result in nausea and vomiting and, subsequently, dehydration and acid-base imbalances.
  • Correcting dehydration with IV fluids may cause fluid overload.

Electrolyte transport

The movement of electrolytes and water between ICF and ECF are done by several mechanisms:
  • simple diffusion
  • facilitated diffusion
  • active transport.
Water moves according to two pressures found in body:
  • hydrostatic pressure
  • osmotic pressure.

Diffusion

is the movement of molecules from high concentration to low concentration.
in order for diffusion to happen:
  • The membrane separating the two areas must be permeable.
  • Occurs in liquids, gases, and solids.
  • Movement stops when the concentrations are equal in both areas.
Simple diffusion requires no external energy.

Facilitated diffusion

A protein carrier in the cell membrane combines with a molecule, mainly one large to pass, and assists in moving it from an area of high concentration to one of low concentration.
Facilitated diffusion is passive and requires no energy.

Active transport

Molecules move against the concentration gradient.
External energy is required. Active transport is used in sodium-potassium pump. The intracellular and extracellular sodium and potassium concentrations are different.

Osmosis

Water move down a concentration gradient, that is, from a region of low solute concentration (low concentration) to one of high solute concentration (high concentration), across a semipermeable membrane.
  1. Requires no energy.
  2. Stops when there's no concentration differences or If building hydrostatic pressure opposing any water movement.
  3. Concentration correlates with osmotic pull.

Oncotic pressure (colloidal osmotic pressure)

Is the osmotic pressure caused by plasma colloids in solution. The major colloid intra-vascularly is protein.
Normally, plasma oncotic pressure is is greater than interstitial oncotic due to smaller protein presence. Fluid moves out of the capillary and into the interstitial space or vice versa are determined by the interaction of:
  • Move water out of the capillaries
    • Capillary hydrostatic pressure
    • Interstitial oncotic pressure
  • Move fluid into the capillaries
    • Plasma oncotic pressure
    • Interstitial hydrostatic pressure
At the arterial (carry oxygenated blood to all tissues) end of the capillary, capillary hydrostatic pressure exceeds plasma oncotic pressure, and fluid moves into the interstitial space.

At the venous (carry oxygenated blood to the heart) end of the capillary, the capillary hydrostatic pressure is lower than plasma oncotic pressure, drawing fluid back into the capillary by the oncotic pressure created by plasma proteins.

NB: plasma / blood / colloidal oncotic pressure pushes fluid into capillary, however, capillary hydrostatic pressures pulls water out the capillary.
oncotic-hydrostatic-pressures
Oncotic hydrostatic pressures at arterial venous end, visit source.

Fluid Shifts

If capillary or interstitial pressures change, fluid may abnormally shift from one compartment to another, resulting in edema or dehydration.

Over-hydration and edema

Edema, an accumulation of fluid in the interstitial space
occurs if:
  • venous hydrostatic pressure rises (water moves out)
  • obstruction of lymphatic outflow causes decreased removal of interstitial fluid, and high venous hydrostatic pressure (inhibition of water backward movement)
  • plasma oncotic pressure decreases (water moves out)
  • interstitial oncotic pressure rises  (water moves out)

Dehydration

Dehydration refers to loss of pure water alone without a corresponding loss of sodium.

NB: The term fluid volume deficit is not interchangeable with the term dehydration.

Increased venous pressure

As discussed above when venous pressure rises, Edema develops, It's important for nurses to know the causes of increased venous pressure to have previous considerations regarding edema development in patients under their care, These include:
  • fluid overload
  • liver and heart failure
  • obstruction of venous return to the heart as in venous thrombosis and tight clothing
  • venous insufficiency as in varicose veins

Decrease in Plasma Oncotic Pressure

As discussed before in edema, decreased plasma oncotic pressure will lead to fluid accumulation in interstitial space since fluid remains in the interstitial space if the plasma oncotic pressure is too low to pull it into the capillary.

NB: Low plasma protein means low oncotic pressure. Causes include:
  • renal disorders which may lead to uncontrolled protein excretion
  • liver disease which means impaired protein metabolism
  • Under-nutrition

Elevation of Interstitial Oncotic Pressure

Damaged capillary walls let plasma proteins accumulate in the interstitial space, this happens in:
  • trauma
  • burns
  • inflammation

Shifts of Interstitial Fluid to Plasma

An increase in the plasma osmotic or oncotic pressure draws fluid into the plasma from the interstitial space. This could happen with administration of:
  • colloids
  • dextran
  • mannitol
Mannitol is a diuretic that is used to reduce swelling and pressure inside the eye or around the brain and to help body produce more urine.
  • hypertonic solutions. 

Increased interstitial hydrostatic pressure

this will lead to a shift of fluid into plasma. This increase may be caused by:
  • wearing elastic compression stockings or bandages
this may be therapeutically indicated to decrease peripheral edema.

Regulation Of Water Balance

In order to go through systems that regulates water balance, we must explain Osmotic pressure, which is an important factor affecting biological cells. Osmoregulation is the homeostasis mechanism of an organism to reach balance in osmotic pressure. 

Osmotic pressure is the pressure caused by the dissolved salts that must be applied to the solution side to stop fluid movement when a semipermeable membrane separates a solution from pure water. (Feher, 2017). The higher the concentration, the greater the solution’s pulling, or osmotic pressure. 

Remember that osmosis was defined as Water movement down a concentration gradient, from low concentration to high concentration, across a semipermeable membrane.

When osmosis is carried out between semipermeable membrane, the volume of the high concentrated solution increases as it becomes diluted by water from the low concentrated liquid.

This causes the level of the high concentrated solution to rise, increasing its hydrostatic pressure, and resulting in a faster transfer of water back to the low concentrated liquid side. When the pressure reaches a value that yields a reverse water transfer rate equal to the osmosis rate, bulk transfer of low concentrated liquid ceases. This pressure is called the osmotic pressure of the solution. (Flowers et al., 11.4 Colligative Properties 2019)

Osmotic pressure is measured in milliosmoles (mOsm) and may be expressed as either fluid osmolarity or fluid osmolality.
Osmole is molecular weight of a solute, in grams, divided by the number of ions.
  • Osmolarity: measures the concentration of molecules per volume of solution (mOsm/L).
  • Osmolality: measures the concentration of molecules per weight of water (mOsm/Kg).
Osmolality is the test typically performed to evaluate the concentration of plasma and urine. Determining osmolality is important because it indicates the body’s water balance.
  1. Normal plasma osmolality: 275-295 mOsm/kg.
  2. Water deficit: 295 mOsm/kg (high particles' concentration or low water content).
  3. Water excess: 275 mOsm/kg (low particles' concentration or high water content).
Highlight on the clinical significance of osmolality:
  1. The major determinants of plasma osmolality are sodium and glucose..
  2. Osmolality of urine: 100-1300 mOsm/kg, This value is affected by fluid intake and  antidiuretic hormone as well as renal response.
  3. Fluids with the same osmolality as the cell interior are termed isotonic (such as ECF and ICF in normal conditions).
  4. If a cell is surrounded by hypotonic fluid, water moves into the cell, causing it to swell and possibly to burst.
  5. If hypertonic fluid surrounds a cell, water leaves the cell and it shrinks.
As we discussed before in homeostasis, the body balances water volume at all time into a normal range. In healthy individual who has access to water fluid intake will equal fluid output, a normal thirst and ADH mechanism, and normally functioning kidneys.

Hypothalamic-Pituitary Regulation

Osmoreceptors in the hypothalamus sense a body fluid deficit or increase in plasma osmolality, which in turn stimulates thirst and ADH release from the hypothalamus, ADH is also stored in the pituatry gland at the base of brain.

The distal tubules and collecting ducts in the kidneys respond by increasing permeability, water reabsorption and increasing excretion in the urine.

The patient who has impaired recognition or act on the sensation of thirst is at risk for fluid deficit and hyperosmolality. NB: ADH is released in stress and nausea as well as in nicotine & morphine use.

Renal Regulation

The kidneys filter the total plasma volume many times each day and reabsorb 99% of this filtrate, producing approximately 1.5 L of urine per day.

Selective reabsorption of water and electrolytes and secretion of electrolytes result in the production of different in composition and concentration urine in comparison to plasma.

This process helps maintain fluid, electrolytes and acid-base balance. The renal tubules are the site for the actions of ADH and aldosterone.

Adrenal Cortical Regulation

Glucocorticoids and mineralocorticoids secreted by the adrenal cortex help regulate both water and electrolytes.
  • Glucocorticoids like cortisol owe an antiinflammatory action along with their ability to increase serum glucose levels. Cortisol secretion occurs in response to physical and psychologic stress including fluid and electrolyte balance.
  • Mineralocorticoids like aldosterone boost sodium retention "water follows because of osmotic changes" and potassium excretion. Adrenocorticotropic hormone (ACTH) from the anterior pituitary act directly on the adrenal cortex to stimulate the secretion of aldosterone. Decreased renal perfusion or decreased sodium delivery to the distal portion of the renal tubule activates the renin-angiotensin-aldosterone system (RAAS), which results in aldosterone secretion.
NB: Cortisol is the most abundant glucocorticoid. In large doses, cortisol has both glucocorticoid and mineralocorticoid effects. 

Cardiac Regulation

Atrial natriuretic peptide (ANP) and b-type natriuretic peptide (BNP), are hormones produced by cardiomyocytes, In the renal tubules they promote excretion of sodium and water, resulting in a decrease in blood volume and blood pressure.

They are produced in response to:
  • increased atrial pressure
  • high serum sodium levels.
NB: They suppress secretion of aldosterone, renin, and ADH, and the action of angiotensin II.

Gastrointestinal Regulation

On daily basis, GI tract normally secretes approximately 8000 mL of digestive fluids each day. Most of it, is reabsorbed, meaning that only a small amount is eliminated in feces. 

NB: Diarrhea and vomiting prevent GI reabsorption leading to significant fluid and electrolyte loss.

Insensible Water Loss

is invisible vaporization from the lungs and skin, accounts for 600 to 900 mL/day is lost.

Gerontological nursing consideration in fluids and electrolytes

The older adult experiences normal physiologic changes with aging that increase susceptibility to fluid and electrolyte imbalances. Among them are:
  • decreased in the renal blood flow and loss of the ability to concentrate urine.
  • decrease in hormones regulation fluids and electrolytes.
  • Loss of subcutaneous tissue and thinning of the dermis causes inability to respond to heat or cold quickly.
  • decrease in the thirst mechanism, resulting in decreased fluid intake despite increases in osmolality and serum sodium level.
  • Increased risk of free-water loss and subsequent hypernatremia.
  • Functional & Mental status changes may occur that affect the ability to independently obtain fluids.

Fluid And Electrolyte Imbalances

Fluid and electrolyte imbalances may be caused by:
  • major illness or injury because illness disrupts the normal homeostatic mechanism as in burns, heart failure.
  • therapeutic measures as in IV fluid replacement, diuretics cause or contribute to fluid and electrolyte imbalances.
  • Perioperative patients with fluid restrictions, blood or fluid loss, and due the stress of surgery.
Extracellular fluid volume deficit (hypovolemia) and volume excess (hypervolemia) are major classification of the disturbances in fluids.

NB: ECF volume imbalances are typically accompanied by one or more electrolyte imbalances, particularly changes in the serum sodium level.

Fluid Volume Deficit

It's the abnormal loss of body fluids and electrolytes.

Causes of fluid volume deficit

  • high insensible water loss or perspiration (high fever, heatstroke)
  • Diabetes insipidus
  • Osmotic diuresis
  • Hemorrhage
  • GI losses: vomiting, NG suction, diarrhea, fistula drainage, Overuse of diuretics
  • Inadequate fluid intake
  •  Third-space fluid shifts: burns, intestinal obstruction

Signs and symptoms of fluid volume deficit

  • Restlessness, drowsiness, lethargy, Postural hypotension, Weakness, dizziness, confusion, Seizures, coma
  • Thirst, dry mucous membranes
  • Decreased skin turgor, capillary refill
  • increased HR & low CVP
  • Low urine output
  • high Respiratory rate
  • Weight loss

Nusring management of fluid volume deficit

  1. Collaborate with physician to correct the underlying cause and to replace both water and any needed electrolytes.
  2. Administer according to physician prescription:
    1. Balanced IV solutions, such as lactated Ringer’s solution, are usually given.
    2. Isotonic (0.9%) sodium chloride is used when rapid volume replacement is indicated.
    3. Blood is administered when volume loss is due to blood loss.

Fluid Volume Excess

is defined as an isotonic expansion of the extracellular fluid due to an increase in total body sodium content and an increase in total body water.

Causes of fluid volume deficit

  • Excessive isotonic or hypotonic IV fluids
  • Heart failure & Renal failure
  • Primary polydipsia
  • Shift of fluid from interstitial fluid into plasma fluid changes the intravascular volume.
  • Syndrome of inappropriate antidiuretic hormone
  • Cushing syndrome & Long-term use of corticosteroids

Signs and symptoms of fluid volume deficit

  • Headache, confusion, lethargy, Seizures, coma
  • Peripheral edema
  • Jugular venous distention & Bounding pulse, increased blood and central venous pressures
  • Polyuria (with normal renal function)
  • Dyspnea, crackles, pulmonary edema 
  • Muscle spasms
  • Weight gain

Nursing management of fluid volume excess

  1. Collaborate with physician to correct the underlying cause and to replace both water and any needed electrolytes.
  2. Diuretics and fluid restriction are the primary forms of therapy.
  3. Restriction of sodium intake may also be indicated. If the fluid excess leads to ascites.

Electrolytes imbalances summary

Electrolyte concentrations vary from those in the ICF to those in the ECF.
  1. Sodium. Sodium ions outnumber any other cations in the ECF; therefore it is essential in the fluid regulation of the body.
  2. Potassium. The ECF has a low concentration of potassium and can tolerate only small changes in its concentrations.
As we mentioned previously in Active transport, the body regulates sodium and potassium concentrations through cell membrane pumps exchanging sodium and potassium ions that's called sodium-potassium pump.

Major electrolytes disturbances include:
  • Hyponatremia: serum sodium level < 135 mEq/L
  • Hypernatremia: serum sodium level > 145 mEq/L.
  • Hypokalemia: serum potassium level < 3.5 mEq/L.
  • Hyperkalemia: serum potassium level > 5.0 mEq/L.

Causes of electrolyte imbalances:

  • Fluid and sodium retention.
  • Fluid volume deficit with excessive loss of sodium.
  • crush injury due to release of intracellular potassium.
  • Shift of Potassium Out of Cells as in Acidosis, Catabolism, Tumor lysis syndrome.
  • Shift of Potassium Into Cells as in Increased insulin, Alkalosis, Tissue repair, stress.
  • Fluid overload. Fluid volume excess may be related to a simple fluid overload or diminished function of the homeostatic mechanisms responsible for regulating fluid balance.
  • Low or high electrolyte intake.
  • Certain medications. such as  NSAIDs.
  • Diseases:
    • Renal disease
    • Potassium-sparing diuretics
    • Adrenal insufficiency
    •  ACE inhibitors

Signs and symptoms of electrolytes imbalances

  1. Hyponatremia:
    • anorexia, nausea and vomiting
    • headache, lethargy, dizziness, confusion
    • muscle cramps and weakness, muscular twitching, seizures
    • dry skin
    • edema.
  2. Hypernatremia:
    • Hyperthermia
    • hallucinations, lethargy, restlessness
    • pulmonary edema
    • twitching
    • Elevated HR and BP.
  3. Hypokalemia:
    • fatigue, anorexia, muscle weakness
    • polyuria, decreased bowel motility
    • paresthesia
    • paralytic ileus, abdominal distention
    • hypoactive reflexes
  4. Hyperkalemia:
    • muscle weakness
    • Elevated HR
    • paresthesia, dysrhythmias
    • intestinal colic, cramps, abdominal distention
    • Anxiety.

Assessment and Diagnostic Findings

The following are laboratory studies useful in diagnosing fluid and electrolyte imbalances:
  • Assess skin turgor, vital signs mainly HR and BP.
  • Monitor intake and output.
  • Monitor weight daily.
  • Physical examination and meticulous examination of signs and symptoms.
  • Laboratory investigations:
    • Serum electrolyte levels.
    • ECG changes can also contribute to the diagnosis of fluid and electrolyte imbalance.
    • ABG test to  acid-base imbalances.

Medical Management of electrolytes imbalances

  1. Treatment hyponatremia caused by water excess:
    • fluid restriction is often the only treatment.
    • If severe symptoms (seizures) develop, small amounts of IV hypertonic saline solution (3% sodium chloride) can restore the serum sodium level while the body is returning to a normal water balance.
  2. Treatment of hyponatremia associated with abnormal fluid loss:
    • fluid replacement with sodium-containing solutions.
    • The primary goal of treatment of hypernatremia is to treat the underlying cause.
    • In primary water deficit, fluid replacement is provided either orally or IV with isotonic or hypotonic fluids such as 5% dextrose in water or 0.45% sodium chloride saline solution.
  3. The goal of treatment for sodium excess is to dilute the sodium concentration with sodium-free IV fluids, such as 5% dextrose in water, and to promote excretion of the excess sodium by administering diuretics
  4. Treatment of hypokalemia consists of:
    • oral or IV potassium chloride (KCl) supplements and increased dietary intake of potassium. Except in severe deficiencies, KCl is not given unless there is urine output of at least 0.5 mL/kg of body weight per hour
  5. Treatment of hyperkalemia consists of the following:
    • Eliminate oral and parenteral potassium intake.
    • Increase elimination of potassium. This is accomplished with diuretics, dialysis
    • Force potassium from ECF to ICF, by IV administration of regular insulin (along with glucose so the patient does not become hypoglycemic) or IV sodium bicarbonate for the correction of acidosis. This therapy is not indicated for patients with tachycardia or coronary artery disease.
    • Reverse the membrane potential effects of the elevated ECF potassium by administering IV calcium gluconate. Calcium ions can immediately reverse the membrane excitability. In cases in which
  6. Dialysis is performed to remove nitrogenous wastes, control potassium, remove sodium, fluid and acid-base balance.
  7. Nutritional therapy.

Pharmacologic therapy

  • Conivaptan (Vaprisol) and tolvaptan (Samsca) are used in patients with hyponatremia from excess water loss to block the activity of ADH.
  • Tolvaptan is used to treat hyponatremia associated with heart failure, liver cirrhosis, and syndrome of inappropriate antidiuretic hormone.
  • AVP receptor agonists treat hyponatremia by stimulating free water excretion.
  • Diuretics decrease fluid volume excess.
  • Calcitonin can be used to lower the serum calcium level and is particularly useful for patients with heart disease or heart failure who cannot tolerate large sodium loads.
Treatment with these drugs is started in a hospital setting under monitoring.

Nursing care plan for fluid and electrolytes imbalances: nursing diagnosis

Nursing diagnoses and collaborative problems for the patient with fluid imbalances include, but are not limited to, the following: ECF volume deficit:
  1. Deficient fluid volume related to excessive ECF losses or decreased fluid intake
  2. Decreased cardiac output related to excessive ECF losses or decreased fluid intake
  3. Risk for deficient fluid volume related to excessive ECF losses or decreased fluid intake
  4. Other probable nursing diagnosis:
    • Excess fluid volume related to water retention
    • Impaired gas exchange related to pulmonary edema
    • Risk for impaired skin integrity related to edema
    • Activity intolerance related to disease process
    • Disturbed body image

Nursing care plan for fluid and electrolytes imbalances: Nursing management, implementations

Intake and output

The utilization of 24-hour intake and output records gives important data with respect to fluid and electrolyte issues. An accurately recorded intake-and-output flow sheet can recognize sources of excessive intake or liquid losses. Intake ought to include oral, IV, and tube feedings.

Output includes urine, abundance sweat, wound or tube drainage, vomiting, and loose bowels. Estimate liquid loss from wounds and sweat. Measure the urine specific gravity concurring with organization policy. Readings of greater than 1.025 demonstrate concentrated urine, while those of less than 1.010 demonstrate dilute urine.

Cardiovascular status

Observing the patient for cardiovascular changes is fundamental to avoid or identify complications from fluid and electrolyte imbalances. Signs and symptoms of ECF volume excess and deficit are reflected in changes in blood pressure, beat force, and jugular venous distention.

In fluid volume excess the beat is full, bounding, and not effortlessly obliterated. Increased volume causes enlarged neck veins (jugular venous distention) and increased blood pressure.

In mild to moderate liquid volume deficit, compensatory mechanisms incorporate sympathetic nervous system stimulation of the heart and peripheral vasoconstriction.

Stimulation of the heart increases the heart rate and, combined with vasoconstriction, keeps up the blood pressure within typical limits.

An alter in position from lying to sitting or standing may evoke a further increase in the heart rate or a diminish in the blood pressure (orthostatic hypotension).

In case vasoconstriction and tachycardia give insufficient compensation, hypotension occurs when the patient is recumbent. Severe fluid volume deficit can cause flattened neck veins and a frail, thready beat that's effortlessly obliterated. Serious, untreated fluid deficit will result in shock.

Respiratory changes

Both fluid excess and fluid deficit affect respiratory status. ECF excess can result in pulmonary congestion and pulmonary edema as increased hydrostatic pressure within the pulmonary vessels forces fluid into the alveoli.

The patient will encounter shortness of breath and wet crackles on auscultation. The patient with ECF deficit will demonstrate an increased respiratory rate because of diminished tissue perfusion and resultant hypoxia.

Neurological status

Changes in neurologic function may happen with fluid volume excesses or deficits. ECF abundance may result in cerebral edema from expanded hydrostatic pressure in cerebral vessels. Then again, significant volume consumption may cause an modification in sensorium secondary to diminished cerebral tissue perfusion.

Evaluation of neurologic function incorporates assessment of :
  1. the level of awareness, which incorporates reactions to verbal and agonizing stimuli and assurance of a person’s orientation to time, place, and person.
  2. pupillary reaction to light and equality of pupil size.
  3. deliberate movement of the extremities, degree of muscle strength, and reflexes.

Body weight

Exact day by day weights give the most straightforward estimation of volume status. An increase of 1 kg is equal to 1 L of fluid retention (given the individual has kept up regular dietary intake or has not been on NPO status).

Get the weight under standardized conditions, that's , weigh the patient at the same time each day, wearing the same pieces of clothing, and on the same carefully calibrated scale. Remove excess bedding and empty all waste packs before the weighing. In the event that the patient has things show that are not there each day, such as bulky dressings or tubes, note this at the side the weight.

Skin assessment

Identify clues to ECF volume deficit and abundance by assessing the skin. Look at the skin for turgor and portability. Ordinarily a fold of skin, when squeezed, will promptly move and, on release, quickly return to its previous position.

Skin regions over the sternum, guts, and front lower arm are the normal sites for assessment of tissue turgor. In older individuals, diminished skin turgor is less predictive of liquid shortage because of the loss of tissue elasticity.

In ECF volume deficit, skin turgor is decreased, and there's a lag within the squeezed skinfold’s return to its unique state (alluded to as tenting).

Further Readings of fluid and electrolytes disturbances:

This is a list of more in depth articles regarding each fluid and electrolytes Imbalance:
the list is being updated automatically.

References:

  1. Feher, J. (2017). Osmosis and osmotic pressure. Quantitative Human Physiology, 182–198. https://doi.org/10.1016/b978-0-12-800883-6.00017-3 
  2. Flowers, P., Bott, S., Carpenetti, D., Eklund, A., El-Giar, E., Frantz, D., Hooker, P., Kaminski, G., Look, J., Martinez, C., Milliken, T., Moravec, V., Powell, J. D., Sorensen, T., Soult, A., Theopold, K., Langley, R., Robinson, W. R., &amp; Blaser, M. (2019). 11.4 Colligative Properties. In Chemistry 2e. essay, OpenStax, XanEdu. 
  3. Lewis, S. M., &amp; Collier, I. C. (2016). Medical-surgical nursing: Assessment and management of clinical problems. McGraw-Hill. 
  4. Wakim, S., &amp; Grewal, M. (2021, September 4). Homeostasis and feedback. Biology LibreTexts. https://bio.libretexts.org/Bookshelves/Human_Biology/Book%3A_Human_Biology_(Wakim_and_Grewal)/10%3A_Introduction_to_the_Human_Body/10.7%3A_Homeostasis_and_Feedback. 

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