Fluid and Electrolytes
● Fluid Volume Overload/FVE
1. What is it?
a. Excess fluid in the system
b. Dilute electrolytes
c. Fluid moves into cell, causing them to expand
d. Damage to the brain
2. Who is at risk?
a. Heart failure patients: blood backs up from improper pumping
b. Renal failure: kidneys cannot remove fluid
c. Polydipsia: consuming too much fluid
d. SIADH: inappropriate ADH secretion (ADH is water-retaining hormone)
e. Cushing’s syndrome: excessive cortisol causes water and sodium
retention
f. Cirrhosis: blood backs up in the liver
g. Excessive salt intake: causes fluid shift
h. Poorly controlled IV fluids
3. S/s:
a. Headaches: cells in the brain expand
b. Confusion
c. Lethargy
d. Edema
e. JVD
f. Full, bounding pulse
g. Dyspnea/crackles/pulmonary edema
h. Muscles spasms
i. Weight gain: fluid retention
j. Seizures/coma (if severe enough)
4. Treatment:
a. Fluid restriction
b. Diuretics (helps to body flush excess fluids)
c. Strict I’s and O’s
● Fluid Volume Deficit/FVD
1. What is it?
a. Dehydration
b. Lacking fluid causes the electrolytes to become concentrated
c. Fluid leaves the cells, causing them to shrink
d. Body will attempt to fix with the RAAS system
2. Who is at risk?
a. Excessive sweating
b. DI: polyuria from improper ADH balance
c. Hemorrhage (blood loss)
, d. GI losses (vomiting, diarrhea)
e. Overuse of diuretics
f. Third-space fluid shift
g. Ascites
3. S/s:
a. Weight loss
b. Decreased turgor
c. Oliguria
d. Dry and sticky mucus membranes
e. Hypotension: not enough fluid to maintain BP
f. Decreased cap refill
g. Restlessness/confusion/drowsiness: affects LOC
h. Tachycardia
i. RR increases: body trying to compensate for hypoxia
j. Flattened neck vessels
k. Vasoconstriction: body trying to compensate for hypotension
4. Treatment:
a. Strict I’s and O’s
b. Replace fluids using isotonic solutions
● Sodium:
1. Normal: 135-145
2. What is it?
a. Major cation of the extracellular fluid
b. Plays a role in:
I. Concentration of the ECF
II. Fluid distribution
III. Generation and transmission of nerve impulses
IV. Muscle contractility
V. Regulation of Acid/Base
VI. Na+ imbalances are typically associated with: imbalance in the
ECF volume
VII. Fluid and Na have an interdependent relationship
● Hypernatremia
1. Normal: 135-145
2. What is it?
a. Sodium in excess
b. Hypernatremia causes hyperosmolarity, which causes cellular
dehydration from the water leaving the cells in order to be with the excess
sodium.
c. This causes cell shrinkage, which is especially felt in the brain
3. Who is at risk?
a. Dehydration: not enough water to dilute properly
b. Hypertonic IV solutions
● Fluid Volume Overload/FVE
1. What is it?
a. Excess fluid in the system
b. Dilute electrolytes
c. Fluid moves into cell, causing them to expand
d. Damage to the brain
2. Who is at risk?
a. Heart failure patients: blood backs up from improper pumping
b. Renal failure: kidneys cannot remove fluid
c. Polydipsia: consuming too much fluid
d. SIADH: inappropriate ADH secretion (ADH is water-retaining hormone)
e. Cushing’s syndrome: excessive cortisol causes water and sodium
retention
f. Cirrhosis: blood backs up in the liver
g. Excessive salt intake: causes fluid shift
h. Poorly controlled IV fluids
3. S/s:
a. Headaches: cells in the brain expand
b. Confusion
c. Lethargy
d. Edema
e. JVD
f. Full, bounding pulse
g. Dyspnea/crackles/pulmonary edema
h. Muscles spasms
i. Weight gain: fluid retention
j. Seizures/coma (if severe enough)
4. Treatment:
a. Fluid restriction
b. Diuretics (helps to body flush excess fluids)
c. Strict I’s and O’s
● Fluid Volume Deficit/FVD
1. What is it?
a. Dehydration
b. Lacking fluid causes the electrolytes to become concentrated
c. Fluid leaves the cells, causing them to shrink
d. Body will attempt to fix with the RAAS system
2. Who is at risk?
a. Excessive sweating
b. DI: polyuria from improper ADH balance
c. Hemorrhage (blood loss)
, d. GI losses (vomiting, diarrhea)
e. Overuse of diuretics
f. Third-space fluid shift
g. Ascites
3. S/s:
a. Weight loss
b. Decreased turgor
c. Oliguria
d. Dry and sticky mucus membranes
e. Hypotension: not enough fluid to maintain BP
f. Decreased cap refill
g. Restlessness/confusion/drowsiness: affects LOC
h. Tachycardia
i. RR increases: body trying to compensate for hypoxia
j. Flattened neck vessels
k. Vasoconstriction: body trying to compensate for hypotension
4. Treatment:
a. Strict I’s and O’s
b. Replace fluids using isotonic solutions
● Sodium:
1. Normal: 135-145
2. What is it?
a. Major cation of the extracellular fluid
b. Plays a role in:
I. Concentration of the ECF
II. Fluid distribution
III. Generation and transmission of nerve impulses
IV. Muscle contractility
V. Regulation of Acid/Base
VI. Na+ imbalances are typically associated with: imbalance in the
ECF volume
VII. Fluid and Na have an interdependent relationship
● Hypernatremia
1. Normal: 135-145
2. What is it?
a. Sodium in excess
b. Hypernatremia causes hyperosmolarity, which causes cellular
dehydration from the water leaving the cells in order to be with the excess
sodium.
c. This causes cell shrinkage, which is especially felt in the brain
3. Who is at risk?
a. Dehydration: not enough water to dilute properly
b. Hypertonic IV solutions
