Fluid & Electrolytes

No 8. To Facilitate the Maintenance of Fluid and Electrolyte Balance
By: Karen Paclibar

With Faye Abdellah’s Patient- Centered Approaches to Nursing, it aims to deliver nursing care for the whole individual which encompasses the 21 Nursing Problems.  Abdellah emphasized nursing as a complex art of service and to identify one of the nursing problem under Sustenal  Care Needs is, To Facilitate the Maintenance of Fluid and Electrolyte Balance.

Man cannot live without water. As we all know the body is mostly comprised of water. An adult is comprised of 60% water (Williams, 2007). This water is found in the most diminutive places such as cells and blood. As such, a person requires water in order to survive; the human body relies on it to sustain itself. If a person does not have an adequate amount of water in his or her body, the person will experience symptoms such as nausea  and dizziness; this will ultimately become dehydration due to the fact that the body is not receiving enough water in terms of what is required (Williams,2007).

Water is an integral component within a person’s health maintenance. The functions of water within the human body allow it to fundamentally perform essential functions. For instance, the human body utilizes water to aid digestion. These are the building-blocks of a person’s body. This also serves a medium to wash out the body’s waste. With no water, the body won’t be able to function very well. Even the blood that flows through our veins is very dependent to transfer nutrients, vitamins to our cells throughout our human body (Juan & Basiotis , 2004). It also serves as a means to regulate the body’s temperature. Its usage and consumption differs as some people sweats a lot and consumes more than enough. Electrolytes are minerals in our body that have an electric charge. They are in our blood, urine and body fluids. Maintaining the right balance of electrolytes helps our body's blood chemistry, muscle action and other processes. Sodium, calcium, potassium, chlorine, phosphate and magnesium are all electrolytes. We get them from the foods we eat and the fluids we drink.

Levels of electrolytes in a body can become too low or too high. That can happen when the amount of water in the body changes. Causes include some medicines, vomiting, diarrhea, sweating or kidney problems. Problems most often occur with levels of sodium, potassium or calcium.

Fluid Balance & Electrolyte Balance

The kidneys maintain fluid balance in the body by regulating the amount and components of fluid inside and around the cells. The fluid inside the cell is called the Intracellular Fluid (ICF). It contains large amount of potassium, magnesium and phosphate ions. The fluid in the spaces are so called Extracellular Fluid ( ECF) includes blood plasma and interstitial fluid which contains large amounts of sodium, chloride, and bicarbonate ions plus cell nutrients  such as oxygen, glucose, fatty acids and amino acids. It also contains carbon dioxide, transported from the cells to the lungs for excretion and other cellular products transported from cells to kidneys.  Basically there are 4 aspects of forces that move fluid in and out of vessels namely: oncotic pressure of plasma proteins, hydrostatic pressure of interstitial fluid, hydrostatic pressure of tissue fluid, osmotic pressure.

Electrolyte imbalances can affect all body systems. Too much or too little potassium greatly affects excitability of the cardiac muscle, which causes arrhythmias. Multiple neurologic symptoms may result from electrolyte imbalance, ranging from disorientation or confusion. Too much or too little of sodium may also cause oliguria which increase or decrease blood pressure.

Fluid and electrolyte balance is really essential for health. Several factors can cause disruption of fluid and electrolyte balances such as: illnesses, injury, surgery, and treatments.

Normal Adult Values 
Calcium: 4.5-5.5 mEq/L
Chloride: 97-107 mEq/L
Potassium: 3.5-5.3 mEq/L
Magnesium: 1.5-2.5 mEq/L
Sodium: 136-145 mEq/L

As I mentioned above, fluid and electrolyte imbalance results from several factors and I can attest to this especially in a hospital care setting. Working in a Chemo Base Unit is no joke. One day you see your patient alert and oriented, vitally and hemodynamically stable then the following day you will see your patient unresponsive, with muscle twitching, shortness of breath, unstable vital signs and so on and so forth. I remember one time a patient who is post chemotherapy came to ER and was admitted to our unit which  presented with severe mucositis (oral thrush/ulcers), with profuse diarrhea, looking pale and dry, lethargic. The patient is always nauseated and with on and off vomiting, with vital signs BP (90/58); HR (120); RR (24); O2 (95%) on room air. As the primary nurse, I followed up the blood results keenly and unluckily, it came out to have severe electrolyte imbalance. Serum K (3.0meq/L); serum Mg (0.59meq/L); serum Ca (7.5mg/L). IV fluid with additives were ordered by the physician. Electrolyte boluses were also given, and ECG was done, vital signs were monitored accordingly. And transfer to ICU was facilitated for further monitoring. With such symptoms a nurse can easily identify especially that it really needs urgent management and intervention.

What is an electrolyte imbalance?

There are many causes for an electrolyte imbalance. Causes for an electrolyte imbalance may include:
•Loss of body fluids from prolonged vomiting, diarrhea, sweating or high fever
•Inadequate diet and lack of vitamins from food
•Malabsorption - your body may be unable to absorb these electrolytes due to a variety of stomach disorders, medications, or may be how food is taken in
•Hormonal or endocrine disorders
•Kidney disease
•A complication of chemotherapy is tumor lysis syndrome. This occurs when your body breaks down tumor cells rapidly after chemotherapy, causing a low blood calcium level, high blood potassium levels, and other electrolyte abnormalities.

Certain medications may cause an electrolyte imbalance such as:
•Chemotherapy drugs (cisplatin)
•Diuretics (furosemide[Lasix] or bumetanide[Bumex])
•Antibiotics (amphotericin B);
*Corticosteroids (hydrocortisone)

What are some symptoms of electrolyte imbalance to look for?

•As described, an electrolyte imbalance may create a number of symptoms.  The symptoms of electrolyte imbalance are based on which of the electrolyte levels are affected.
•If your blood test results indicate an altered potassium, magnesium, sodium, or calcium levels, you may experience muscle spasm, weakness, twitching, or convulsions.
•Blood test results showing low levels may lead to: irregular heartbeat, confusion, blood pressure changes, nervous system or bone disorders.
•Blood test results showing high levels may lead to: weakness or twitching of the muscles, numbness, fatigue, irregular heartbeat and blood pressure changes.

Signs and symptoms of water imbalance:

                         Water deficit
                           Water Excess
Change in urinary output:oliguria except in solute excess where polyruia is seen
Drowsiness; apathy and lethargy
SIGNS: flushed skin, scant body secretions,tongue appears dry and fissured; mucous membranes feel “sticky”weight loss, increase temp, personality changes, hallucinations, delirium, manic behavior, convulsions, coma
SIGNS: weight gain, skin warm and moist, cramps,

Clinical Manifestations of excess and deficit states of major electrolytes
                                                                                          Excess                                                Deficit
Hypernatremia:edema,congestive heart failure,hypertension
Hyponatremia: weakness, fatigue,anorexia, nausea and vomiting,<mental activity, hypotension,diarrhea
Hyperkalemia: muscle weakness, colic,diarrhea, paresthesia,muscle irritability,ECG changes,cardiac arrest
Hypokalemia: muscle weakness, paralytic ileus, abdominal distention, lethargy, tachycardia, metabolic alkalosis
Hypercalcemia: flank pain, calculi formation,<muscle tone,mental confusion, impaired memory,slurred speech
Hypocalcemia: convulsions, muscle cramps, tingling of fingertips,ears,nose,toes,tetany
Hyperchloremia: few clinical problems
Hypochloremia: Achlorhydia, increased respiratory rate,dyspnea,metabolic alkalosis

Fluid and electrolyte imbalance if not managed well may result to even a serious threat to life!

*Basic Pathophysiology 2nd Edition A Conceptual Approach by:       Groer-Shekleton  pp300-335
*Atlas of  Pathophysiology  by: Springhouse,Anatomical Chart Company pp.26-33

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