fluids

• Extracellular Fluid


  • Interstitial (14%)
  • Plasma (5%)
  • Arterial (2%)
  • Venous (3%)
  • Transcellular (1%)
• Intracellular Fluid


  40% of Total Body Water
• Fluid Regulation


  1. Diffusion (higher to lower concentration)

  2. Filtration (higher to lower pressure)

  3. Osmosis (movement of water from lower to higher concentration)
• Hydrostatic Pressure


  Pushes water and antibodies from the intravascular to interstitial space; powered by the heart's pumping action
• Colloidal Osmotic Pressure


  Pulls water from the interstitial to the intravascular space
• Primary colloid


  ALBUMIN (macromolecule from liver)
• Fluid Regulation


  • Kidney (regulates fluid through urine output, regulates sodium and fluid balance)
  • Endocrine Regulation (thirst mechanism: hypothalamus, aldosterone and antidiuretic hormone, sodium retention and water reabsorption)
  • Renin-angiotensin Aldosterone System (renin, angiotensin-converting enzyme, angiotensin 2, aldosterone)
  • Gastrointestinal (absorbs food and water, about 200 ml of water is excreted in the feces/body)
  • Heart and blood vessels (pumping action of the heart pumps blood)
  • Lungs (elimination of water vapor)
  • Skin (sweating and water loss by evaporation)
• Fluid Volume Deficit (Hypovolemia)


  • High output; normal intake
  • Normal output; low intake
  • No intake or prolonged low intake
• Causes of Fluid Volume Deficit

  • Vomiting
  • Diarrhea
  • GI suctioning (lavage)
  • Diaphoresis
  • Diabetes insipidus
  • Addison's disease
  • Osmotic diuresis
  • Hemorrhage
• Clinical Manifestations of Fluid Volume Deficit

  • Weight loss
  • Oliguria
  • Concentrated urine – high specific gravity
  • Postural hypotension
  • Flattened neck veins
  • Thirst; anorexia
  • Muscle weakness and cramps
• Management of Fluid Volume Deficit

  1. Assessment (intake and output, weight, skin turgor, level of consciousness)

  2. Fluid Supplement (mild: oral, acute/severe: NSS and PLR, lactated ringer, D5LR)
• Fluid Volume Excess (Hypervolemia)

  • High intake; normal output
  • Normal intake; low output
  • No output
• Causes of Fluid Volume Excess

  • Organ failure: renal failure
  • High sodium intake
  • Endocrine problems: SIADH, Cushing's Disease
  • Iatrogenic effect
• Clinical Manifestations of Fluid Volume Excess

  • Distended neck vein
  • Tachycardia
  • Weight gain
  • Increase urine output
• Management of Fluid Volume Excess

  1. Discontinue sodium solution

  2. Diuretics

  3. Restrict sodium and fluids

  4. Dialysis
• Nursing Management for Fluid Volume Excess

  1. Monitor intake and output

  2. Weight daily

  3. Assess breath sounds

  4. Monitor degree of edema (ambulatory: feet and ankles, bedridden: sacral area)

  5. Promote rest
• Fluid and Electrolytes


  • Hypertonic (>0.9%: D50W, D10W, D5LRS)
  • Isotonic (=0.9%: PNSS, Plain LR, D5W)
  • Hypotonic (< 0.9%: 0.25% NaCl, 0.45% NaCl)
• Dehydration


  • Dry mouth
  • Polydipsia
  • Hypertension
  • Polyuria
• Edema


  • Hypotension
  • Ascites
  • Oliguria
• Edema formation


  1. High colloidal osmotic pressure

  2. Low colloidal osmotic pressure
• High edema formation


  1. High hydrostatic pressure

  2. Low hydrostatic pressure
• Hypertonic Fluids


  • D50W
  • D5W
  • 0.45 NSS