FLUID AND ELECTROLYTES IMBALANCE

INTRODUCTION

 BODY FLUIDS:

Total body fluid amounts to about 60% of body weight in the adult, 55% in the older adult,
and 80% in the infants. It helps to maintain body temperature and cell shape. It helps
transport nutrients, gases and waste.
The desired average fluid intake and loss in adult ranges 1500 to 3500 ml daily.
Intake=output.

 ELECTROLYTES:

Electrolytes are minerals in the body with positive (+ve) or negative (-ve) charge. They are in
the blood, urine, tissue and other body fluids.

CATIONS: (+ve) charge ANIONS: (-ve) charge

Sodium (Na+) Chloride (Cl-)

Potassium (k+) Phosphate (PO43-)

Calcium (Ca2+) Bicarbonate (HCo3-)

Magnesium (Mg+) Sulphate (SO4 2-)

Hydrogen (H+)

HOMEOSTASIS:
 Fluid and electrolytes are the basic elements of life. Fluid and electrolyte balance is the
equilibrium state between the fluids and electrolytes within the body. Hence, when there is
a change in the equilibrium state is termed as fluid and electrolyte imbalance.
 The primary fluid of the body is water. It comprises of 70% of living cells and 60% of an
average adult’s total body weight. An average person needs about 2 to 2.5 litters of water
per day to meet the body’s fluid requirements.
BODY FLUID COMPOSITION AND FUNCTION:
 Approximately 60% of a typical adult’s weight consists of fluid (water and electrolytes).
 The amount of body fluids can be influenced by age, gender and body fat.
 In general, younger people have higher percentage of body fluids than older people and
male have proportionately more body fluids than females.
 Body fat: obese people have less fluid than thin people because fat cell contains little water.

COMPARTMENTS:
 The body fluids are located in two compartments:
1. Intra cellular space (fluids inside the cell)
2. Extra cellular space (fluids outside the cell)
a) Intravascular space (fluids with in blood vessels)
b) Interstitial space (fluids around the cell)

FUNCTIONS OF BODY FLUIDS:

 Enzyme in saliva and mucus assist the passage of food into the gut and provide mechanisms
for hydrolysing food into elements that the body can absorb.
 ECF in blood and CSF serve as a transport mechanism to deliver electrolytes, oxygen,
nutrients and hormones to tissues.
 Carry immune system cells to injury site for the body’s defence.
 ECF eliminates the body’s waste products through kidneys, bowel and perspiration.
 Helps in the movement of electrolytes from one body compartment to another ECF plays an
important role in regulation of body temperature.
 Acts as a lubricant.

NORMAL FLUID EXCHANGE:

The major factor that governs the net movement of fluid between the vascular and interstitial
spaces is the difference between the plasma osmotic pressure and the vascular hydrostatic
pressure.

1. Oncotic pressure: It is the pressure exerted by chemical constituent of plasma fluid, i.e.
crystalloids and colloids.
2. Hydrostatic pressure: It is the pressure exerted by the blood flowing through the capillaries.
REGULATION OF BODY FLUID COMPARTMENTS:

I. OSMOSIS AND OSMOLALITY:

 Osmosis is the process of water movement through a semipermeable membrane
from an area of low solute concentration to an area of high solute concentration.
 Osmolality measures the number of dissolved particles contained in a unit of fluid.
 Normal Plasma osmolality is between 275 to 295mOsm/kg.
 If it goes beyond 295mOsm/kg indicates that the concentration of particles is too
great or that the water content is too little- water deficit.
 If it goes below 275mOsm/kg indicates too little solute for the amount of water or
too much of water for the amount of solute- water excess.
 HYPOTONIC: the solution in which the solute is less concentrated than in the cells.
 HYPERTONIC: The solutes are more concentrated in the fluids than in the cell.
 ISOTONIC: The solutes in the fluids are equally concentrated as in the cell.

II. DIFFUSION:
 The natural tendency of substances to move from an area of higher concentration to
one of lower concentration.
 E.g., exchange of oxygen and carbon dioxide between the pulmonary capillaries and
alveoli.

III. FILTRATION:
 The hydrostatic pressure in capillaries tends to filter fluid out of the vascular
compartment into the interstitial fluid.
 E.g., the passage of water and electrolytes from the arterial capillary bed to the
interstitial fluid.
 The hydrostatic pressure is famished by the pumping action of the heart.

IV. SODIUM-POTASSIUM PUMP:

 The sodium-potassium pump is membrane protein that actively transports sodium
ions out of a cell and potassium ions into the cell against their respective
concentration gradients.
 The energy source for Sodium-Potassium Pump mechanism is ATP (Adenosine
triphosphate).
 It is situated in the outer plasma membrane of the cells.
 This process helps maintain the electrochemical balance essential for cell function
and it is crucial for nerve impulses and muscle contraction.
HOMEOSTATIC MECHANISM:
The following organs are involved in homeostasis. They are:
 Kidney:
 The kidney normally filters 170 litters of plasma every day in the adult, while excretion only
1.5 L of urine.
 Regulation of ECF volume and osmolality by selective retention and excretion of body fluids.
 Regulation of electrolytes level in ECF by means of selective retention of needed substances
and excretion of unneeded substances.
 Regulation of pH of ECF by retention of hydrogen ions.
 Excretion of metabolic waste and toxic substances.

 Heart and blood vessels:

 The pumping action of the heart circulates blood through kidney under sufficient pressure to
allow for urine formation.
 Failure of this pumping action interferes with renal perfusion and thus with water and
electrolyte regulation.

 Lung:
 Through exhalation, the lungs remove approximately 300 ml of water daily in normal adults.
 In abnormal condition I.e., Hyperapnea (deep respiration) or continuous coughing increase
the loss of water and the mechanical ventilation with excessive moisture decrease it.

 Pituitary gland:
 The hypothalamus malfunction ADH (Anti-Diuretic Hormone), which is stored in the
posterior pituitary gland and released as needed.
 ADH is sometimes refereed as water conserving hormone since it cause the body to retain
water.
 The function of the ADH is maintaining the osmotic pressure by controlling the retention of
water by the kidney and by regulating blood volume.
 Adrenal gland:
 Aldosterone, an hormone secreted by adrenal gland has a profound effect on fluid balance.
 Increased secretion of aldosterone causes sodium retention (thus water retention) and
potassium loss.
 Decreased secretion leads to sodium and water loss and potassium retention.

 Parathyroid gland:
 The parathyroid hormone in the thyroid gland regulates the calcium and phosphate balance
by means of parathyroid hormone (PTH).
PTH influences bone reabsorption, calcium absorption from the intestine and calcium
reabsorption from the renal tubules.

FLUID VOLUME DISTURBANCES

 Hypovolemia: -

Hypovolemia is refers to as lack of fluid volume. It occurs when the water and electrolytes
are lost in the same proportions as they exist in normal body fluids.

Causes:
 Increase insensible water loss or perspiration
 Haemorrhage
 Osmotic diuretics
 Vomiting, Diarrhoea
 Inadequate fluid intake
 Diabetic insipidus
 Burns
 Intestinal obstruction

Clinical Manifestations:
 Restlessness, drowsy, lethargy, confusion
 Thrust, dry mucus Membranes
 Decreased skin turgor, reduced capillary refill
 Decreased urine output
 Postural hypotension, increased pulse, Decreased CVP
 Increased respiratory rate
 Weight loss, weakness
 Seizure, coma

Collaborative Care:
The goal is to correct the underlying causes and to replace both water and need of
electrolytes

1. Balanced IV solution: Ringer’s Lactate Solution.

2. Isotonic (0.9%) sodium chloride is used when rapid volume replacement is required.
3. Blood administration when the volume loss is due to blood loss.
Nursing diagnosis:
 Deficit fluid volume related to excessive fluid loss or decreased fluid intake.
 Decreased cardiac output related to excessive fluid loss or decreased fluid intake.
 Risk for deficit fluid volume
 Potential complication: Hypovolemic shock
  HYPERVOLEMIYA: -

Hypervolemia is refers to as fluid volume excess. It may result from excessive intake of fluids,
abnormal retention of fluids or fluid shift from intracellular fluid into plasma fluid.

Causes:
 Excessive Isotonic or hypotonic IV fluids.
 Heart failure
 Rental failure
 Primary polydipsia
 SIADH
 Long term use of corticosteroids

Clinical Manifestations:
 Headache, confusion, lethargy
 Jugular vein distension
 Bounding pulse, increased BP, increased CVP
 Polyuria
 Peripheral edema
 Dyspnoea, Crackles
 Muscle spasm
 Weight gain
 Seizure, coma

Collaborative Care:
The goal of treatment is to remove the excess fluids without making any abnormal changes
in electrolyte composition:
 Primary care:
1. Fluid restriction.
2. Discontinue the IV infusion when the fluid excess is related to excessive administration of
sodium containing fluids.
3. Restriction of sodium intake.
 Other measures:
1. Diuretics are prescribed, when dietary restriction of sodium alone is insufficient to reduce
edema.
2. The choice of diuretics is based on the severity
3. Of the Hypovolemic state, the degree of impairment of renal function & the potency of
diuretic.

 Haemodialysis:
  Haemodialysis or peritoneal dialysis is advisable when the renal function is severely
impaired and so the pharmacological agents can not act efficiently.
 Abdominal parenthesis:
 If fluid excess leads to ascites.
 Thoracentesis:
 When fluid excess leads to pleural effusion.

Nursing diagnosis:
 Excess fluid volume related to increased water/sodium retention.
 Activity intolerance related increased water retention and fatigue/weakness.
 Impaired gas exchange related to water retention leading to pulmonary edema.
 Disturbed body image related to altered body appearance secondary to edema.
 Potential complication: pulmonary edema, ascites.

ELECTROLYTE IMBALANCE

SODIUM
(Normal range: 135-145mEq/L)

 Hypernatremia:

Hypernatremia is defined as a plasma sodium level greater than 145mEq/L. It is usually

associated with water loss and sodium gain. As a result, the sodium concentration increases
and the increased concentration pull fluid out of the cell.

CAUSES:
 Excessive sodium intake:
1. IV fluids: hypertonic NaCl, excessive Isotonic NaCl, IV Sodium Bicarbonate
2. Hypertonic tube feeding without water supplements
3. Near drowning in the salt water
 Inadequate water intake
1. Excessive water loss:
2. Increased insensible water loss
3. Osmotic diuretic therapy
4. Diarrhoea
 Disease status:
1. Diabetes Insipidus
2. Cushing syndrome
3. Uncontrolled Diabetes Mellitus
 4. Primary hyperaldosteronism

CLINICAL MANIFESTATIONS:
 Decreased ECF volume:
a. Restlessness, agitation, twitching, Seizure, coma
b. Intense thirst, dry & swollen tongue, stick mucus membrane
c. Postural hypotension, increased CVP, weight loss, increased pulse
d. Weakness, lethargy

 Normal or increased ECF volume:

a. Restlessness, agitation, twitching, Seizure, coma
b. Intense thirst, flushed skin
c. Weight gain, peripheral and pulmonary edema, increased BP, increased CVP

MEDICAL MANAGEMENT:
 Gradual lowering of the Sodium level by the infusion of hypotonic electrolyte solution
 Isotonic solution
 Diuretics

NURSING MANAGEMENT:
 Monitor the serum sodium levels and the patient’s response to the therapy
 Restrict the dietary intake of sodium
 Prevent the ingestion of over-the-counter medications with high Sodium content
 Note the patient’s thirst and elevated body temperature
 Monitor for changes in behaviour such as Restlessness, disorientation and lethargy

NURSING DIAGNOSIS:
 Risk for acute confusion related to electrolyte imbalance.
 Risk for injury related to altered sensorium and decreased level of consciousness.
 Risk for electrolyte imbalance related to excessive loss of sodium/ excessive Intake/
retention of water.
 Potential complication: severe neurologic changes.

 Hyponatremia (Sodium deficit):

 Hypernatremia is defined as a plasma sodium level less than 135mEq/L. It is one of the most
common electrolyte disorders in adults, especially older adults. Hyponatremia is usually
associated with changes in fluid volume status.

CAUSES:
 Excessive sodium loss:
1. GI loss: diarrhoea, vomiting
2. Renal loses: Diuretics, Adrenal insufficiency, Renal disease
3. Skin loses: Burns, wound drainage
 Inadequate sodium intake
 Excessive water gain
1. Excessive hypotonic IV fluids
2. Primary polydipsia
 Disease status
1. SIADH
2. Heart failure
3. Primary hyperaldosteronism

CLINICAL MANIFESTATIONS:
 Decreased ECF volume
1. Irritability, confusion, Dizziness, tremors
2. Dry mucus membranes
3. Postural hypotension, decreased BP, decreased CVP
4. Cold, clamp skin

 Normal or increased ECF volume

1. Headache, apathy, confusion, muscle spasm, Seizure, coma
2. Nausea, vomiting, diarrhoea, abdominal cramps
3. Weight gain, increased BP, increased CVP

MEDICAL MANAGEMENT:
 Sodium replacement therapy:
 Oral intakes of sodium by eat or drink.
 Administration of Small amount of IV hypertonic saline solution.
 Lactate Ringer’s solution
 The correction of serum sodium must not Increase greater than 12mEq/L in 24 hours to
avoid neurological damage.
NURSING MANAGEMENT:
 Monitor serum sodium levels and the patient’s response to therapy.
 Avoid adding up salt in diet.
 Record the lab values and inform to the physician.

NURSING DIAGNOSIS:
 Risk for fluid volume deficit related to excessive intake of sodium/ excessive loss of water.
 Risk for electrolyte imbalance related to excessive intake sodium/ excessive loss of water.
 Potential complication: brain damage, Seizure, coma.

Potassium
(Normal range: 3.5-5.0mEq/L)

 HYPOKALEMIA: -

Hypokalaemia is defined as a plasma potassium level less than 3.5mEq/L. It is a common electrolyte
disorder especially in the older adult population. It results from an increased loss of potassium,
from an increased shift of potassium from ECF to ICF or rarely from deficient dietary potassium
intake.

CAUSES:

 Potassium loss
i. GI loss: diarrhoea, vomiting
ii. Renal losses: diuretics, hyperaldosteronism
iii. Skin losses: diaphoresis, dialysis

 Shift of potassium into cells

i. Increased insulin e.g. dextrose load
ii. Alkalosis
iii. Tissue repair
iv. Increased epinephrine e.g. stress

 Lack of potassium intake

i. Starvation
ii. Low potassium in diet

CLINICAL MANIFESTATION:
 Fatigue
  Muscle weakness, leg cramps
 Nausea, vomiting, paralytic ileus
 Soft, flabby muscle
 Paraesthesia, decreased reflexes
 Polyuria
 weak irregular pulse
 hyperglycaemia

MEDICAL MANAGEMENT:
 Treated with oral and IV replacement therapy.
 Administer 40 to 80 mEq/L day of potassium.
 IV route is indicated if oral potassium therapy is not feasible.
 Potassium rich diet for patients at risk of hypokalaemia.

NURSING MANAGEMENT:
 Monitor for the presence of hypokalaemia in the patients at risk.
 Encourage the patients for potassium rich diet (bananas, malen, citrus fruit, fresh and frozen
vegetables, fresh meats).
 Monitor the patients who are taking digitalis which may cause potassium deficiency.

NURSING DIAGNOSIS:
 Risk for electrolyte imbalance related to excessive loss of potassium.
 Risk for injury related to muscle weakness and hyporeflexes.
 Potential complication: dysrhythmias.

 HYPERKALEMIA: -
Hyperkalaemia is defined as an elevation of the potassium level greater than 5mEq/L. It is
rare electrolyte disorder but it affects people with acute and chronic renal failure.
Hyperkalemia is results from impaired renal excretion.

CAUSES:
 Excessive potassium intake
i. Excessive or massive parenteral administration
ii. Potassium containing drugs. E.g. [potassium penicillin
iii. Potassium containing salt substitute
 Shift of potassium out of cells
a. Acidosis
b. Tissue catabolism
 Failure to eliminate potassium
a. Renal disease
 b. Potassium-sparing diuretics

CLINICAL MANIFESTATIONS:
 Irritability, anxiety
 Abdominal cramping, diarrhoea
 Weakness of lower extremities
 Paraesthesia
 Irregular pulse
 Cardiac arrest

MEDICAL MANAGEMENT:
 Immediate ECG should be obtained to detect the changes.
 Restriction of dietary potassium.
 Potassium containing diuretics.
 Calcium gluconate administered in case of dangerously elevated serum potassium level.

NURSING MANAGEMENT:
 Identification and close monitoring of patients who are at risk of hyperkalemia.
 Observe the sign of muscle weakness and dysrhythmias.
 Monitoring of serum potassium levels.

NURSING DIAGNOSIS:
 Activity intolerance related to lower extremity muscle weakness.
 Risk for electrolyte imbalance related to excessive retention/ cellular release of potassium.
 Risk for injury related to altered sensorium and decreased level of consciousness.
 Potential complication: Dysrhythmias.

CALCIUM
(Normal range: 8.5-10.5mg/dl)

 HYPOCALCEMIA: -

Hypercalcemia I defined as plasma calcium greater than 5.5mEq/L. Hypercalcemia can occur
in any age group. It is a common electrolyte disorder that can have serious physical
complications.

CAUSES:
1. Decreased total calcium:
 Chronic kidney disease
 Elevated phosphorus
  Primary hypoparathyroidism
 Vitamin D deficiency
 Magnesium deficiency
 Acute pancreatitis
 Chronic alcoholism h
 Diarrhoea
2. Decreased ionized calcium:
 Alkalosis

CLINICAL MANIFESTATIONS:
 Easy fatigability
 Depression, anxiety confusion
 Numbness, tingling in extremities %h region around mouth
 Hyperreflexia, muscle cramps
 Chvostek’s sign
 Trousseau’s sign
 Laryngeal spasm, tetany, Seizure

MEDICAL MANAGEMENT:
 IV administration of calcium like:
 Calcium gluconate
 Calcium chloride
 Calcium gluceptade
 Vitamin D administration to increase the absorption of calcium from GI tract.
 Increase the dietary intake of calcium at least 1000-1500mg/day.

NURSING MANAGEMENT:
 Monitor the patients who are at risk of hypocalcaemia.
 Seizure precautions are initiated if hypocalcaemia is severe.
 People at high risk for osteoporosis are instructed about the need for adequate dietary
intake of calcium.

 HYPERCALCEMIA: -
Hypocalcaemia is defined as a plasma calcium level less than 4.5mEq/L. It results from
Vitamin D deficiency, underactive PTH glands, kidney disorders, inadequate intake of calcium
or diseases that impair calcium absorption.
 CAUSES:
1. Increased total calcium:
 Malignancy with bone metastasis
 Prolonged immobilization
 Hyperparathyroidism
 Vitamin D overdose
 Thiazide diuretics
 Milk-alkali syndrome
 Multiple myeloma
2. Increased ionized calcium:
 Acidosis

CLINICAL MANIFESTATIONS:
 Lethargy, weakness
 Depressed reflexes
 Decreased memory
 Confusion, psychosis
 Anorexia, Nausea, vomiting
 Bone pain, fractures
 Polyuria, dehydration
 Stupor, coma

MEDICAL MANAGEMENT:
 Administration of fluids to dilute serum calcium and promote it’s excretion by the kidney.
 IV administration of 0.9% NaCl solution temporarily dilutes the serum calcium levels.
 Administering furosemide lowers serum calcium levels.
 Calcitonin administered to decrease the calcium level in plasma.

NURSING MANAGEMENT:
 Monitor the patients who are at risk of hypercalcemia.
 Identification and close monitoring of patients who are at risk of hypercalcemia.
 Monitoring of serum calcium levels.

MAGNISIUM
(Normal range: 1.5-2.5mEq/L)
  HYPOMAGNESEMIA: -

Hypomagnesaemia is defined as a plasma magnesium level less than 1.5mEq/L. it can be

associated with conditions such as chronic alcoholism, malabsorption, and certain medical
treatments like chemotherapy. It commonly occurs in patients with limited magnesium
intake or decreased renal losses.

CAUSES:
 Diarrhoea, vomiting
 Chronic alcoholism
 Malabsorption syndrome
 Prolonged malnutrition
 Increased urine output
 Poorly controlled Diabetes Mellitus

CLINICAL MANIFESTATIONS:
 Confusion
 Tremors, Seizures
 Hyperactive deep tendon reflex
 Insomnia
 Increased pulse, increased BP
 Muscle cramps

MEDICAL MANAGEMENT:
 Oral supplements and increase the dietary intake of foods high in magnesium.
 IV administration of magnesium (e.g. magnesium sulphate) is given in case of severe
hypomagnesaemia.
 For mild deficiency- intake of magnesium rich food s or by suing oral magnesium supplement
(e.g. magnesium containing antacids).

NURSING MANAGEMENT:
 Monitor the patients who are at risk of hypocalcemia.
 Food rich in magnesium:
 Green leafy vegetables
 Legumes
 Whole grains
 Bananas, oranges, grapes
  Dairy products
 Meat, sea food

 HYPERMAGNESIMIA: -

Hypermagnesaemia is defined as a plasma magnesium level greater than 5mEq/L. It occurs

only with an increase in magnesium intake accompanied by renal insufficiency or failure. A
patient with chronic kidney disease who ingests products containing magnesium (e.g. milk)
will have problem with excess magnesium.

CAUSES:
 Renal failure
 Adrenal insufficiency
 Excessive administration of magnesium (e.g. treatment of eclampsia)
 Tumour lysis syndrome
 Diabetic ketoacidosis

CLINICAL MANIFESTATIONS:
 Lethargy, drowsiness
 Nausea, vomiting
 Diminished deep tendon reflexes
 Flushed, warm skin
 Decreased Pulse, Decreased BP
 Dysphagia

MEDICAL MANAGEMENT:
 Avoiding administration of magnesium to patients with renal failure.
 In severe hypomagnesaemia, all parenteral and oral magnesium salts are discontinued.
 In respiratory depression or defective cardiac conduction Ventilator support and IV calcium
are indicated.
 Haemodialysis

NURSING MANAGEMENT:
 Careful monitoring of patients with high risk of hypomagnesaemia.
 Interpretation of lab results and informs to the physician and follows up the orders.

PHOSPHHATE
(Normal range: 2.8-4.5mg/dl)

 HYPOPHOSPHATEMIA: -

Hypophosphatemia is defined as plasma phosphorus level less than 1.2mEq/L. It can result
from long-term lack of intake, increased growth and tissue repair and recovery from
malnourished state. Failure to meet these increased needs causes phosphorus depletion.

CAUSES:
 Malabsorption syndrome
 Recovery from malnutrition or refeeding
 Glucose or insulin therapy
 Total parenteral nutrition
 Alcohol withdrawal
 Recovery from diabetes ketoacidosis
 Respiratory Alkalosis

CLINICAL MANIFESTATIONS:
 CNS depression: confusion, coma
 Muscle weakness
 Polyneuropathy, Seizures
 Cardiac problems: Dysrhythmias, decreased stroke volume
 Osteomalacia
 Rhabdomyolysis

MEDICAL MANAGEMENT:
 Oral supplementation and ingestion of foods high in phosphorus (e.g. dairy products).
 IV administration of sodium phosphate or potassium phosphate.
 Frequent monitoring of serum phosphate and calcium levels is necessary to guide IV
therapy.

NURSING MANAGEMENT:
 Careful monitoring of patients with high risk of hypomagnesaemia.
 Interpretation of lab results and informs to the physician and follows up the orders.

 HYPERPHOSPHATEMIA: -
 Hyperphosphatemia is defined as a plasma phosphate level greater than 3mEq/L. It can
result from excessive intake of phosphate containing foods, excess Vitamin-D, AKI or CAD
which causes altered ability of the kidney to excrete phosphate.

CAUSES:
 Renal failure
 Chemotherapy drugs
 Enemas containing phosphorus (e.g. Fleet enema)
 Excessive ingestion of phosphorus (e.g. milk)
 Phosphate containing laxatives
 Hypothyroidism
 Sickle cell anemia

CLINICAL MANIFESTATIONS:
 Hypocalcaemia
 Numbness and tingling in extremities and regional around mouth
 Hyperreflexia, muscle cramps
 Tetany, Seizures
 Deposition of calcium Phosphate precipitated in skin, soft tissue, viscera, blood vessels

MEDICAL MANAGEMENT:
 The ingestion of high phosphorus rich foods and fluids are restricted.
 Phosphate binding agents or gels (e.g. Calcium carbonate) Which limit intestinal Phosphate
absorption and thus increase Phosphate secretion into the intestine.
 Haemodialysis.
 Insulin or glucose infusion can rapidly decrease the levels.

NURSING MANAGEMENT:
 Careful monitoring of patients with high risk of hypophosphatemia.
 Interpretation of lab results and informs to the physician and follows up the orders.

CHLORIDE
(Normal range: 95-105mEq/L)

 HYPOCHLOREMIA: -
 Hypochloraemia is defined as a plasma chloride level less than 96mEqL. Chloride is essential
electrolyte that plays a crucial role I maintaining the body’s acid base balance, as well as
fluid balance.

CAUSES:
 Salt restricted diet
 GI tube drainage, severe diarrhoea
 Volume depletion
 Accumulation of HCo3 in ECF

CLINICAL MANIFESTATIONS:
 Metabolic alkalosis
 Hyper-excitability of muscles
 Tetany, Hyperactive
 Deep tendon reflexes, weakness
 Twitching, muscle cramps
 Dysrhythmias

MEDICAL MANAGEMENT:
 0.9% of sodium chloride or 0.45% of sodium chloride of normal saline IV infusion to replace
the chloride.
 Discontinue and change of diuretics.
 High calorie rich foods are provided:
 Tomato juice
 Salty broth
 Canned vegetables
 Processed meat
 Fruits
 Ammonium chloride, an acidifying agent to treat metabolic alkalosis.

NURSING MANAGEMENT:
 Monitoring ABG values, intake and output, serum electrolytes.
 Monitor patient’s level of consciousness, muscle strength and movement.
 Vital signs are monitored.
 Educate about the high calorie rich diet.

 HYPERCHOLEREMIA:
 Hypocholeremia is defined as a plasma chloride level greater than 106mEq/L. With increase
in the chloride level, Hypernatremia, carbonate loss, and metabolic acidosis can also occur.

CAUSES:
 Dehydration
 Kidney disorders
 Respiratory alkalosis
 Medications
 Metabolic corrections

CLINICAL MANIFESTATIONS:
 Tachycardia
 Diminished cognitive ability
 Hypertension
 Rapid respiration
 Weakness
 Deep respiration

MEDICAL MANAGEMENT:
 Lactated Ringer’s Solution to convert lactate to Bicarbonate in the liver, which will increase
the base carbonate level and correct the Acidosis.
 Sodium Bicarbonate in IV infusion to increase the bicarbonate levels, which leads to the
renal excretion of chloride ions as bicarbonate and chloride complete for combination with
sodium.
 Diuretics to eliminate chloride as well sodium fluids and chloride are restricted.

NURSING MANAGEMENT:
 Monitoring ABG values, intake and output, vital signs.
 Assess the respiratory, neurological, cardiac system & document the changes.

SUMMARY
In this topic I discussed about body fluid, its composition and function, regulation of body fluid,
balance or imbalance, homeostasis mechanism, electrolytes and their functions (Sodium,
Potassium, Calcium, Magnesium, Phosphate, Chloride), electrolytes disorders, pathophysiology,
their causes, clinical manifestations, diagnostic evaluation, medical management, nursing
management, nursing diagnosis.

CONCLUSION

Fluid and electrolyte imbalance refers to disruption in normal levels or proportions of fluid and
electrolytes in the body. This can occur due to various reasons such as dehydration, excessive fluid
intake, kidney problems, hormonal imbalances, or certain medical conditions. Imbalance can lead to
symptoms ranging mild to severe, affecting vital physiological functions.

BIBLIOGRAPHY

1. Black M. Joycee, Medical Surgical Nursing, Volume 1:8 th edition, evolve publisher, page no.
135-147.
2. Sharma k Suresh, Tesxtbook of pharmacology, Pathology and Genetics for Nurses, Volume:2,
Jaypee publishers, page no. 608-611.
3. Fluid and electrolyte imbalance: interpretation and assessment – mandi D. Walker (journal
of infusion nursing), 2016.
4. General characteristics of patients with electrolyte imbalance admitted to emergency dept.
By Arif Kadri Balc, Ozlem Koksal, Nuran Oner world, journal of emergency medicine.
5. Overview of fluid and electrolyte imbalance by Norma Metheny R.N (1981), journey of
national intravenous therapy association.