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- Fluid and Electrolyte Balance
- Fluid and electrolyte balance
- Fluid and Electrolyte Balance
- The Regulation of Fluid and Electrolyte Balance
In this article, the last in a four-part series, we explore fluid maintenance with particular reference to disorders of the pituitary gland.
Electrolytes play a vital role in maintaining homeostasis within the body. They help regulate myocardial and neurological function, fluid balance, oxygen delivery, acid-base balance, and other biological processes. Electrolytes are important because they are what cells especially those of the nerve, heart, and muscle use to maintain voltages across their cell membranes and to carry electrical impulses nerve impulses, muscle contractions across themselves and to other cells. Electrolyte imbalances can develop from excessive or diminished ingestion and from the excessive or diminished elimination of an electrolyte. The most common cause of electrolyte disturbances is renal failure.
Fluid and Electrolyte Balance
In this article, the last in a four-part series, we explore fluid maintenance with particular reference to disorders of the pituitary gland. Fluid management techniques and related nursing care are also covered.
Body fluids are mainly water and electrolytes, and the three main organs that regulate fluid balance are the brain, the adrenal glands and the kidneys Tortora and Grabowski, One-third of the total is circulatory fluid, sometimes known as extracellular fluid ECF ; the remainder is intracellular fluid ICF contained within cells Docherty and McIntyre, ; Edwards The anatomy and physiology of homeostasis are covered in part one of this series.
Most tissues contain a lot of water bones and adipose tissue are the two main exceptions. It has many functions, including Tortora and Grabowski, ; Adam and Osborne, :. When fluid volume decreases, the concentration of sodium in the blood will increase increased osmolarity, the amount of solute per unit volume , which in turn stimulates the hypothalamus Tortora and Grabowski, The hypothalamus is an osmoreceptor - a sensory end organ that reacts to changes in osmotic pressure and has an effect on the pituitary gland.
In response, the posterior pituitary gland releases antidiuretic hormone ADH, sometimes called vasopressin into the bloodstream, resulting in the kidneys retaining water.
This in turn results in more concentrated urine and an increase in water returned to the ECF, thus correcting the volume depletion Tortora and Grabowski, ; Edwards, Fig 1. When sodium concentration in the blood decreases the adrenal cortex is stimulated into secreting the hormone aldosterone, which instructs the distal nephrons of the kidney to retain more sodium.
Normal levels of sodium in the ECF will attract and maintain the optimum amount of water Tortora and Grabowski, ; Edwards, ADH release is also influenced in the following circumstances. Sensors detect stretching of the atria of the heart indicating excessive returning volume of ECF increased venous return. They stop ADH secretion, which leads to increased excretion of water through renal filtration. The aorta and carotid arteries also have receptors that are sensitive to a reduction in blood pressure related to the pressure in the left ventricle.
In addition to regulating total volume, the osmolarity of bodily fluids is closely monitored and regulated because variations may cause damage to cellular structure swelling or shrinking , disrupting normal cellular function Edwards, ; Metheny, Regulation of ECF osmolarity is achieved by balancing the intake and output of sodium with that of water.
If there is too much or too little of any of these electrolytes this can cause problems. For example, cardiac arrhythmias are triggered by low potassium and low magnesium levels Docherty, ; Smith, These figures may differ slightly according to local policies. The average fluid input per day is 2,ml water as food 1,ml, water as liquid 1,ml, water from catabolism ml and output is 2,ml. Daily input and output is summarised in Table 1.
In some cases patients will need fluid and electrolyte replacement therapy , which nurses are responsible for delivering and monitoring. In general crystalloid fluids for example saline 0.
Colloid solutions are not generally indicated for most patients for ECF replacement RCUK, ; Nolan, ; Smith, because they move easily into the ICF making them less effective and creating other clinical issues for example pulmonary oedema and hypotension.
Albumin levels are also important in fluid balance, and should be monitored closely. A reduction in albumin due to loss, for example in sepsis where there is a higher rate of albumin loss into the tissues, may result in hypotension and hypovolaemia Kokko and Tannen, Albumin replacement colloid therapy is indicated for hypoalbuminaemia volume-depleted patients.
The greatest effect is in patients with temporary albumin loss, for example trauma, surgery or burns Kokko and Tannen, Other issues that nurses should consider when nursing patients with fluid balance problems include: the accurate measurement and monitoring of IV fluids over a particular hour period, including correct documentation and prescription of fluids and fluid types; being aware of electrolyte levels and the correct administration of replacement elements as prescribed; the accurate measurement of oral fluid input and urine output, working in partnership with the patient where possible.
Daily morning weights are useful to establish a trend in overall fluid balance and useful in chronic fluid management conditions such as renal failure RCUK, ; Docherty and McIntyre, ; Adam and Osborne, In seriously ill patients urinary catheterisation is recommended to assist with accurate fluid balance measurement , as is regular vital sign monitoring including pulse, blood pressure remember that the blood pressure may be normal initially as the peripheral vessels compensate , respiratory rate, pulse oximetry oxygen saturation and central venous pressure if available RCUK, ; Docherty and McIntyre, ; Smith, Sign in or Register a new account to join the discussion.
Fluid and electrolyte balance
This article is only available in the PDF format. Download the PDF to view the article, as well as its associated figures and tables. Professor Muntwyler, in his preface, indicates that his intention in writing this monograph is to provide "a detailed and simplified treatment of various fundamental principles and The simplified principles are presented in great detail with formulae, equations, and many numerical examples and diagrams. However, this tends to make a textbook that, while valuable for the student, would not be easily read by a practicing physician who might wish to review principles. On the other hand, it cannot; its simplified treatment does not lend itself as a reference book for those with any knowledge of the field. The volume devotes 58 pages to water and electrolyte metabolism, 66 pages to acid-base balance, and 20 pages to correction of fluid, electrolyte, and.
Care of the Critically Ill Patient pp Cite as. The major function of the cardiorenal system is to maintain the fluid bathing the cells at a constant composition, for it is through this pericellular fluid that O 2 and nutrients are delivered and waste products of metabolism removed. The early marine vertebrates had an extracellular fluid similar to that of their salt water environment, but with evolution to fresh water and land there were various modifications, which included the development of an integument impermeable to water and modifications in renal function to allow the excretion or conservation of water and sodium according to the prevailing conditions. This chapter will outline the distribution of water and electrolytes throughout the body and the aspects of circulatory and renal physiology which are responsible for maintaining this steady state. Unable to display preview. Download preview PDF.
Fluid and Electrolyte Balance
Electrolytes are minerals in your body that have an electric charge. They are in your blood, urine, tissues, and other body fluids. Electrolytes are important because they help. Sodium , calcium , potassium , chloride, phosphate, and magnesium are all electrolytes. You get them from the foods you eat and the fluids you drink.
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The Regulation of Fluid and Electrolyte Balance
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PDF | Humans demonstrate a remarkable ability to regulate daily body water and electrolyte balance so long as food and fluid are readily.