one like & comment please.

1. MICRO TEACHING
ON
FLUID,ELECTROLYTE
AND ACID IMBALANCES
PRESENTED BY,
DEBASHRITA MISRA
1ST YEAR M.SC NURSING

2. INTRODUCTION
Infants and young children are at risk than adults for
disturbance in fluid and electrolyte balance due to
difference in body position,higher metabolic rate and
immaturity for physiologic regulation systems.

3. COMPOSITION OF BODY FLUIDS
total body
fluid 60% of
body wt
intracellular
fluids
extracellular
fluids
interstitial
fluid 15% of
body wt
trancellular
fluid
eg.plasma
intravascular
fluid
eg.CSF

4. EXTRACELLULAR FLUID
VOLUME DEFICIT
(DEHYDRATION)
 Isotonic dehydration
 Hypotonic dehydration
 hypertonic dehydration

5. EXTRACELLULAR FLUID
VOLUME EXCESS
 Edema

6. FLUID VOLUME DISTRUBANCES
1.hypovolemia:fluid volume deficit
2.hypervolemia:fluid volume excess

7. NORMAL SERUM VAUES OF
ELECTROLYTES IN CHILDREN
Electrolyte newborn Infant and child
Sodium 131-144mmol/L 132-141mmol/L
Potassium Premature 4.5-7.2mmol/L
Term 3.2-5.7mmol/L
3.3-4.7mmol/L
Calcium Premature 3.5-4.5mEq/L
Term 4-5mEq/L
4.4-5.3mEq/L
Magnesium 1.3-2.7mg/dL 1.6-2.7mg/dL

8. ELECTROLYTE IMABALANCE
electro
lytes
Electrolyte
imbalance
cause Clinical manifestation treatment
sodium Hyponatrem
ia
(deficit)
Hypovolemic
Sodium loss
Anorexia,nausea,vomitin
g,confusion,distress,wea
kness In progress
seizure,coma,myocardial
ischemia,arrest and
death
Sodium replacement
RL solution
Diuretics(for SIADH)
Hypernatre
mia
(excess)
Hypotonic loss
Hypertonic sodium
gain
Thirsty,unconsciousnes
,hypertonicity
Hypotonic fluids
Diuretics
potassi
um
Hypokalemi
a(deficit)
Potassium loss
Shift potassium into
Cell Lack of
Potassium intake
Abdominal
distension,respiratory
muscle impaired,
polyuria,polydipsia
Potassium replacement
Hypokalemic diet
Hyperkalem
ia(excess)
Excess potassium
intake
Shift of potassium
out of cell
Cramping,diarrhea,leg
weakness,dysfunction of
cardiac muscle,oliguria
and anuria
ECG
Restricted dietary
potassium
Potassium

9. calcium Hypocalcem
ia(deficit)
 Alkalosis
 Chronic alcoholism
 Chronic renal failure
 Increased calcium
excretion
 Decreased calcium
intake or absorption
Tetany,twitchin
g and
cramping,pedal
spasm,seizure,c
ongestive heart
failure.
 Oral or iv
administration
of calcium
 High calcium
food
Hypercalcem
ia(excess)
 Increased calcium intake
 Shift calcium from bones
to extracellular fluid
 Decreased calcium
excretion
Decreased
neuromuscular
excitability,const
ipation,fatigue,co
nfusion
 Diuretics
 Glucocorticoids
 dialysis

10. magnesium Hypomagnesemi
a(deficit)
 decreased mg
intake or
absorption
 shift
magnesium
 increased mg
excretion
 loss mg by
abonormal
route
Tetany,
hyperactive
reflexes
 administratio
n of mg
 treat
underlying
cause
Hypermagnesemi
a(excess)
 decreased mg
excretion
 increased mg
intake
Decreased muscle
irritability,hypote
nsion,lethargy,car
diac arrest
 ECG
 Calcium
gluconate
 Increased
fluid intake
 dialysis

11. NORMAL BLOOD PH AND GASES IN
CHILDREN
infants Children adolescents
Arterial blood pH 7.18-7.50 7.27-7.49 7.35-7.41
Arterial blood pO2 60-70mmHg 80-108mmHg 80-100mmHg
Arterial blood pCO2 27-41mmHg 32-48mmHg 32-48mmHg
Arterial blood HCO3 19-24mmol/L 18-25mmol/L 20-29mmol/L

12. ACID BASE IMBALANCE
causes Clinical
manifestations
treatment
Metabolic
acidosis
Decrease serum pH
(<7.35)
Due to decrease
bicarbonate
 bicarbonate
loss.
 Increase acid
production
Tachypnea,tachy
cardia,hypotensi
on,pulmonary
edema,confusion
,seizures
 Treat underlying
causes
 Dialysis
Metabolic
alkalosis
Excess bicarbonate  Vomiting,diarrh
ea
 Cystic fibrosis
 Renal failure
 diuretics
confusion,seizur
e,muscle cramps
 treat underlying
cause
 discontinue
diuretics
 hemodialysis

13. Respiratory
acidosis
Excess ECF
carbonic acid
 hypoventilat
ion
 CO2
retention
Increased
PCO2,CNS
depression,
tachycardia,
hypotension,
coma
 Decrease sedative
use
 Treat underlying
cause
 Bronchodialators
for bronchospasm
Respiratory
alkalosis
Deficit carbonic
acid
 Increased
metabolic
rate
 Increased
intracranial
pressure
Decreased
PCO2,breathlessn
ess,muscle cramps
 Restore effective
ventilation
 Sedation,breathing
exercise

14. CONCLUSION
Fluid and electrolyte balance is a dynamic process
that is crucial for life.It plays an important role in
homeostis.Imbalance may result from many factors,
and it is associated with the illness.

15. ASSIGNMENT
Write down the nurses responsibility in
hypernatremia?

16. BIBLIOGRAPHY
1.Suzanne C. smeltzer, Bare, Janice L.Hinkle. “Text
book of medical-surgical Nursing”,11thedition,2009.Wottess
kluwer Pvt Ltd, New Delhi,page No:301-352
2.Helen 5. Lewis et al,”Medical Surgical Nursing”,
Mosby first printed in India 2007, Page no 84-97