Fluid,Electrolyte,and

Acid-Balance

Dr. sabah Abbas

Instructor, Fundamentals of Nursing Department,
College of Nursing, University of Baghdad
Introduction:
The body normally maintains a balance between the 
amount of fluid taken in and the amount excreted. 
Health promotion requires a maintenance of body 
fluid
and acid-base balance . These interventions include 
ongoing assessments , modifying dietary and fluid
intake, administering medications ,assisting with I.V.
therapy, and blood replacement..
  Anatomy and Physiology:
Fluids and electrolytes are vital to life and adequate 
balance is imperative to maintain healthy functioning
of the body.
Fluids and electrolytes are involved in almost every 
cellular reaction and function.
Chemical reactions that occur in the body depend 
upon careful acid and base balance ……
Body Fluids
As the primary body fluid ,water is the most important 
nutrient of life. Although life can be sustained for many days
with out food ,humans can survive for only a few days without
water. Water in the body functions primarily to :
- Provide a medium for transporting nutrients to cells and 
wastes from cells.
-Provide a medium for transporting substances such as 
hormones, enzymes, blood platelets, and red and w.b,c through
out the body .
- Facilitate cellular metabolism & proper cellular chemical 
functioning.
-Act as a solvent for electrolytes & nonelectrolytes 
- Help maintain normal body temperature. 
- Facilitate digestion & promote elimination 
- Act as a tissue lubricant 
Body Water &Fluid Compartments
Total body water or fluid refers to the total amount of 
the total amount of water , which is approximately 50% -
60% of the body weight in healthy person.
Fluid is located in two fluid compartments: - intracellular 
fluid( ICF) or extra cellular fluid ( ECF), based on its
location in the body.
ICF : IS the fluid with in cells, constituting about70% of 
the total body water or 40% of the adults body weight.
ECF: is all fluid out side the cell ,accounting for about 
30% of total body water or 20% of the adults body
weight.
Body Water &Fluid Compartments
ECF includes two major areas, the intravascular& 
interstitial compartments .A third areas ,usually minor ,
compartment is the transcelluar fluids, intravascular fluid,
or plasma, is the liquid component of the blood (i.e. fluid
found with the vascular system)
Interstitial fluid : is the fluid that surrounds tissue cells & 
includes lymph.
Transcellular fluid include cerebrospinal, pericardial, 
synovial ,intraocular, & pleural fluids as well as sweat
digestive secretions.
The capillary walls & cell membranes separate the 
intracellular & extracellular compartments.
Body Water &Fluid Compartments
Variations in fluid content : its is from the normal 
50%- 60% of the body weight can occur, depending on
such factors as the persons age, body fat ,& gender.
Infants have considerably more total body fluid & ECF 
than adult. Because ECF is more easily lost from the
body than ICF, infants are more prone to fluid volume
deficits . Fat cells contain little water. Women tend to
have more body fat than men do ,they have also less body
fluid than men .
Decreasing percentage of body fluid in older people is 
related to increase in fat cells. Older adults lose muscle
mass as a part of aging . The combined increase of fat &
loss of muscle results in reduced total body water,
After the age of 60 years, total body water is about 45% 
of persons body weight.
This decrease in water increases the risk for fluid 
imbalance in older adults..
Fluid balance : The desirable amount of fluid intake & 
loss in adults ranges from 1.500 to 3.500 ml. each
24hours, with most people averaging 2.500 to 2.600 ml.
per day. persons intake should normally be approximately
balance by output or fluid loss. A general rule is that in
healthy adults, the output of urine normally the ingestion
of liquids &the water from food& oxidation is balanced by
the water loss through the feces, the skin, & the
respiratory process.
Fluid sources
The human body obtains water from several sources, 
including ingested liquids ,food &as a by –product of
metabolism.
Fluid intake is regulated primarily by the thirst mechanism. 
Located with in the hypothalamus, the thirst control
center is stimulated by intracellular dehydration &
decreased blood volume.
The water contained in food is the second largest source 
of water for the body.
Water is an an end product of oxidation that occurs 
during the metabolism of food substances, specifically
carbohydrates, fats ,& proteins.
Fluid Losses
Fluid is lost from the body through sensible & 
insensible losses
Sensible losses : can be measured & include fluid 
lost during urination, defecation & wounds.
Insensible losses: losses cant be measured or seen 
&include fluid lost from evaporation the skin & as
vapor from the lungs during respiration.
Fluid output averages 2.500 to 2.900 ml.\ day 

 Fluid and Electrolyte Regulation
 Maintaining homeostasis of fluid volume & electrolytes is essential to
healthy body functioning. The body produces this balance by shifting
fluids between the ECF & ICF. The mechanisms responsible for
regulating this shift of fluids & transporting materials to &from
intracellular compartments are osmosis, diffusion, active transport,
&filtration,
 - Fluid and Food Intake and Loss-

 - Skin & Lungs

 Gastrointestinal Tract
 Kidneys
 Terminologies


- Solute: Substance dissolved in a solution

• Solvent: Liquid that contains a substance in solution
• Permeability: Capability of a substance, molecule, or ion to diffuse 
through a membrane (covering of tissue over a surface, organ, or
separating spaces)

Filtration : The movement of fluid through semi permeable 

membrane from an area with higher hydrostatic pressure to an area
with lower hydrostatic pressure creates an outward gain of fluid in the
interstitial spaces .
-Osmosis: Solvent molecules move across a membrane to an 
area where there is a higher concentration of solute that cannot pass
through the membrane.
 Hydrostatic Pressure: The force of fluid presses
outward against the blood vessel wall
 Diffusion: Particles move across a permeable membrane
and disperse in all directions through a solution or a gas
Colloid Osmotic Pressure : There is a movement of 
fluid between the intravascular and interstitial compartments,
based on the number of solute particles on the concentrated
side and presence of a semi permeable membrane.
Acid : is a substance that donates hydrogen ions. For 
example, hydrochloric acid (HCl) ionizes in water (a solution)
to form hydrogen ions and chloride ions. HCl, which is found
in gastric juices,
A base :is a substance that accepts hydrogen ions (proton 
acceptor).
 Electrolytes:
An electrolyte is a compound that, when dissolved in
water or another solvent, forms or dissociates into ions .
The electrolytes provide inorganic chemicals for cellular
reactions and control mechanisms. Electrolytes have
special physiological functions in the body that promote
neuromuscular irritability, maintain body fluid osmolarity,
regulate acid-base balance, and distribute body fluids
between the fluid compartments.
Electrolytes are measured in terms of their electrical
combining power, or chemical activity. the quantities of
cations and anions in a solution, expressed as mill
equivalents per liter (mEq/L). Because electrolytes
produce either positively charged ions (cations) or
negatively charged ions (anions), they are critical
regulators in the distribution of body fluid.
Electrolytes:

The main electrolytes in body fluid are: 

sodium (Na+), potassium (K+), calcium (Ca2+), and 
magnesium (Mg2+). The extracellular fluid contains the
largest quantities of sodium, chloride, and bicarbonate
ions, but only small quantities of potassium, calcium,
magnesium, phosphate, sulfate, and organic acid ions.
The intracellular fluid contains only small quantities of 
sodium and chloride ions and almost no calcium ions.
Large quantities of potassium , phosphate ions ,
magnesium and sulfate ions are contained within
intracellular fluid .
 Acid-Base Balance
- 
-
Acid-base balance : refers to the homeostasis of the 
hydrogen ion concentration in extracellular fluid. The 
slightest variation in the hydrogen ion concentration 
causes marked alterations in the rate of cellular chemical 
reactions. The pH symbol is used to indicate the hydrogen
ion concentration of body fluids; 7.35 to 7.45 is the
normal pH range of extracellular fluid.
Hydrogen ions (H+), which carry a positive charge, are 
protons.
Depending on the number of hydrogen ions present, a 
solution can be either acidic, neutral, or alkaline
Acid-Base Balance:
A neutral solution has a pH of 7. In such a solution there 
are equal numbers of hydrogen ions (H+) and hydroxyl ions
(OH–), which can combine to form water (H2O).
When the number of hydrogen ions is increased, the 
solution becomes acidic (pH value below 7); a decrease in the
number of hydrogen ions causes the solution to become alkaline
( pH value above 7 ).
When the number of free hydrogen ions in a solution 
increases to the point that the pH value becomes less 
than 7.35, the body is in a state of acidosis. The opposite 
occurs with alkalosis, in which a pH value higher than 
7.45 results from a low hydrogen ion concentration. 
Regulators of Acid-Base Balance

The body has three main control systems that 

regulate acid-base balance to counter acidosis or
alkalosis: the
buffer systems; respiration; and renal control of 
hydrogen ion concentration.
These systems vary in their reaction time in 
regulating and restoring balance to the hydrogen ion
concentration of a solution.
Regulators of Acid-Base Balance
Chemical Buffer systems: A buffer is a substance 
that prevents body fluids from becoming overly
acidic or alkaline. They combine with excess acids or
bases to prevent major changes in PH, keeping the
pH of body fluids as close as possible to normal
(7.35- 7.45) . Alternately, a buffer may function like
an acid& release hydrogen ions when too few are
present in a solution.
The body has three buffer systems: 1- the 
carbonic acid- sodium bicarbonate buffer system ,
2- the phosphate buffer system, 3- the protein
buffer system .
Regulators of Acid-Base Balance

1- the ratio of carbonic acid (H2CO3), the most common

acid in human body fluid, to the body's most common base,

bicarbonate(HCO3), is important buffer system of the body.

Normal ECF has a ratio 20 part bicarbonic to 1 part carbonic acid.

This system buffers as much has 90% of the( H+ ) of ECF. The lungs

help by regulating the production of a carbonic acid resulting from

the combination of co2 & water. The kidneys assists the

bicarbonate system by regulating the production of bicarbonate.

Regulators of Acid-Base Balance
2-phospate buffer system: 
is active in intracellular fluids, especially in the renal 
tubules, it converts alkaline sodium phosphate (Na2po4),a
weak base , to acid- sodium phosphate(NaH2po4) in the
kidneys.
3- protein buffer system: is a mixture of plasma 
proteins & the globin portion of hemoglobin in R.B.C.
Because plasma proteins& hemoglobin possess chemical
groups that can combine with or liberate hydrogen ions,
they tend to minimize changes in pH & serve as excellent
buffering agents over a wide range of pH values working
both inside & outside the cells.
Respiratory Regulation 0f Hydrogen Ions:

Carbon dioxide ,constantly produced by cellular

metabolism (carbonic acid H2CO3,yields co2 &H2O), is

excreted by exhalation. When the amount of co2 in the blood

increases, the sensitive chemoreceptor in the respiratory center

in the medulla are stimulated to increase the rate& depth of

respirations to eliminate more co2. As more co2 is exhaled, the

H2CO3 level in the blood decreases,

Respiratory Regulation 0f Hydrogen Ions:

the PH of the blood becomes more alkaline. When the

blood level of co2 decreases, the respiratory center decreases

the rate& depth of respirations to retain the Co2 , so that

carbonic acid can be formed ,thereby maintaining the delicate

balance.

As a results, the lungs are the primary controller of the bodys

carbonic acid supply.


- Renal Regulation of Hydrogen Ions
 :The kidneys excrete or retain hydrogen ions &form or
excrete bicarbonate ions in response to the PH of the blood.
 In the presence of acidosis, the kidneys excrete hydrogen ions
& form &conserve bicarbonate ions, thus raising the PH to
the normal range .
 If alkalosis is present, the kidneys retain hydrogen ions &
excrete bicarbonate ions in an effort to return to a balanced
state. As a result, the concentration of bicarbonate in the
plasma is regulated by kidneys.
 The PH of urine varies, depending on the ions that are being
excreted, but it is generally between 4.5& 8.2
 Acid-base regulation by the kidneys occurs more slowly than
that which occurs by the carbonic acid- sodium bicarbonate
system or by respiratory regulation.
Fluid Imbalances
Fluid imbalances occur when the body's
compensatory mechanisms are unable to maintain a
homeostatic state. Fluid imbalances involve either the
volume or distribution of water or electrolytes.
- Fluid Volume deficit:- It can be caused by a
loss of both water& solutes in the same proportion
from the ECF space. The state is commonly known as
hypovolemia or isotonic fluid loss.
Fluid Imbalances
Both osmotic & hydrostatic pressure changes force
the interstitial fluid into the intravascular space in an effort
to compensate for the loss of volume in the blood vessels.
As the interstitial space is depleted, its fluid becomes
hypertonic, & cellular fluid is then drawn into the interstitial
space ,leaving cells without adequate fluid to function
properly. Fluid volume deficit can rapidly result in a weight
loss of 5% in adults & 10% in infants. A 15% weight loss
caused by fluid deficiency usually is life threatening.
-
Third- space fluid shift refers to a distributional shift of body 
fluids into the transcellular compartment, such as the pleural,
peritoneal( ascites), or pericardial areas: joint cavities :the
bowel :or an excess accumulation of fluid in the interstitial
space. Third –space shift may occurs as a result of a severe
burn. a bowel obstruction or hypolbuminemia..
Fluid Volume Excess- -:Excessive retention of water& 
sodium in ECF in near equal proportions results in a condition
termed fluid volume excess. It also called hypervolemia or
excess of isotonic fluid . Due to the increased extracellular
osmotic pressure from the retained sodium & water, fluid is
pulled from the cells to equalize the tonicity. By the time the
intracellular & extracellular spaces are isotonic to each other,
an excess of both water &sodium in the ECF, whereas the cells
are nearly depleted.
-
The excessive ECF may accumulate in either the intravascular 
compartments or interstitial spaces.
Accumulation of fluid in the interstitial space is known as 
edema , can be observed around the eyes, fingers, ankles, and
sacral space, & can be accumulate in or around body organs.
Accumulation of fluid may result in a weight gain in excess of 
5%.
Electrolyte Imbalances:- . In health, normal homeostatic 
mechanisms function to maintain electrolyte and acid-base
balance. In illness, one or more of the regulating mechanisms
may be affected, or the imbalance may become too great for
the body to correct without treatment
*- 
 Hyponatremia : 

Sodium is the primary determinant of extracellular fluid concentration 

because of its high concentration and inability to cross the cell
membrane easily. The low extracellular serum sodium causes water to
enter the cells in the brain, thereby producing cerebral edema as
manifested by the cognitive and sensory changes .

Hypernatremia: 

is an excess in the extracellular level of sodium. With an excess of sodium

or a loss of water, a hyperosmolar state exists because the ratio of sodium
to water is too high. This ratio causes an increase in the extracellular
osmotic pressure, which pulls fluid out of the cells into the extracellular
space .
 Potassium: The normal range of extracellular potassium is
narrow (3.5–5.0 mEq/L).
Hypokalemia -is a decrease in the extracellular level of-
potassium. Gastrointestinal-tract disturbances and the use of
diuretics can place the client at risk for hypokalemia and an acid-
base imbalance (metabolic alkalosis). Besides diuretics, other major
drug groups that can cause hypokalemia are laxatives,
-corticosteroids, and antibiotics.
Hyperkalemia : is an increase in the extracellular level of
potassium. There are major drug groups that may cause
hyperkalemia:
• Potassium-sparing diuretics
• Central nervous system agents
• Oral and intravenous replacement potassium salts
Hyperkalemia can also inhibit the action of digitalis
----
 Chloride

-As previously stated, chloride and water move in the 

same direction as sodium ions, influencing the osmolality of
extracellular
-Hypochloremia- is a decrease in the extracellular level 
of chloride. .Gastrointestinal tract losses may cause a decrease in
chloride because of the acid content of gastric juices, mainly
hydrogen chloride. Because the bicarbonate ion compensates for
the loss of chloride, the client is at risk for developing metabolic
alkalosis . signs and symptoms of hypochloremia are muscle
twitching and slow, shallow breathing
. Hyperchloremia - is an increase in the extracellular level of 
chloride. It usually occurs with dehydration, hypernatremia, and metabolic
acidosis. The signs and symptoms
of hyperchloremia are muscle weakness, deep, rapid breathing, and 
lethargy progressing to unconsciousness if untreated.
 Acid-Base Disturbances
It is occur when the carbonic acid or bicarbonate levels become
disproportional . The common types of acid-base imbalances are
respiratory acidosis and alkalosis and metabolic acidosis and alkalosis.

-- Respiratory Alkalosis (Carbonic Acid Deficit) :

:Respiratory acidosis is characterized by a decreased hyd rogen ion
concentration (a blood pH above 7.45) and a decreased arterial carbon
dioxide pressure (less than 35 mm Hg). Respiratory alkalosis is caused
by hyperventilation (excessive exhalation of carbon dioxide) resulting in
hypocapnia (decreased arterial carbon dioxide concentration).
Hyperventilation can be triggered by hypoxia at high altitudes, anxiety,
fear, pain, fever, and rapid mechanical ventilation.
 Respiratory Acidosis
(Carbonic Acid Excess)

Respiratory acidosis is characterized by an increased 

hydrogen ion concentration (a blood pH below 7.35), an
increased arterial carbon dioxide pressure (greater than 45 mm
Hg), and an excess of carbonic acid. Respiratory acidosis is
caused by hypoventilation or any condition that depresses
ventilation.
Hypoventilation can begin in the respiratory system, as 
occurs with respiratory failure, or outside the respiratory system,
as occurs with drug overdose. Common drugs that can cause
central nervous system depression and place the client at risk
for respiratory acidosis are narcotics, barbiturates, and
anesthetic agents .
- Administering intravenous (I.V.) Therapy
A relatively common form of therapy for handling fluid 
disturbances is the use of various solutions with infused
intravenously.
The physician or other licensed healthcare professional 
prescriptive privileges is responsible for prescribing the kind and
a mount of solution to be used.
The nurse is responsible for initiating, monitoring, and 
discontinuing the therapy. The nurse must understand the
patients need for I.V. therapy , the type of solution being used,
its desired effect, and untoward reactions that may occur.
 Selected I.V. Solutions
-1- Isotonic solutions:
- 5% dextrose in water (D\W)
- o.9% Nacl ( normal saline)
- Lacted Ringers solution
2- Hypotonic solutions:
o.33% Nacl (1\3- strength normal
saline)
0.45% Nacl (1\2 strength normal
saline)
3- Hypertonic solutions:
Selected I.V. Solutions
5% dextrose in 0.45% Nacl
10% dextrose in water (D W)10

5% Dextrose in 0.9 % Nacl (normal saline)