Fluids

Body Fluid Content

F M
E A
M L
A E
L
E

Body Fluid averages 60% of adult weight

Body Fluid Replacement

Sources
Oral liquids, water in food & by food oxidation
Recommended dietary allowance:
Average adult intake 2500 mL/24 hrs
Men: avg. 3L/day
Women: avg. 2.2 L/day

(McCarron, 2007)
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Fluid & Electrolyte Imbalance
Threat to life
Loss of body water
Sensible Water Loss

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urologyhealth.org

Humans requires approximately

30 mL/kg water per day
Insensible Water Loss
Skin: 500 mL/day perspiration

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Lungs: 500 mL day per expired air

Loss varies per rate & depth of respirations

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How many pounds is 1 kg?
Body Fluid Compartments 2/3
Intracellular fluid (ICF)
Inside the cell
facweb.northseatle.edu

1/3
Extracellular fluid (ECF)
Plasma
Interstitial Fluid
Outside the cell Transcellular Fluid
Rich in oxygen, carbon dioxide, nutrient and waste exchange
 Extracellular Fluid

Interstitial Transcellular
Plasma
Fluid Fluid

nlm.nih.gov
 Composition of Body Fluids
Body fluids are comprised
of solute and solvent

Substance

H2O
scienceiscool.org

Primary Solutes: Solute

Sodium Solvent
Urea +
Glucose Solution
Body Fluid Solutes
Electrolytes Nonelectrolytes
95% bodys solutes 5% of bodys solutes
Separate into ions Do no separate into
when placed in water particles when placed in
water
Chemicals carry electrical
Examples:
charge
Glucose
Distribution/movement of
water Urea
Maintain acid-base Creatinine
balance Bilirubin
 Water moves from area of lower
Transport concentration of solutes to an
Osmosis area with higher solute
concentration.

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 Concentration of solutes in solution
Pressure pulling fluid into the vessel
Osmotic Draws water through membrane to
the higher concentrated side
Proteins attract water and are major
contributor to osmotic pressure
Osmolality
Osmotic pull or pressure exerted by
all particles per unit of water
DDeesscri
in s cribbes
insi ide es f flui
de t the luidds
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weight Expressed
Expressedasas
of solvent milliosmoles/kg
milliosmoles/kgofofwater
water
Osmolarity
Osmotic pull or pressure exerted by all
particles per unit of solution

Describesfluids
Describes fluids
outside the body
outside the body

Expressed
milliosmoles/liter of solution spservices.co.uk
Tonicity
Concentration of solution in relation to plasma

Higher tonicity: greater concentration of solutes in

solution (hypertonic) as compared with plasma

Same concentration of solute in solutions as

compared with plasma (isotonic)

Lower tonicity: lower concentration of solutes in

solution (hypotonic) as compared with plasma
Osmotic Movement of Fluids
Cells are
affected by
osmolality of
fluids that
surrounds them
Plasma Osmolality
Standard for comparing
tonicity of IV infusions
Isotonic

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280-300 mOsm/L
Average: 290 mOsm/L
Classification of IV Fluids
(Infusates)
Crystalloids

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Solutions that contain electrolytes
May be used for fluid volume replacement
True solutions
Diffuse through membranes easily
May be isotonic, hypotonic, or hypertonic
Primary fluid used for IV infusions in the
hospital and outpatient clinics
Hypotonic Solutions
Used to lower sodium, hydrate ICF, &
interstitial spaces
Less solute & more water than isotonic sol.
Lower osmolarity than body fluids
Moves water into cells by osmosis
Examples:
0.45% sodium chloride
Lowerdextrose
2.5% concentration
in water
of solutes
D5W than body
(5% dextrose fluids
in water)
After infused

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D5W
Isotonic before infused
As the body quickly uses the dextrose for
energy, the solute (dextrose) is depleted
This leaves only water
which then makes
the solution hypotonic

isotonic hypotonic chinookmed.com

Isotonic Solutions
Same osmolarity as body fluids
Used to increased ECF volume
Expands intravascular compartment
Does not enter cells since osmotic force solution
equals osmotic force cell content
Examples:
Solutions havechloride
0.9% sodium same
concentration of solutes
D5W (5% dextrose in water)
as body fluids
Ringers
Lactated Ringers

http://www.slideshare.net/nclexvideos/third-
 Fluids need to
be on IV pump
Hypertonic Solutions
Higher osmolarity than body fluids
Used for severe sodium depletion, replace fluid loss
from burns
Causes water to move out of cells into ECF
Administer slowly to prevent overload and rapid fluid shifts
Greatly expand intravascular compartment
Examples:
3% NaCl
higher concentration
D5NS
of solutes than body fluids
D5 in.45%NS
10% dextrose in water

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http://www.tumblr.com/tagged/nclex?
before=1337817600
Plasma Osmolality
Standard for comparing
tonicity of IV infusions
Isotonic

holytaco.com

280-300 mOsm/L
Average: 290 mOsm/L
Determining Serum Osmolarity
Osmolarity of IV infusion is determined
by average serum osmolality 290 mOsm/L

Hypertonic: >375 mOsm/L

250-375 mOsm/L

Hypotonic: < 250 mOsm/L

Determining Serum Osmalality
IV infusion is determined by average
serum osmolality
290 mOsm/L

Formula to calculate
serum osmolality

(Na+ x 2) + BUN + glucose

3 18
Determining Serum Osmolality
(Na+ x 2) + BUN + glucose
3 18
Na+ 135 mEq/L
BUN 21 mg/dL
Glucose 90 mg/dL 123rf.com

(135 x 2) + 21 + 90 = serum osmolality

3 18
270 + 7 + 5 = 282 mOsm/L 282 mOsm/L
Determining Serum Osmolarity
Isotonic serum osmolality

Hypertonic: >375 mOsm/L

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282 mOsm/L Isotonic: 250-375

mOsm/L

Hypotonic: < 250 mOsm/L

Determining appropriate IV fluid
Isotonic serum osmolality

Administer Isotonic IV fluids:

0.9% NaCl
123rf.com

0.2% dextrose in 0.9% NaCl

Lactated Ringers
Determining Serum Osmolality
(Na+ x 2) + BUN + glucose
3 18
Na+ 115 mEq/L
BUN 1 mg/dL psychcentral.com

Glucose 50 mg/dL
(115 x 2) + 1 + 50 = serum osmolality
318

230 + 0.33 + 2.7 = 233 mOsm/L

Determining Serum Osmolarity
Hypertonic: >375 mOsm/L

Isotonic: 250-375 mOsm/L

psychcentral.com

Hypotonic: < 250 mOsm/L

233 mOsm/L Hypotonic serum osmolality

Determining appropriate IV fluid
Hypotonic serum osmolality

psychcentral.com

Administer Hypertonic IV fluids:

5%dextrose in 0.45%NaCl (D51/2NS)
5% dextrose in 0.9%NaCl (D5NS)
3% NaCl
Determining Serum Osmolality
(Na+ x 2) + BUN + glucose
3 18
Na+ 160 mEq/L

eprognosis.org
BUN 66 mg/dL
Glucose 612 mg/dL
(160 x 2) + 66 + 612 = serum osmolality
3 18

320 + 22 + 34 = 376 mOsm/L

Determining Serum Osmolarity
Hypertonic serum osmolarity

eprognosis.org
376 mOsm/L
Hypertonic: >375 mOsm/L

Isotonic: 250-375 mOsm/L

Hypotonic: < 250 mOsm/L

Determining appropriate IV fluid
Hypertonic serum osmolarity

eprognosis.org

Administer Hypotonic IV fluids:

0.45% sodium chloride
2.5% dextrose in water
D5W (5% dextrose in water)
after infused
 Colloids
IV fluids that contain solutes in form of large
proteins or other large molecules
Colloids remain in blood vessels
Pull fluid from interstitial compartment into
blood vessels
Called plasma or volume expanders
Increases vascular volume quickly
Example:
mims.com
Albumin, Dextran, Plasmanate & Hetastarch
 First Spacing
Normal distribution of body water

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 Second Spacing
Excess accumulation of fluid in interstitial spaces

2-4 kg of fluid needs to be retained for edema to be seen

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 Pitting Edema
+1: (trace) rapid return to normal
+2 (4 mm) rebounds in seconds
+3 (6 mm) 10-20 second return to normal
+4 (8mm) > 30 second return to normal
 Third Spacing
Loss of albumin, or protein, in intravascular space leads to
decreased oncotic pressure
Accumulation of trapped extracellular fluid in transcellular and
interstitial fluid compartments

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