Fluids and Electrolyte Balance (Na, K, Cl, )

Fluids and Electrolyte Balance .

1. Fluids and electrolyte balance ( Clinical Pharmacy Practice) Presented by: M Pharmacy (Pharmacy Practice) ( I / II Sem) A.U.COLLEGE OF PHARMACEUTICAL SCIENCES 1

2. Contents: ●Introduction ● Mechanism of fluid and electrolyte balance ● Sodium ● Potassium ● Calcium ● Phosphorus ● Magnesium ● Bicarbonates ● References A.U.COLLEGE OF PHARMACEUTICAL SCIENCES 2

3. INTRODUCTION Electrolytes are compounds that separate into  ions , or charged particles, in water. Electrolytes form when salts, such as sodium chloride or potassium phosphate, dissociate and form ions. For example, sodium chloride dissociates into a sodium ion and a chloride ion when dissolved in water. There are two types of electrolytes: Cations Anions The positively charged electrolytes are known as  cations . Examples of cations include sodium , calcium ,  potassium , and magnesium . The negatively charged electrolytes are  anions . Examples of anions include chloride, phosphate, sulfate, and bicarbonate.  Water in the body is found in two compartments: the  i ntracellular fluid compartment   and the  extracellular fluid compartment . Electrolytes found in the  intracellular fluid  compartment include potassium cations, magnesium cations, and phosphate anions. The extracellular fluid compartment contains electrolytes such as sodium cations, chloride anions, and bicarbonate anions. A.U.COLLEGE OF PHARMACEUTICAL SCIENCES 3

4. Functions of body fluids : 1.Regulate body temperature. 2.Provide medium for cellular metabolism 3.Facilitate in the transport ( nutrients, hormones, proteins and others ) Fluid and electrolyte balance is achieved by the body through the process of  homeostasis . Homeostasis is the collective series of adjustments that prevent change in the internal environment of the body. Electrolytes are involved in maintaining homeostasis through the following physiologic body functions: Osmotic equilibrium Acid-base balance Intracellular and extracellular concentration differentials A.U.COLLEGE OF PHARMACEUTICAL SCIENCES 4

5. A.U.COLLEGE OF PHARMACEUTICAL SCIENCES 5 Figure-1 Figure-2

6. Mechanism of fluid and electrolyte movement : Osmosis Filtration Diffusion Figure:4 Filtration A.U.COLLEGE OF PHARMACEUTICAL SCIENCES 6 Figure:3

7. Sodium( Na) : ● Major cation for extra cellular fluid Normal values: 135 to 147mEq/L or mmol/L. The three main functions: fluid balance, osmotic regulation, and maintenance of membrane potential The sodium concentration is defined as the ratio of sodium to water. Laboratory test are used mainly to detect disturbances in water balance and body osmolality. The kidney are major organs of sodium and water balance ● Hypernatremia : increase in sodium concentration may indicate impaired sodium excretion and dehydration ● Hyponatremia : Decrease in sodium concentration may reflect over hydration, abnormal sodium loss or decreased sodium intake. Control of sodium by the body is accomplished through the hormones aldosterone and antidiuretic hormone (ADH). A.U.COLLEGE OF PHARMACEUTICAL SCIENCES 7

8. Body System Hypernatremia Hyponatremia Central Nervous System Headache, confusion, seizures, coma, increased intracranial pressure. Restlessness, seizures, coma, irritability. Musculoskeletal Weakness, fatigue, muscle cramps. Weakness. GI Anorexia, nausea, vomiting, watery diarrhea - Cardiovascular Hypertension and bradycardia Tachycardia, hypotension, syncope Tissue Lacrimation, salivation Red swollen tongue, decrease saliva and tears. Renal Oliguria Oliguria Metabolic - Fever Clinical manifestation of Hypernatremia and Hyponatremina : A.U.COLLEGE OF PHARMACEUTICAL SCIENCES 8

9. Potassium ( k ) : Potassium (typical range 3.5–5 mEq/L, depending on age) is the primary intracellular cation in the body; it plays essential roles in cellular metabolism and maintains membrane potential as well as promotes neuromuscular and cardiac function. Potassium homeostasis is primarily maintained through renal elimination, which varies depending on serum concentrations as well as the release of aldosterone and angiotensin II. Nonrenal mechanisms such as hormones, acid-base status, and osmolality also play a role in potassium regulation Medications such as diuretics or nephrotoxic agents can affect potassium balance. Hypokalemia Hyperkalemia serum potassium less than 3.5 mEq/L. serum potassium greater than 3.5 mEq/L. Causes: Decreased dietary intake, Gastrointestinal losses, Renal losses, Cellular shifts Cause: Pseudo- hyperkalemia , Transcellular shift, Impaired renal excretion, Excessive intake Blood transfusions Sign and Symptoms : 1. Neuromuscular -Muscle weakness , Paralysis Rhabdomyolysis, Hyporeflexia 2. Cardiac -EKG findings: T-wave flattening/ inversion U-wave, ST depression, Cardiac toxicity to digitalis 3. Renal- Polyuria, Polydipsia 4. Gastrointestinal -Paralytic ileus Sign and symptoms: 1.Neuromuscular :Weakness, Paresthesia, Flaccid paralysis 2. Cardiac :EKG findings: peaked T waves flattened P waves, prolonged PR, widened QRS, Ventricular fibrillation, Cardiac arrest A.U.COLLEGE OF PHARMACEUTICAL SCIENCES 9

10. Treatment for hypokalemia: ●Treatment for hypokalemia initially is aimed at correcting the existing metabolic abnormalities. ● Potassium chloride is administered at 10 mEq/L/h peripherally or 20 mEq/L/h centrally if EKG changes are present. ● Hypokalemia alone rarely produces cardiac arrhythmias. Treatment for hyperkalemia: Treatment Dosage Rationale Calcium gluconate 10–30 mL in 10% solution intravenously Membrane stabilization Sodium bicarbonate 50 mEq intravenously Shifts K+ into cells Dialysis - Removes K+ from serum A.U.COLLEGE OF PHARMACEUTICAL SCIENCES 10

11. Calcium ( Ca) : Calcium (typical range 6.2–11 mg/dL, depending on age) is one of the most abundant ions in the body; it is required for proper neuromuscular activity, integrity of membranes, endocrine function, coagulation, and bone metabolism. Calcium is found in the body as complexed, protein bound, or ionized and is primarily located in the teeth and bone. Hypocalcemia is defined as serum calcium less than 8.5 mg/dL Signs and Symptoms : Hypotension laryngeal, Tetany , anxiety, depression, Psychosis Treatment : oral or intravenous calcium supplementation. Hypercalcemia is defined as serum calcium greater than 10.5mg/dL. Signs and Symptoms: Hypertension, Bradycardia, Constipation, Anorexia, Nausea, vomiting, Nephrolithiasis, Bone pain, Psychosis Pruritus. Treatments: In severe cases, cardiac conductivity abnormalities may be present. In mild to moderate cases of hypercalcemia, fluid therapy is first line and usually effective. For severe cases, intravenous fluid therapy, loop diuretics, and dialysis therapy may be needed to prevent dysrhythmias, kidney failure, and death. A.U.COLLEGE OF PHARMACEUTICAL SCIENCES 11

12. Phosphorus ( P ) : The main intracellular anion, phosphorus (typical range 2.7–9 mg/dL, depending on age), is critically important for maintaining cellular function, bone and cell membrane composition, pH, energy (ATP), and all physiologic functions requiring energy. Homeostasis is maintained through GI absorption, renal excretion, and parathyroid hormone activity. Hyperphosphatemia Hypophosphatemia ● Hyperphosphatemia is defined by serum concentrations more than 2.7–4.5 mg/dL, depending on age. ● Symptoms: anorexia, nausea and vomiting, dehydration, poor appetite, neuromuscular symptoms, and tachycardia ● Hypophosphatemia is defined by serum concentrations less than 2.7–4.5 mg/dL, depending on age. ● Symptoms: neurologic , neuromuscular , cardiac, respiratory, or hematologic dysfunction. A.U.COLLEGE OF PHARMACEUTICAL SCIENCES 12

13. Magnesium (mg) : Magnesium (typical range 1.6–2.3 mg/dL, depending on age) It has important physiologic functions such as acting as an essential cofactor for hundreds of enzymatic reactions, including glucose, fatty acid, DNA, and protein metabolism. Homeostasis is maintained through the GI tract, renal system, and bone through the parathyroid hormone. Hypermagnesmia Hypomagnesmia ●A serum magnesium concentration greater than 2.4 mg/dL ●Common causes include excessive supplementation, renal disease, laxative overuse, and/or increased intake of magnesium-containing antacids ●signs and symptoms : nausea, sweating, flushing, muscular weakness, hypotension, and bradycardia. ●Treatment: decrease mg intake, diuretic therapy ●A magnesium concentrations less than 1.3 mg/dL ●Common causes of hypomagnesemia include decreased intake, excessive renal/ GI loss, and intracellular shifts of magnesium. ●Symptoms :apathy, depression, muscle weakness, ataxia, muscle cramps, and cardiac complications. A.U.COLLEGE OF PHARMACEUTICAL SCIENCES 13

14. Chloride ( Cl): A typical normal range is 97 to 107 milliequivalents per litre (mEq/L) or 97 to 107 millimoles per litre (milli mol/L). Chloride is an essential  electrolyte . Electrolytes are minerals that are found in your blood. These electrolytes help with: Muscle function, Nerve function , Keeping the pH of your blood in the normal range Maintain your balance of fluids‌ Hypochloremia Hyperchloremia Hypochloremia is an  electrolyte imbalance   and is indicated by a low level of chloride in the blood.  The normal adult value for chloride is 97-107 mEq/ L. Causes: Trauma, kidney failure , acid-base imbalance excessive corticosteroids. Symptoms: Fatigue, muscle weakness, tachycardia, dyspnea Treatment: Measure serum chloride every 4to6hrs. 10% calcium gluconate: 10ml-93mg of elemental calcium. Hyperchloremia is an  electrolyte imbalance   and is indicated by a high level of chloride in the blood.  The normal adult value for chloride is 97-107 mEq/ L. Causes: Dietary changes, renal abnormalities, GI abnormalities, medications: diuretics, corticosteroids. Symptoms: Muscular weakness, diaphoresis, fever, tetany. Treatment: Hemodialysis Furosemide (1mg/kg/h) but avoid thiazide diuretics. Restore intravenous volume and promote excretion. A.U.COLLEGE OF PHARMACEUTICAL SCIENCES 14

15. Bicarbonate: Normal bicarbonate levels are 23 to 30 mEq/L in adults . Bicarbonate, also known as HCO3, is a byproduct of your body's metabolism. Your blood brings bicarbonate to your lungs, and then it is exhaled as carbon dioxide. Your kidneys also help regulate bicarbonate. Bicarbonate is excreted and reabsorbed by your kidneys. This regulates your body's pH, or acid balance.  The type of acidosis is categorized as either respiratory acidosis or metabolic acidosis, depending on the primary cause of your acidosis . Respiratory acidosis   occurs when too much CO2 builds up in the body . This may happen due to: chronic airway conditions, like  asthma, injury to the chest, Obesity , sedative misuse, overuse of alcohol, muscle weakness  in the chest Metabolic acidosis: starts in the kidneys instead of the lungs. It occurs when they can’t eliminate enough acid or when they get rid of too much base. There are three major forms of metabolic acidosis: Diabetic acidosis occurs in people with  diabetes t hat’s poorly controlled. If your body lacks enough  insulin ,  ketones  build up in your body and acidify your blood. Hyperchloremic acidosis  results from a loss of sodium bicarbonate. This base helps to keep the blood neutral. Both  diarrhoea a nd   vomiting ca n cause this type of acidosis. Lactic acidosis  occurs when there’s too much lactic acid in your body. Causes can include chronic alcohol use,  heart failure ,   cancer ,   seizures ,  liver failure , prolonged lack of oxygen , and  low blood sug a r . E ven prolonged exercise can lead to lactic acid buildup. Renal tubular acidosis  occurs when the kidneys are unable to excrete acids into the urine. This causes the blood to become acidic. A.U.COLLEGE OF PHARMACEUTICAL SCIENCES 15

16. Symptoms: Respiratory acidosis Some of the common symptoms of respiratory acidosis include the following: ● Fatigue Or  Drowsiness ● Becoming Tired Easily ● Confusion ● Shortness Of Breath Metabolic acidosis ● confusion ● Fatigue ● Headache ● Sleepiness ● Lack Of Appetite ● Jaundice Treatments: 1.IV sodium bicarbonate, which helps balance the acids in your blood Alkalosis: Alkalosis occurs when your body has too many bases. It can occur due to decreased blood levels of carbon dioxide, which is an acid. It can also occur due to increased blood levels of bicarbonate, which is a base. A.U.COLLEGE OF PHARMACEUTICAL SCIENCES 16

17. Types of alkalosis: 1.Respiratory alkalosis:  occurs when there isn’t enough carbon dioxide in your bloodstream. It’s often caused by high fever, lack of oxygen, liver disease. 2.Metabolic alkalosis: Metabolic alkalosis develops when your body loses too much acid or gains too much base. Causes: Antacids, laxatives, alcohol abuse. Symptoms: nausea numbness prolonged muscle spasms muscle twitching hand tremors Treatment for alkalosis: 1.Saline infusion 2.Stopping the medications that caused the condition, for example high dose of diuretics . A.U.COLLEGE OF PHARMACEUTICAL SCIENCES 17

18. References: 1. https://www.google.com/search/about-this-image?img=H4sIAAAAAAAA_- 2. https://images.app.goo.gl/KczRaZJEWz5tJ76c7 3.https://g.co/kgs/6d5kRL 4. https://images.app.goo.gl/qtuXpbBHrmdbFTXM7 5. https://study.com/learn/lesson/fluid-electrolytes-overview-imbalance-kidney-problems.html 6. https://www.accp.com/docs/bookstore/pedsap/ped2018b2_sample.pdf 7. https://www.himsr.co.in/wp-content/uploads/2020/03/Fluid-and-Electrolyte-ppt1-by-Dr.-Mohsin.pdf A.U.COLLEGE OF PHARMACEUTICAL SCIENCES 18

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