fluid electrolyte balance

1. PREPARE BY
MRS. SUCHISMITA SETHI
LECTURER, MSN

2. INTRODUCTION
• Fluid & electrolyte balance is a dynamic process that is
crucial for life & homeostasis.
• Approximately 60% of typical adult weight consist of
fluid & electrolyte.
• Young people has higher percentage of body fluid then
older people.
• Man has more fluid then female.
• Obese people has less fluid then the bcoz fat cell
contain little water.
• 2/3 rd of body fluid in the intra cellular fluid
compartment 1/3 of fluid in extra cellular fluid
compartment

3. • Body fluid
• Intra cellular fluid extra cellular fluid
• 1. Intra vascular ( fluid with in the blood vessel, 6 lit
blood contain 3lit plasma & 3 lit erythrocyte, leukocyte &
thrombocytes)
• 2. Interstitial ( fluid that surround the cells , lymph is
interstitial , total amount 11-12 l)
• 3. Transcellular ( contain 1 lit of fluid, cerebrospinal fluid,
pericardial fluid, synovial fluid, intra ocular & pleural fluid etc)

4. REGULATION OF BODY FLUID
• 1. OSMOSIS & OSMOLALITY
• 2 DIFFUSION
• 3. FILTRATION
• SODIUM –POTASSIUM PUMP

5. DIFFUSION
• It is the process in which the substance move
from an area of higher concentration to an
area of lower concentration.
• Ex- If you pour cream in to a cup of coffee, the
movement of molecule will eventually cause
the cream to be dispersed through out the
beverage.

6. 1. OSMOSIS & OSMOLALITY
• OSMOSIS:- Movement of water from an area
of lower substance concentration to an area of
higher concentration.
• OSMOLALITY:-
It refers to concentration of substance in the -
body fluid. Ex- blood osmolality 270-300
miliosmol/lit.

7. cont....
1. ISOTONIC FLUID:- The fluid that has same
osmolality as blood. Ex- 0.9% NS, 5% dextrose.
2. HYPOTONIC SOLUTION:- A solution that has
lower osmolality then blood. When hypotonic
solution given to a patient water in the solution
leave the blood to other ECF area & enter the
cells. Ex- 0.45% NS, 0.2% NS
3. HYPERTONIC SOLUTION:- It has greater osmotic
pressure the blood . When hypertonic solution
given to a patient water leave the cells & enter
the blood stream & other ECF space. Ex-manitol,
3% NS.

8. Cont...
• FILTRATION:- It is the movement of both water
& smaller molecules through the semi
permeable membrane.
• SEMI PERMIABLE MEMBRANE:- It is the
membrane work like a screen that keep larger
substance on one side & permit only smaller
molecule to filter to the other side of the
membrane. Here filtration promote the
hydrostatic pressure difference between areas.

9. Cont...
HYDROSTATIC PRESSURE:- (Water pushing
pressure)
It is the force that water exert. It is the force
within the fluid compartment.
In the blood vessel the hydrostatic pressure is the
blood pressure generated by contraction of
heart.
It gradually decrease as the blood move through
the artery & about 30 mmhg in capillary bed.
Hydrostatic pressure push water out of the
vascular system in to the interstitial space.

10. Cont...
• ONCOTIC PRESSURE:- ( Colloidal osmotic
pressure)
• It is the osmotic pressure caused by plasma
colloids in solution.
• Protein maintain oncotic pressure. Plasma
protein molecule attract the water & pull the
fluid from the tissue space to the vascular
space.
• Plasma oncotic pressure is 25 mmhg.
• Interstitial space oncotic pressure is 1 mmhg.

11. SOURCE OF BODY FLUID GAIN & LOSS
IN ADULT
• INTAKE(ML):-
• Oral intake:-
As water:- 1000
In food:- 1300
Water of oxidation 200
TOTAL:- 2500 ML.
• OUT PUT (ML):-
• Urine:- 1500
• Stool:- 200
• Insensible:-
Lungs:- 300
Skin:- 500 ml
TOTAL:- 2500ML.

12. HOMIOSTATIC MECHANISM
• Body has homeostatic mechanism to keep the
composition & volume of the body fluid within
normal.
• Body organs which maintain the homeostatic
mechanism are:-
1. Kidney
2. Heart
3. Lungs
4. Pituitary gland
5. Adrenal gland
6. Others.

13. Cont...
1. KIDNEY:-
• Kidney filters 180 liters of plasma every day
in adults & excreats 1-2 lit of urine.
• It work with the response of aldosterone &
anti diuretic hormon.
• It maintain ECF volume & osmolality by
selective retaintion & excretion of body fluid.
• It regulate PH by retaintion of hydrogen ion &
excret metabolic waste & toxic substance.

14. Cont..
• 2. HEART & BLOOD VESSELS:-
The pumping action of heart circulate blood
through the kidney under sufficient pressure.
Adicuate kidney perfusion cause adecuate urin
output.
3. LUNGS FUNCTION:- Respiratory system
removes 300 ml of fluid in respiration. Hyper
respiration & continuous coughing cause
increase loss of fluid.

15. Cont..
4. PITUITARY FUNCTIONS:-
Hypothalamus make ADH & stored it in posterior
pituitary
ADH maintain osmotic pressure by controlling
retaintion & excretion of water by kidney.
5. ADRENAL GLAND:- Aldosterone is a mineralo
corticoid which secreted by zona glomerulosa (
outer zone) of adrenal gland. Increase secretion
of aldosterone cause sodium retaintion &
potassium loss , which cause water retaintion.
Decrease secretion cause NA & water loss &
potassium retaintion.

16. OTHER MECHANISM
• A. Baroreceptors
• B. Renin-Angiotensin- Aldosterone System
• C. Antidiuretic hormone & thirst
• D. Osmoreceptors
• E.Natriuretic Peptide

17. A. Baroreceptors
• Baroreceptors are located in left left arterium
& carotid & aortic arches.
• These receptors respond when there is
changes in circulating blood volume &
regulate sympathetic & parasympathetic
neural activity as well as endocrine activity.

18. Cont..
• ACTION:-
• When there is decrease arterial pressure
• Baroreceptors transmit impulse from carotid & aortic
arch to vasomotor center.
• Stimulate sympathetic system
• Constriction of renal increase HR, contractility
Arteriols cerculating blood volume
Release aldosterine increase
Decrease GFR
Increase NA & H2O reabsorption

19. Cont....
• B. RENIN-ANGIOTENSIN-ALDOSTERONE SYSTEM:-
• renin reliese by juxtaglomerular cells of the kidney in
response to decrease renal perfusion.
• Angiotensin is the substance form in the liver .
• Angiotensin converting enzyme convert angiotensin
1- angiotensin 2
• Angiotensin II cause vaso constriction, increase
arterial perfusion pressure & stimulate thirst.
• Then aldosterone is release in response to increase
renin.
• It increase water & sodium retainsion.

20. Cont...
C. ANTI DIURETIC HORMONES:-
• Antidiuretic hormone also known as arginine vasopressin is
a nine aminoacid peptide secreted from posterior pituitary.
• It conserve the body water by reducing the loss of water in
urine.
• Antidiuretic hormone binds to receptors on cells in
collecting ducts of the kidney & promote reabsorption of
water back in the circulation.
• In absence of antidiuretic hormone the collecting duct are
virtually impermiable to water & it flow out as urine.
• Antidiuretic hormone stimulates water reabsorption by
stimulating insertion of water channels or aquaporins in to
the membranes of kidney tubules. These channels
transport solute free water through tubular cells & beck in
to the blood, leading to decrease in plasma osmolality &
increase osmolality of urine.

21. Cont...
d. OSMORECEPTORS:-
• Osmoreceptors are present in the
hypothalamus. It sense changes in sodium
concentration.
• Decrease osmotic pressure neurons become
dehydrated & quickly release impulse to
posterior pituitary to release ADH.
• Due to the influence of ADH there is
reabsorption of water & decrease urine output.

22. ELETROLYTE IMBALANCE
• 1. hyponatrimia
• 2. Hypernatrimia
• 3. hypokalemia
• 4. hyperkalemia
• 5. hypocalcimia
• 6. hypercalcemia
• 7. hypomagnesemia
• 8. hypermagnesemia
• 9. hypophosphetimia
• 10. hyperphosphrtemia
• 11. hypochlorimia
• 12. hyperchloremia

23. HYPOKALEMIA
• Hypokalemia is a serum potassium level lower then 3.5
mEq/L
• In potassium deficit every body system affected.
• CAUSE:-
• Excessive use of medication such as diuretics or
corticosteroid
• Increase secretion of aldosterone such as in Cushing
syndrome
• Vomiting, diarrhea
• Wound drainage
• Prolong nasogastric suction
• Excessive diaphoresis
• Kidney disease impair the reabsorption of potassium.

24. • Inadequate potassium intake such as fasting or
NPO
• Movement of potassium from extra cellular fluid
to intra cellular fluid (alkalosis, hyperinsulism)
• IV therapy with potassium deficit solutions.
SIGN & SYMPTOMS:-
• Thready, weak & irregular pulse
• Weak peripheral pulse
• Orthostatic hypotension
• Weakness of skeletal muscle of respiration cause
ineffective respiration
• Anxiety, lethergy confusion & coma.
• Skeletal muscle weakness cause flaccid paralysis
• Deep tendon hyporeflexia.

25. INTERVENTION
• Monitor cardiovascular, respiratory, neuromuscular, GI
& renal status.
• Monitor electrolyte value.
• Administer potassium supplements orally or IV.
• Institute safety measure for the client experiencing
muscle weakness
• Administer potassium retaining diuretics prescribe
• Instruct the cline food high in potassum such as
banana, carrots, fish, orange, mushrooms, potatoes,
tomatoes.

26. HYPERKALEMIA
• hyperkalemia is a serum potassium level exceed
5.0 mEq/L
• CAUSES:-
• Over ingestion potassium containing food &
medication such as Potassium chloride & salt
substitute.
• Rapid infusion of potassium containing IV fluid
Decrease potassium excretion such as potassium
retaining diuretics, kidney disease, adrenal
insufficiency such as in Addison’s disease
• Movement of potassium from intracellular fluid
to extracellular fluid such as tissue damage,
acidosis, hyperuricemia & hypercataolism.

27. Sign & symptoms
• Slow , weak, irregular heart rate.
• Weakness of skeletal muscle cause leading to
respiratory failure.
• Muscle twitching, cramps
• Tingling & burning followed by numbness in the
hands & feet.
• Paralysis in the arms & leg
• ECG:-Tall peaked T wave, flat P wave, widen QRS
complexes & prolonged PR interval.

28. INTERVENTION
• Monitor cardiovascular, respiratory, neuromuscular &
renal status.
• Discontinue IV potassium & continue oral potassium
suppliments.
• Innitiate potassium restricted diet
• Prepare to administer potassium excreting diuretics if
renal function is not impaired.
• In case of impair renal function prepare to administer
sodium polystyrene sulfonate which promote intestinal
sodium absorption & potassium excretion.
• Prepare the client for dialysis.
• Provide hypertonic glucose with regular insulin to
move excess potassium in to the cell.

29. CALCIUM
• Function:-
• Muscle contraction
• Oocyte activation
• Build strong bone & teeth
• Blood clotting
• Nerve impulse transmission, regulating heart
beat
• Fluid balance within cell.

30. HYPOCALCIMIA
• It is the serum calcium level is lower then 8.6 mg/dl
CAUSE:-
Inadiquate oral intake of calcium
Lactose intolorance
Malabsorption syndrome such as crohn’s disease
Inadequate intake of vitamin D
end stage kidney disease
Diarrhea
Wound drainage
Alkalosis
Medical calcium binder
Removal of parathyroid gland
Acute pancreatitis
Immobility

31. SIGN & SYMPTOMS
• Decreased heart rate
• Hypotension
• Diminiesd peripheral pulse
• Respiratory muscle tetany which cause respiratory
failure.
• Skeletal muscle Twitches
• Positive Trousseau’s & chvostek’s sign
• Hyper active deep tendon reflexes.
• Hyper active bowel cause cramping & diarrhea.
DIAGNOSIS:-Serum calcium level less then 8.6 mg/dl.
• ECG:- Prolonged ST interval, prolonged QT interval

34. INTERVENTION
• Administer calcium suppliment orally or calcium
intravenously.
• Administer medication that increase calcium
absorption.
• Provide Aluminium hydroxide which reduce
phosphorus level, causing the counter effect of
increasing calcium level.
• Provide vitamin D for the absorption in GI tract.
• Increase seizure precaution
• Provide 10% calcium gluconate to treat acute calcium
deficit.
• Instruct the client to consume food high in calcium

35. HYPERCALCIMIA
• Hypercalcimia is a serum calcium level that exceed 10
mg/dl.
• CAUSE:-
• Exceed oral intake of calcium
• Exceed oral intake of vitamin D
• Decrease calcium excretion due to kidney disease or
thiazide diuretics.
• Increase bone reabsorption of calcium due to
Hyperparathyroidism, hyperthyroidism
• Malignancy
• Immobility
• Use of glucocorticoid
• Dehydration, Use of lithium & Adrenal insuffiency

36. SIGN & SYMPTOMS
• Increased HR in early phase cause bradycardia that
lead to cardiac arrest in late phase.
• Increase BP.
• Bounding full peripheral pulse
• Skeletal muscle weakness cause respiratory movement
ineffective.
• Profound muscle weakness
• Decrease GI motility cause hypoactive bowel sound.
• Anorexia, nausea, abdominal distension & constipation

37. INTERVENTION
• Discontinue the IV infusion of solution
containing calcium or oral medication
containing calcium or vitamin D.
• Discontinue thiazide diuretics & replace with
diuretics.
• Administer the medication that inhibit calcium
resorption from the bone such as phosphorus,
calcitonin, bisphosphonate & prostaglandin
synthesis inhibitors.
• Prepair for dialysis.
• Avoid the food high in calcium

38. MAGNESIUM
• Function:-
• Maintain normal nerve & muscle function
• Support healthy immune system
• Bone strong
• Adjust blood glucose level
• Production of energy & protein

39. HYPOMAGNESEMIA
• It is the electrolyte imbalance where magnessium
level below 1.5mEq/L.
• Normal magnesium value is 1.5-2.5mEq/L.
ETIOLOGY:-
• Decrease intake or excessive loss of magnessium.
• Mal nutrition & starvation diet
• Severe diarrhea or crohn’s disease.
• Alcoholism
• High blood calcium level
• Excessive urination
• Certain medication such as cisplatin, diuretics

40. SIGN & SYMPTOMS
• Positive Trousseau’s sign & Chvostek’s sign
• Muscular weakness & parasthesis
• Slow & involuntary twisting movement
• Leg & foot cramps
• Seizure
• Cardiac dysrhythmias
• Ataxia, dizziness, insomenia & confusion
• Visual hallusination

41. DIAGNOSTIC EVALUATION
• Serum magnessium lower then 1.5 mEq/L
• 24 hour urine excretion
• Decrease serum albumin value
• ECG- prolong PR & QT interval, widening QRS,
ST segment depression, flattened T wave &
prominent u Wave.

42. INTERVENTION
• Daily oral magnesium oxide 300 mg provided
in mild case
• IV administration of magnesium sulfate 10 -40
mEq/L.
• Treat magnessium intoxication with calcium
chloride or gluconate.

43. HYPERMAGNESEMIA
• It is the increase magnessium level more then 2.5
mEq/L.
• Magnesium is necessary for maintanance of heart
& nurvous system.
• ETIOLOGY:-
• Chronic renal failure
• Severe dehydration
• Over dose of magnessium salt.
• Adrenal insufficiency
• DKA
• Lithium therapy
• Hypothyroidism

44. CLINICAL MANIFESTATION
• Nausea & vomiting
• Hypotension
• Lethergy or drowsiness
• Skeletal muscle weakness
• Diminised reflexses
• Facial paralysis
• Breathing become swallow
• Bradycardia
• Coma respiratory failure

45. diagnosis
• Serum magnessium level greater then
2.5mEq/L
• ECG:- prolonge PR interval, tall T wave,
prolong QT interval& widen QRS
INTERVENTION:-
• Increase fluid intake, incase of kidney failure
do dialysis
• Restrict magnesium containing diet.

46. PHOSPHATE
• Function:- to build & repair bone & teeth
• Help nerve function & muscle contraction

47. HYPOPHOSPHETEMIA
• It means phosphorus level below 2.5 mg/dl
• CAUSES:-
• Impaired kidney function
• Over use of diuretics
• Abnormal intestinal absorption
• Deficiency og vitamin D
• Alcoholism
• DKA

48. • CLINICAL MANIFESTATION:-
• Skeletal & smooth muscle weakness
• Parasthesis
• Bone pain
• Neurological problem such as memory loss,
seizure
DIAGNOSIS:-
• Serum phosphate level less the 2.5 mg/dl.
• Urine phosphate level more then 1.3g.

49. • Management:-
• Diatary phosphate suppliment
• In case of severe condition administer
parenteral dose of KPO4 2.5 mg/kg

50. HYPERPHOSPHATEMIA
• It is the condition in which body phosphate
level more then 4.5 mg/dl
CAUSE:-
• Excessive intravenous administration of
phosphate
• Vitamin D intoxication
• Over dose of laxative & enema.
• Tumour lysis syndrome.

51. • CLINICAL MANIFESTATION:-
• Numbness & tingling in the extremities.
• Muscle cramp
• Depression
• Memory loss
• Convulsion
DIAGNOSTIC EVALUATION:-
• serum phosphate level more then 4.5 mg/dl
• urine phosphate level less the 0.9gm.

52. • MANAGEMENT:-
• ORAL PHOSPHATE BINDER USE to decrese
absorption of phosphorus.
• Provide food low in phosphate.
• if necessary do dialysis

53. CHLORINE
• Function:- electrical nutrality & pressure of
extracellular fluid.
• Acid base balance of the body

54. HYPOCHLOREMIA
• Chlorine level below 97 mEq/l
• ETIOLOGY:-
• Decrease chlorine intake
• Metabolic alkalosis
• Prolong use of diuretics
• Prolong diarrhea, vomiting & GI suction
CLINICAL MANIFESTATION:-
• Disorientation
• Excessive sleeping
• Muscle atrophy
• Weakness
• Muscle cramp
• Ineffective breathing

55. DIAGNOSIS:-
• Serum chlorine level less then 98mEq/L
MANAGEMENT:-
• Provide IV therapy of 0.9% of sodium chloride
• Provide ammonium chloride .
• Provide KCL in case of metabolic acidosis
• Provide high sodium & potassium diet.

56. HYPERCHLOREMIA
• it is the increase chlorine level 108 mEq/l
• Etiology:-
• Excessive chlorine intake such as NS infusion
• Use of certain drugs such as carbonic anahydrase
inhibitor
• Dehydration
• Vomiting
• Diarrhea
• CLINICAL MANIFESTATION:-
• Tachypnea
• Decrease cognitive ability
• Hypertension
• Kussumaul breathing

57. • DIAGNOSIS:-
• Serum chloride level 108mEq/L
• MANAGEMENT:-
• Provide RL solution to correct the acidosis
• Provide diuretic to eliminate chloride.

59. ACIDS
• Acids are the produced as the end product of
metabolism.
• Acids contains hydrogen ions & hydrogen ions donor .
• Acid give up hydrogen ions to decrease the strength of
acids.
• Acid strength depends upon number of hydrogen ion it
contains.
• The lungs excrete 13000-30000mEq/day volatile
hydrogen in the form of carbonic acid as carbon
dioxide
• The kidney excrete 50mEq/day of non volatile acids.

60. BASE
• It do not contain any hydrogen ions
• It accept hydrogen ion from acid to form
weaker acid or decrease the strength of base.

61. REGULATORY SYSTEM FOR HYDROGEN IONS
CONCENTRATION IN THE BLOOD
• 1. BUFFERS
• 2. LUNGS
• 3. KIDNEY
• 4. POTASSIUM

62. BUFFERS
• Function of buffer is to keep the PH within the
narrow limit.
• When too much acid or base are release
within the system the buffer absorb or release
hydrogen ions as needed.
• It carries excess hydrogen to the lungs

63. PRIMARY BUFFER SYSTEMS IN THE
EXTRACELLULAR FLUID:-
1. HAEMOGLOBIN SYSTEM:-
Haemoglobin system maintain acid base balance
by process called chloride shift.
Chloride shift in & out of the cells in response to
the level of o2 in the blood
One chloride ion exit the cell as well as a
bicarbonate ion enter and vice versa

64. 2. PLASMA PROTEIN SYSTEM:-
• Plasma protein has the ability to attract or
release hydrogen ions.
• The system functioning along with the liver to
very the amount of hydrogen ions in the
chemical structure of plasma protein.

65. 3. CARBONIC ACID-BICARBONATE
SYSTEM
• This system maintains a pH pf 7.4 with a ratio
of 20part bicarbonate(HCO3) to a part of
carbonic acid(H2CO3)
• This ratio(20:1) determine the hydrogen ion
concentration of body fluid.
• Carbonic acid concentration is controlled by
the excretion of co2 by the lungs
• The kidney control the bicarbonate
concentration

66. 4. Phosphate buffer system
• This system present in the cells & body fluid
• This system neutralise hydrogen ion

67. C. LUNGS
• The lungs are the second defence of body to maintain
acid base balance.
• In acidosis PH decrease respiratory depth & rate
increase to exhale acids.
• The carbonic acid created by neutralizing the action of
bicarbonate & goes to the lungs.
• In lungs carbonic acid break to co2 & water & exhale.
• In alkalosis PH increase & respiratory rate & depth
decrease.
• Co2 retained & carbonic acid increase to neutralize &
decrease the strength of excess bicarbonate.
• The lungs are the capable of inactivating only hydrogen
ion carried by carbonic acid.
• Excess hydrogen caused by other mechanism must be
created by kidney.

68. d. KIDNEY
• In acidosis the PH decrease & excess hydrogen
ion are secreted in to the tubules & combine
with buffer for excretion in urine.
• In alkalosis PH increase & excess bicarbonate
ions move into the tubules, combine with Na
& excrete in to the urine.
• Excess hydrogen ion excreted in the in the
form urine in the form of phosphoric acid.

69. E. POTASSIUM
• Potassium move in or out of the cell in an
attempt to maintain acid base balance.
• In acidosis hydrogen ion move in to the cell &
k+ ion move out of the cell to maintain acid
base balance.
• In alkalosis cells release hydrogen ion in to the
blood to increase acidity of the blood k+ enter
in to the cell k+ level decrease in serum.

70. COMMON ACID BASE IMBALANCE
ARE:-
• 1. RESPIRATORY ACIDOSIS
• 2. RESPIRATORY ALKALOSIS
• 3. METABOLIC ACIDOSIS
• 4. METABOLIC ALKALOSIS

71. 1. RESPIRATORY ACIDOSIS
• It is the relative increase in hydrogen ion
concentration in blood.
• ETIOLOGY:-
• Problem in respiration such as asthma,
atelectasis, Bronchitis, emphysema,
pneumonia.
• Brain Trauma:- cause depression of medulla
oblongata & depress respiratory center.
• CNS depressant such as sedative & opiod.

72. CLINICAL MANIFESTATION
• Neurologic:- Drowsiness, disorientation,
headache, coma, seizure.
• Cardiovascular:- Decrease BP, ventricular
fibrillation, flushed skin due to peripheral vaso
dilation.
• Respiratory system:- Hypoventilation with
hypoxia.

73. INTERVENTION
• Monitor sign of respiratory depression
• Administer oxygen as prescribed.
• Place the client in a semi fowler position.
• Encourage & assist the client to turn, cough &
deep breath.
• Encourage hydration to thin secretion
• Suction the client airway
• Prepare patient for endotracheal intubation &
mechanical ventilation if co2 level above 50
mm/hg

74. 2. Respiratory alkalosis
• It is the decrease in hydrogen ion concentration that results
from the accumulation of base.
• ETIOLOGY:-
• Fever:- Increase metabolism cause over stimulation of
respiratory system.
• Hyperventilation:- Rapid respiration decrease carbonic acid
increase base.
• Hypoxia:- Stimulation respiratory system increase
respiratory rate.
• Hysteria:- It is a neurologic condition which leads to
vigorous breathing & excessive exhaling co2.
• Pain:- Over stimulation of the respiratory center in the
brain stem results in a carbonic acid deficit.

75. CLINICAL MANIFESTATION
• Neurologic:- Lethergy, confusion, numbness,
tingling, seizure.
• Cardiovascular:- Tachycardia, dysrhythmia.
• GI:- Nause, vomiting, Epigastric pain.
• Respiratory :- Hyperventilation.
• INTERVENTION:-
• Encourage appropriate breathing pattern.
• Provide re-breathing mask.
• Provide carbon dioxide breathing( re-
breathing in to a paper beg).

76. 3. METABOLIC ACIDOSIS
• It is the increase of buffer base that is lower then normal with
a relative increase of hydrogen ion concentration.
• CAUSE:-
• DKA:- Insufficient supply of insulin cause increase fat
metabolism, which leads to excessive accumulation of ketone
or other acid, bicarbonate decrease.
• Excessive ingestion of acetylsalicylic acid increase hydrogen
concentration.
• High fat diet:- High fat metabolism cause build up of ketones &
acids.
• Insufficient metabolism of carbohydrate:- When the o2 supply
is not sufficient for the metabolism of carbohydrate, lactic acid
is produced & lactic acidosis results.
• Malnutrition:- Improper metabolism of nutrition cause fat
catabolism leading to an excess build up ketone & acids.

77. CLINICAL MANIFESTATION
• Neurology: Drowsiness, disorientation, dizziness, headache,
coma.
• Cardio:- Decrease BP, warmth, dysrhythmia, flushed skin.
• GI:- Nause, vomiting, diarrhoea, abdominal pain.
• Respiratory:- Dee[p, rapid respiration.
• INTERVENTION:-
• Monitor sign of respiratory distress.
• Assess level of consciousness for CNS depression.
• Monitor IO chart.
• Provide electrolyte to increase buffer base.
• Monitor K+ level closely as metabolic acidosis resolve
potassium level decrease.
• Provide insulin therapy in case of DKA to move glucose in to
the cell
• Do dialysis to remove protein & waste product to lessening
the acidic state.

78. 4. METABOLIC ALKALOSIS
• T is the deficit in carbonic acid & accumulation of base.
• ETIOLOGY:-
• Diuretics:- Loss of hydrogen ion & chloride from Diuresis
cause compensatory increase in amount of bicarboate in
the blood.
• Excessive vomiting or GI suction leads to excess loss of
hydrochloric acid.
• Hyper aldosteronism:- increase renal tubular reabsorption
of sodium occur with the resultant loss of hydrogen ion.
• Use of excessive sodium bicarbonate cause an increase
amount of base in the blood.
• Massive transfusion of whole blood:- The citrate anti
coagulant used for storage of blood is metabolised to
bicarbonate.

79. CLINICAL MANIFESTATION
• Nervous system:- Drowsiness, nervousness,
confusion, seizure, tremour.
• Cardio:- Tachycardia.
• GI:- Anorexia, nausea, vomiting
• Respiration:- Hypoventilation
• INTERVENTION:-
• Monitor for sign of respiratory distress
• Monitor k+ & calcium level.
• Replace k+

80. NORMAL ARTERIAL BLOOD GAS VALUE
LABORATORY TEST NORMAL RANGE
• PH 7.35---7.45
• Pco2 35—45 mm hg
• HCO3 22-27mEq/L
• Po2 80-100 mm Hg

81. QUESTION:-The nurse review the ABG result of a client &
note the following :- PH 7.45, Pco2 of 30 mm Hg, & HCO 3-
of 20 mEq/L. The nurse analyse the result indicating which
condition?
• SOLUTION:- RESPIRATORY ALKALOSIS
RATIONAL:- The normal pH is 7.35-7.45. In a respiratory
condition an oposite effect is seen between the pH &
Pco2.In this situation the pH is at the highest end of the
normal value & Pco2 is low. In an alkalosis condition the
pH is elevated. Therefore the value identified in the
question indicate a respiratory alkalosis that is
compensated by the kidney through the renal excretion
of bicarbonate. Because the pH has returned to a normal

82. QUESTION-2:- A nurse is caring for a client with a nasogastric
tube that is attached to low suction. The nurse monitor the
client , knowing that the client is at risk for which acid base
balance?
• ANS:- metabolic alkalosis.
Metabolic alkalosis is defind as a deficit or loss of
hydrogen ions & acids or an excess of bicarbonate(
base) that results from the accumulation of base or
from a loss of acid without a comparable loss of base
in the body fluid. This occurs in condition resulting in
hypovolemia, the loss of gastric fluid, excessive
bicarbonate intake, the massive transfusion of whole
blood & hyperaldosterinism. Loss of gastric fluid via
nasogastric suction or vomiting cause metabolic
alkalosis as a result of the loss oh hypochloric acid.