Fluid and electrolyte balance - Overview: Nursing

Fluid and electrolyte balance is the regulation of fluids and electrolytes or charged molecules known as ions to maintain a stable internal environment, known as homeostasis, maintaining fluid and electrolyte homeostasis is essential for normal functioning of the body.

Now, fluid is needed for essential functions like cellular metabolism and the delivery of oxygen and nutrients to the cells.

It's distributed in two major compartments inside the cells called intracellular fluid and outside the cells called extracellular fluid.

The extracellular fluid compartment is further divided into the intravascular space which is inside the blood vessels. The interstitial space which is found between the cells and the transcellular space where fluids like pericardial cerebrospinal and synovial fluid are contained in spaces lined with epithelial cells.

Ok. So the fluid in these compartments is made up of water as well as dissolved substances called solutes.

There are large solutes that can't easily cross cell membranes such as plasma proteins like albumin and small solutes that can easily cross cell membranes such as oxygen, glucose and electrolytes.

Now, electrolytes can be categorized as either cations which are positively charged like sodium or anions which are negatively charged like phosphate electrolytes can be measured in the urine, cerebrospinal fluid and blood.

And they're usually expressed as milli equivalents per liter of fluid or meq over L OK. So sodium or NA plus is the most abundant cation in the extracellular fluid.

Its major functions are maintaining fluid volume and fluid osmolality, which is the concentration of particles dissolved in the fluid.

Sodium's normal range is between 135 to 145 milli equivalents per liter. Potassium or K plus is the main cation in the intracellular fluid.

And it's responsible for maintaining the osmolality of the fluid within the cells. Potassium works closely with sodium to maintain the cells resting membrane potential, which is the distribution of ions on either side of the cellular membrane.

Potassium is also essential for normal neuromuscular and cardiac function. Potassium's normal range is between 3.5 and five milliequivalents per liter.

Then there's calcium or ca two plus which influences the excitability of nerve and muscle cells and is essential for muscle contraction.

It's also involved in blood clotting and maintaining strong bones and teeth. Calcium's normal range is between 8.4 and 10.6 mgs per deciliter.

Next, magnesium or mg two plus influences the function of both cardiac and skeletal muscles through its actions in the neuromuscular junction, which is where muscles and nerves meet.

It also assists in enzyme reactions during carbohydrate and protein metabolism. Magnesium normally ranges between 1.3 and 2.1 mgs per deciliter.

Finally, phosphate or po 43 minus is an essential component of adenosine triphosphate or ATP, which is the body's main energy source for cellular metabolism and nucleotides which make up DNA and RNA.

It also works with calcium to form bones and teeth. Phosphate's normal range is between 3.0 and 4.5 mg per deciliter.

All right now, fluid and electrolytes are constantly shifting in and out of the cells and between fluid compartments to maintain homeostasis.

This is often passive movement, meaning no energy is required. Forms of passive movement include diffusion, osmosis and filtration.

When energy is required, active transport is used. Now, diffusion involves passive movement of solutes downhill with the solute concentration gradient.

So moving from an area of higher solute concentration to an area of lower solute concentration until their concentration is equal in both areas.

For example, simple diffusion occurs during gas exchange in the lungs. As oxygen or O2 moves from the alveolar cells into the pulmonary capillaries because the concentration of oxygen is greater inside the alveolar cells than the capillaries.

It diffuses from inside the cells into the capillaries. In cases where some assistance is needed for solutes to diffuse across the cell's membrane.

Facilitated diffusion is used where either channel proteins open. So ions can move in and out of the cell or special proteins called carrier proteins carry a solute across the membrane.

Then there's osmosis which involves the movement of fluids across a cell membrane. Osmosis is driven by osmotic pressure which is determined by the difference in solute concentration on either side of the membrane.

The osmotic pressure pulls fluid from the side with a lower concentration of solutes to the side with a higher concentration of solutes which keeps fluid balance between fluid compartments.

Next, filtration is the movement of water and small solutes across the cell membrane. But in contrast to osmosis, the movement is driven by hydrostatic pressure which is determined by the difference in fluid pressure.

On either side of the membrane, hydrostatic pressure is created by the force of gravity and BP from the pumping action of the heart with filtration, fluid moves out of the capillaries and into the interstitial space.

This happens during capillary exchange and when plasma is filtered by the kidneys, lastly, active transport moves solutes uphill against the concentration gradient.

So moving from an area of lower solute concentration to an area of equal or higher solute concentration. This requires energy in the form of adenosine triphosphate or ATP for example, ATP powers the sodium potassium pump.

The pump moves three sodium ions out of the cell for every two potassium ions moved into the cell in order to maintain the resting membrane potential of the cell.

All right, to maintain homeostasis intake or what enters the body should be balanced with output or what leaves the body.

Most fluid and electrolyte intake comes from person's diet. While output comes from sensible loss through urine and feces as well as insensible loss through breathing and sweating.

Now, one way fluid and electrolytes are balanced is through monitoring by osmo receptors in the hypothalamus. When the osmo receptors detect increased plasma osmolality or decreased plasma volume, the posterior pituitary gland is stimulated to release antidiuretic hormone or ADH which triggers the kidneys to retain fluid.

So fluid volume increases and osmolality decreases. Increased osmolality also stimulates the thirst mechanism in the hypothalamus, prompting a person's desire to drink.

Likewise, when osmoreceptors detect decreased osmolality or increased fluid volume, ADH released is inhibited, more fluid is excreted from the kidneys and homeostasis is restored.

All right, as a quick recap fluid and electrolyte balance is the regulation of the amount and distribution of fluids and electrolytes to maintain a stable internal environment to maintain balance, fluid and electrolytes are in constant motion through the processes of diffusion, facilitated diffusion, osmosis filtration and active transport.

At the same time, the body monitors plasma osmolality and fluid volume to regulate fluid balance through ADH and the thirst mechanism.