Fluid and Electrolyte Imbalances

Jaime C. Paz

Chapter Outline

Fluid Imbalance

Loss of Body Fluid

Excessive Body Fluid

Electrolyte Imbalance

Physical Therapy Considerations

Preferred Practice Patterns

Regulation of fluid and electrolyte imbalance is multifactorial and applies to many body systems. For this reason, specific practice patterns are not delineated in this chapter.

Please refer to Appendix A for a complete list of the preferred practice patterns in order to best delineate the most applicable practice pattern for a given patient with fluid and electrolyte imbalance.

Maintaining homeostasis among intracellular fluid, extracellular fluid, and electrolytes is necessary to allow proper cell function. Proper homeostasis depends on the following factors:

• Concentration of intracellular and extracellular fluids

• Type and concentration of electrolytes

• Permeability of cell membranes

• Kidney function

Many variables can alter a patient’s fluid and electrolyte balance. These imbalances can further result in numerous clinical manifestations, which can subsequently affect a patient’s functional mobility and activity tolerance. Recognizing the signs and symptoms of electrolyte imbalance is therefore an important aspect of physical therapy management. In addition, the physical therapist must be aware of which patients are at risk for these imbalances, as well as the concurrent health conditions and medical management of these imbalances.

Fluid Imbalance

The total amount of fluid in the body is distributed between the intracellular and extracellular compartments. Intracellular fluid contains approximately two-thirds of the body’s fluid. Extracellular fluid is further made up of interstitial fluid and intravascular fluid, which is the blood and plasma.1–3 Fluid imbalance occurs when there is a deficit or an excess primarily in extracellular fluid.^1–6 Table 15-1 provides an overview of fluid imbalances.

TABLE 15-1

Fluid Imbalances

ACE, Angiotensin-converting enzyme; BP, blood pressure; BUN, blood urea nitrogen; ECG, electrocardiogram; NPO, nothing by mouth; SIADH, syndrome of inappropriate antidiuretic hormone secretion; ACE, angiotensin-converting enzyme; NSAIDs, nonsteroidal antiinflammatory drugs; PTH, parathyroid hormone.

Data from Huether SE: The cellular environment: fluids and electrolytes, acids and bases. In McCance KL, Huether SE, Brashers VL et al, editors: Pathophysiology, the biologic basis for disease in adults and children, ed 6, St Louis, 2010, Mosby, pp 96-125; The body fluid compartments: extracellular and intracellular fluids; edema. In Hall JE, editor: Guyton and Hall textbook of medical physiology, ed 12, Philadelphia, 2011, Saunders, pp 285-301; Porth CM: Alterations in fluids and electrolytes. In Porth CM, editor: Pathophysiology, concepts of altered health states, ed 6, Philadelphia, 2002, Lippincott, pp 693-734; Gorelick MH, Shaw KN, Murphy KO: Validity and reliability of clinical signs in the diagnosis of dehydration in children, Pediatrics 99(5):E6, 1997; Mulvey M: Fluid and electrolytes: balance and disorders. In Smeltzer SC, Bare BG, editors: Brunner and Suddarth’s textbook of medical-surgical nursing, ed 8, Philadelphia, 1996, Lippincott; Goodman CC, Kelly Snyder TE: Problems affecting multiple systems. In Goodman CC, Boissonnault WG, editors: Pathology: implications for the physical therapist, Philadelphia, 1998, Saunders; Fall PJ: Hyponatremia and hypernatremia: a systematic approach to causes and their correction, Postgrad Med 107(5):75-82, 2000; Marieb EN editor: Human anatomy and physiology, ed 2, Redwood City, CA, 1992, Benjamin Cummings, p 911.

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