FLUID AND ELECTROLYTE IMBALANCES
Body fluid is composed primarily of water and electrolytes. The body is equipped with homeostatic mechanisms to
keep the composition and volume of body fluids within narrow limits. Organs involved in this mechanism include the
kidneys, lungs, heart, blood vessels, adrenal glands, parathyroid glands, and pituitary gland. Body fluid is divided into
two types: intracellular (within the cells) and extracellular (interstitial or tissue fluid, intravascular or plasma, and
transcellular, such as cerebrospinal or synovial fluids).
All plans of care specific to underlying health condition causing imbalance, e.g., DM, HF, upper GI bleeding, renal
1. Restore homeostasis.
2. Prevent/minimize complications.
3. Provide information about condition/prognosis and treatment needs as appropriate.
1. Homeostasis restored.
2. Free of complications.
3. Condition/prognosis and treatment needs understood.
4. Plan in place to meet needs after discharge.
Because fluid and electrolyte imbalances usually occur in conjunction with other medical conditions, the
following information is offered as a reference. The interventions are presented in a general format for inclusion in the
primary plan of care.
Total body water, essential for metabolism, declines with age and also varies with body fat content and gender. It
constitutes about 80% of an infant’s body weight, 60% of an adult’s, and as little as 40% of an older person’s weight.
Hypervolemia (Extracellular Fluid Volume Excess)
Excess sodium intake including sodium-containing foods, medications, or fluids (PO/IV)
Excessive, rapid administration of hypertonic (or possibly isotonic) parenteral fluids
Increased release of antidiuretic hormone (ADH); excessive adrenocorticotropic hormone
(ACTH) production, hyperaldosteronism
Decreased plasma proteins as may occur with chronic liver disease with ascites, major
abdominal surgery, malnutrition/protein depletion
Chronic kidney disease/acute renal failure (ARF)
Heart failure (HF)