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Anatomy of Fluids, Electrolytes, and Acid-Base Balance in Pediatric Patients

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Differences in Fluids, Electrolytes, and Acid-Base Balance in the Pediatric Population.

The body is mostly composed of water... we can go for a great length of time with no food intake, but with no water intake we rapidly become dehydrated, weak, and can die. Water is used by the body for metabolism (which is why if you don't get enough of it you can't lose weight!), to get rid of the waste byproducts of metabolism, and to regulate the temperature of the body. Water is also the major component in your blood and lymphatic fluid.

In the pediatric population, this fluid balance is even more important than in adults. With their larger body surface area per kilogram, it is easier for infants and children to become dangerously dehydrated.

What are Body Fluids?

Body fluids are any fluid in the body that is made up of both water and solutes. A solute is solid material that is dissolved in a fluid (such as water).

Solutes in body fluid might be an electrolyte (charged particle or ion) or a protein.

Essential electrolytes in the human body include:


Too much or too little of any electrolyte can impair functioning in all parts of the body.

The Dynamic Nature of Fluid in the Body

Fluids in the body are not static. Static means that they stay the same. Rather, they are dynamic, or ever-changing. We can take fluids in to our body by drinking, eating, or with IV fluid administration. We constantly lose fluids out of our body through our skin, feces, urine, and by breathing.
  • Sensible fluid loss: fluid loss we can see and measure. This includes things like how much we urinate in a given time period... how much we defecate if it is diarrhea (loose stools)... how much we bleed out... how much comes out of any type of drainage tube.
  • Insensible fluid loss:fluid loss that we can't see or measure. This includes fluid we breathe out or that comes out through our skin.
  • Unless there is a medical problem, we urinate about the same amount as we take in in fluids. We also lose about as much fluid in normal stool, breathing, and through our skin as we take in from food or as a byproduct of metabolism.

Where in the Body is Fluid Found?

There are two major places in the body to find fluid: the intracellular compartment and extracellular compartment. The extracellular compartment is further divided up between the intravascular compartment and the interstitial compartment.
  • Intracellular Fluid: this is the fluid inside your cells. This fluid has high levels of potassium, magnesium, inorganic phosphorus, and proteins. It has lower levels of sodium, calcium and chloride. Although overall levels of calcium are low, they are higher than either of the extracellular fluid compartments.
  • Extracellular Fluid: this is the fluid outside your cells.
  • Intravascular Fluid: this is the fluid inside your blood vessels (veins, arteries, capillaries). This fluid has high levels of sodium, chloride, and proteins. It has lower levels of potassium, calcium, magnesium, and inorganic phosphorus.
  • Interstitial Fluid: this is the fluid that is in-between your cells outside of your blood vessels. This fluid has high levels of sodium and chloride. It has lower levels of potassium, calcium, magnesium, inorganic phosphorus, and proteins.

How do Fluids and Electrolytes Move Around the Body?

  • Filtration: how water moves between the intravascular and interstitial components.
  • Osmosis: how water moves in and out of the cells/
  • Diffusion: how electrolytes move from an area of greater concentration to an area of lesser concentration.
  • Active Transport: how electrolytes move from an area of lesser concentration to an area of greater concentration.

How are Infants and Young Children Different?

Children are not just tiny adults... they are different in ways that mean that they are far more vulnerable to variations in their fluids, electrolytes, and acid-base balances.
  • Percentage of body that is water is highest at birth and decreases as you get older.
  • Neonates and infants, in proportion to their overall size, have larger brains and more skin. Since these have a lot of interstitial fluid, they have a larger volume of extracellular fluid (in proportion to their size) than older children or adults.
  • Extracellular fluid is exchanged (taken in by mouth or IV and sent out via urine, feces, sweat, or breathing) more frequently than intracellular fluid. Intracellular fluid is the body's fluid volume reserve. This means that neonates and infants have higher needs for fluids on a daily basis and have fewer reserves.... this leaves them more vulnerable to dehydration.

Unique Differences of the Newborn in Regards to Fluid Status

  • Double the metabolic rate of older children.
  • 4-5 times great water intake needs per kilogram of weight than older children.
  • Ability to excrete sodium is 90% less than older children.
  • Massive diuresis in the first 3 to 5 days of life causes a weight loss of up to 10%.

What Happens When Fluid Status is Compromised

Body mechanisms are activated to conserve or restore balance... several of them in the kidneys. The kidneys:
  • conserve water
  • conserve necessary electrolytes
  • excrete waste products
  • eliminate metabolized drugs
  • are immature in children under the age of 2... unable to conserve or excrete water and electrolytes effectively.

What Contributes to Fluid Imbalances in Children?

  • Illness with fever (increased metabolic needs)
  • When receiving phototherapy for hyperbilirubinemia (increased water loss through skin)
  • Illness with increased respiratory rate (increased water loss through lungs)
  • Illness with vomiting and diarrhea (increased loss of both fluids and electrolytes from the gastrointestinal tract).
  • Renal disease (changes rates of fluid loss)
  • Fistulas, blood loss, drainage tubes (increased fluid loss)
  • Burns (increased metabolic needs)

Online Audio Glossary

Audio Glossary for Fluids, Electrolytes, and Acid-Base Balance in Pediatric Patients
Learning the terminology used will help you better understand the processes involved.

Fluid and Electrolyte Balance Videos

While these videos are not specifically about the pediatric population, they contain key concepts necessary to understanding this material. I hope you enjoy them!!
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Any Questions about the Anatomy of Fluids, Electrolytes, and Acid-Base Balance in Pediatric Patients?

Please Let Me Know if There is Anything I Need to Explain More Clearly!

  • QriusI May 20, 2011 @ 9:14 am | delete
    very, very informative and worth going back to over and over again
  • Khaleeka Apr 9, 2011 @ 10:17 am | delete
    I thoroughly enjoyed reading this lens. You have been blessed!
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About Ella Halligan, RN

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References

Ball, J.W., & Bindler, R.C. (2006). Child health nursing: partnering with children and families. Saddle River, NJ: Pearson Education, Inc.

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Keywords for Fluids, Electrolytes and Acid Base Balance

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