Fluid & ELectrolytes

Collaborative Goals

Goal is removal of excess fluid & Na Treat underlying cause Medications - Diuretics *(w/CHF) Meds to increase strength of heartbeat, decrease workload *Dialysis if renal failure Diet

What are Electrolytes

substances which split into ions when dissolved in water able to carry an electrical current Primary electrolytes in body Na+, K+, Ca2+ - studied in Block 1 Other: Cl, Mg, Bicarb (HCO3), Phosphates (PO4), Sulfates (SO4) Electrolytes need to be in correct balance for cells to function properly

Hypercalcemia - S/S

"Warm milk makes you sleepy" Lethargy, weakness, depressed reflexes Decreased memory, confusion psychosis Anorexia, N, V, polyuria, dehydration Bone pain, fractures Ventricular arrhythmias, increase digitalis effect

Hypocalcemia

*Chvostek's sign - tap on facial nerve in front of ear - muscle contraction occurs (Iggy Fig. 13-15, p.189) *Trousseau's sign - apply BP cuff above systolic pressure for a few min. (Iggy Fig. 13-14, p.189) Causes carpal spasm Laryngeal spasm, tetany, seizures, V-tach Nursing Dx & Interventions Treat cause, administer oral or IV Ca, increase Ca in diet, monitor pts. who had neck surgery

Calcium balance controlled by

*Parathyroid hormone (PTH) Stimulated by low serum Ca levels to move Ca out of bone, increase GI absorption, & renal tubule reabsorption Calcitonin - Produced by thyroid gland. Responds to increas Ca. Opposite effects of PTH listed above. Vitamin D - stimulates absorption of Ca from GI tract

Osmosis

- movement of solvent (water) across semi-permeable membrane from area of lower concentration to higher Osmotic pressure or a higher solute concentration pulls fluid into that space Blood has colloid osmotic pressure AKA oncotic pressure due to plasma proteins Oncotic Pressure Osmotic pressure exerted by proteins, especially albumin Large molecules hold fluid in vascular space Keeps fluid from leaking out of vascular space Albumin is especially important to keep fluid from shifting out of intravascular space

Filtration

- transfer of water & dissolved substances thru membrane from region of high pressure to region of lower pressure. Occurs in kidney glomerular capillaries & in blood capillaries

There are 2 compartments in your body holding the body fluids:

1.Intracellular fluid (ICF) About 40% of total body weight (TBW) Maintains cell size & function 2.Extracellular fluid (ECF) ~15-20% of TBW Intravascular fluid - inside blood (plasma) (5%) Interstitial fluid (ISF) (15%) between cells, outside vascular space Transcellular space - small amount of fluid in GI tract, cerebrospinal fluid, pleural, synovial, & peritoneal fluids

Hypercalcemia

2/3 caused by hyperparathyroidism 1/3 caused by malignancy breast, lung, multiple myeloma Bone destruction from tumor invasion or secretion of a parathyroid-related protein Prolonged immobilization results in increase Ca from bone mineral loss Rarely caused by increase Ca intake of antacids or administration during cardiac arrest increase ionized Ca occurs during acidosis

Hormonal Regulation

ADH released from pituitary gland in response to increase blood osmolality Aldosterone released by adrenal cortex in response to increase K+ or decrease Na in plasma Increase reabsorption of Na & excretion of K+ & H+ Decrease Na will retain water Renin-angiotensin mechanism Renin - enzyme secreted by kidneys in response to decrease renal perfusion cause by decrease ECF Renin produces angiotensin I -> angiotensin II causes peripheral vasoconstriction, redirects blood flow to kidneys What drugs block this effect? ~Ace inhibitors

FVD

AKA Hypovolemia or dehydration (water loss only) Etiology Loss of water and Na Vomiting, diarrhea, diaphoresis, diuretics Hemorrhage, burns cause loss of water, electrolytes, protein, RBCs Decreased intake NPO, anorexia, dysphagia, altered perception of thirst, unable to reach water

Chem 101 review

Acid: any substance that can donate H+ ions to other molecules pH<7 (e.g. carbonic acid or H2CO3) Base (Alkaline): any substance that can accept H+ molecules pH>7 (bicarbonate or HCO3-) The pH scale describes the degree of acidity or alkalinity of solutions pH of arterial blood should be 7.35-7.45 Slight change can be life-threatening

Metabolic Acidosis

Acids accumulate OR bicarbonate is lost e.g. Ketoacid accumulation in diabetic ketoacidosis or starvation, ASA overdose Increase lactic acid in shock, heavy exercise HCO3 loss in severe diarrhea or renal failure S/SX: HA, lethargy, confusion, arrhythmias, warm flushed skin, abdominal cramps Compensation- Lungs Increase CO2 excretion & kidneys try to excrete additional acid (H+) deep & rapid respirations (trying to get rid of acid) Urine pH <6 (if compensating) ABGs: pH decrease, HCO3 decrease, PCO2 normal or decrease if lungs compensatin

Water content in average person

Adult Male = 60% of TBW (total body wt.) ~42L in a 70kg man Adult female = 50-55% Fat contains less water than lean tissue Elderly = 45-55% TBW Water is the solvent in which body salts, nutrients, and wastes are dissolved and transported

Hypocalcemia is caused by

Anything that decrease production of PTH such as trauma or surgery to parathyroid gland, neck CRF, acute pancreatitis, loop diuretics Alcoholism, diarrhea, laxative abuse, decrease albumin decreased ionized Ca Alkalosis Multiple blood transfusions of citrated blood

FVD Interventions

Assess & What would you see? I & O (assess urine characteristics) *Daily weight VS Labs Neurological status Respiratory status Cardiac function Renal function

Collaborative Interventions - FVE

Assess for s/sx Daily weights Elevate HOB (head of bed 30-45° if indicated Elevate affected extremities Skin care to protect areas of edema Pt. education Administer diuretics, other meds as ordered Monitor I&O Restrict fluids if ordered (PO & IV) TEDs or other compression, as ordered

FVD S/S

Assess: Negative balance of intake/output Concentrated urine, increase specific gravity Weight loss Dry skin/mucous membranes Poor skin turgor, tenting >20-30sec *Weakness, restlessness, confusion Concentrated Hct. & electrolytes Severe FVD → dec. cardiac output, possible shock What changes may occur in BP, Pulse quality?, RR What may occur in kidneys with FVD? ~Failure

Calcium - Ca++

Ca obtained from food, combined with phosphorus & stored in bone Ca aids in transmission of nerve impulses, myocardial contractions, blood clotting, formation of teeth & bone, muscle contractions Serum Ca levels usually show total of 3 types Ionized (free), bound w/protein (albumin), & complexed w/ phosphate, citrate, or carbonate Ionized is sometimes measured separately - most important in neuromuscular functioning

Respiratory Alkalosis

Carbonic acid & CO2 deficit Anything causing hyperventilation or "blowing off" too much CO2; due to respiratory problem or other event *Anxiety, exercise, fever, early asthma, pneumonia, mechanical hyperventilation (wrong ventilator settings) Also hypoxia, pain, sepsis, PE, CNS disorders pH often corrects self before kidneys need to compensate (would excrete HCO3) S/Sx: numbness & tingling of extremities, tachypnea or hyperventilation, light-headedness, confusion, tachycardia, dysrhythmias, seizures, coma Labs: Plasma pH increase , decrease PCO2 Decrease HCO3 if compensating or normal if not Urine pH >6 if compensating (retain H+ ions

Respiratory Acidosis

Carbonic acid & PCO2 excess: Anything which causes hypoventilation which leads to increase CO2 COPD, drug overdose, severe pneumonia Also atelectasis, Cystic Fibrosis, Chest wall abnormality, respiratory muscle weakness (MD or Guillain-Barre), head injury, obesity S/Sx: drowsiness, disorientation, HA, warm, flushed skin, seizures, slow & shallow RR, ventricular dysrhythmias FYI Labs: ABGS - Plasma pH decrease <7.35, increase PCO2 >45 Kidneys compensate by excreting H+ (pH<6) or retaining HCO3 (bicarb)

Hypernatremia

Caused by Na Gain (rare) Ingestion of concentrated Na Concentrated enteral feedings IVs w/ excessive NaCl or sodium bicarb Primary hyperaldosteronism (adrenal tumor?) Saltwater near-drowning Caused by Water loss (most common): Fluid loss through vomiting, diarrhea Excessive Perspiration (sensible loss of water & elec.) Inability to drink or obtain water increase insensible water loss (e.g. lungs, skin) Diabetes insipidus or osmotic diuresis (later blocks)

Hyperkalemia

Caused by excess intake in IVs, salt substitutes, or meds with K+, hypovolemia, blood transfusions K+ shift out of cells Acidosis, esp. ketoacidosis: H+ replaces K+ in cell Tissue catabolism (fever, sepsis, burns), Crush injury, tumor lysis Failure to eliminate excess K+ Renal failure, K+ sparing diuretics, adrenal insufficiency, ACE inhibitors S/S Irritability, anxiety, weakness LE, paresthesia, abdominal cramping, diarrhea, dysrhythmias Cardiac standstill if sudden (lethal injection)

Hypocalcemia - S/S

Decreased Ca allows Na to move into cells -> increase nerve excitability & sustained muscle contraction (tetany) S/SX: Fatigue, depression, anxiety, confusion *Numbness & tingling in extremities & around mouth (early sign) Dysphagia, Hyperreflexia, muscle cramps

Nsg Dx - FVD

Deficient fluid volume R/T excessive ECF loss or decreased intake Decreased cardiac output R/T excessive ECF loss or decreased intake Potential complications: hypovolemic shock

Dehydration vs. FVD

Dehydration is the loss of pure water alone without losing Na Fluid Volume Deficit (FVD) includes the loss of body fluids and electrolytes. Can occur with: Loss of body fluids due to diarrhea, fistula drainage, hemorrhage, polyuria Inadequate intake Shift of fluid from plasma to interstitial space

Hypernatremia - S/S

Dry, swollen tongue, mucous membranes Flushed skin, intense thirst , fever Postural hypotension (CNS & PNS) Restlessness, agitation, twitching, irritability, seizures Labs Na>145mEq/L Serum osmolality>295 mOsm/kg Urine specific gravity >1.03

Fluid shifts between ECF

Edema - fluid shift from vascular space to interstitial space R/T: Increase venous hydrostatic pressure pushes fluid out What might cause increase pressure in veins? Increase plasma oncotic pressure due to low protein What might cause decrease protein levels in vascular space? Increase interstitial oncotic pressure Oncotic pressure R/T protein molecules holds fluid in the vascular space What's it doing in the interstitial space?

FVD - Interventions

Encourage fluids (be creative) Administer IV hydration, as ordered Oral care Skin care Cover wounds to minimize losses Manage fever (cool baths) Minimize exercise Manage vomiting/diarrhea w/ meds, as ordered Patient education

Nsg Dx for FVE

Excess fluid volume R/T increased sodium & water retention or ineffective heart pumping mechanism Risk for impaired skin integrity R/T edema Potential complications: pulmonary edema, ascites

FVE & FVD

FVE due to fluid retention = too much fluid in vascular space: What conditions or meds may cause? Excess due to increased intake: Rare if renal function OK Excessive IVs Fluid Volume Deficit (FVD) due to loss = insufficient fluid volume in vascular space: What conditions or meds may cause? Fluid deficit due to decreased intake: Caused by? CHF, cushing disease, renal failure, medication long term steroid, hormones, to much sodium in diet of meds, FVD: Vomiting, diarrhea, gi resectioning, burns, hemorrhaging FD due to decreased intake: nausea, stroke, maybe on roof of hot az desert and not taking in enough fluid.

Regulation of Fluid Output

Fluid output primarily through kidneys produce 1200-1500ml urine / day Lose fluid from skin & sweat glands Sensible or insensible loss ~500ml/d What conditions may increase skin's insensible loss? Lungs have insensible loss ~ 400ml per d, increased with O2 use 3-6L of fluid moves in & out of GI tract daily Only 100-200ml eliminated, rest reabsorbed What GI conditions cause increased fluid loss?

Hydrostatic pressure

Force within a fluid compartment Vascular space or tissues is generally higher on arterial side & lower on venous side of capillaries In CHF, hydrostatic pressure higher on venous side of capillary beds Fluid moves out of vascular space into interstitial space causing what sx? Higher on arterial side and lower on the venous side. With CHF Hydrostatic pressure is higher on the venous side and lower on arterial side so this cause fluid to become trap on the wrong side in the interstitial space and cause edema.

Assessment for Fluid Balance

History Vital signs I&O balance Weight Skin turgor/moisture Mucous membranes Lung sounds (crackles if fluid overload) JVD Edema LOC Labs

Acid-Base Balance

Hydrogen ion concentration in the cellular environment is regulated within extremely narrow limits. This is called acid-base balance For optimum cell functioning, body must maintain acid-base balance Body metabolism produces acids which are buffered by body systems (NOTE: CO2 in venous blood is an indication of bicarb & normal is 24-30mEq/L) (NOT THE SAME AS ARTERIAL PCO2)

Biological Regulation (ABG's)

Hydrogen ions are absorbed or released by cells (Takes 2 - 4 hours) Takes place after chemical & physiological buffering H+ ion is exchanged with another + ion - usually K+ If ECF too acidic, H+ enters cell & K+ is released into ECF causing hyperkalemia

Nsg Dx (hypernatremia)

Hypernatremia - Risk for injury due to altered sensorium and seizures secondary to abnormal CNS function Hyponatremia - Risk for injury due to altered sensorium and decreased LOC secondary to abnormal CNS function

FVE

Hypervolemia, over-hydration Etiology Excessive Na intake (PO or IV) Compromised regulatory systems Renal insufficiency Congestive Heart Failure (CHF) Cirrhosis Endocrine Disorders (SIADH)

Hyponatremia

Hyponatremia (Sodium & fluid Loss) caused by GI losses: such as? Skin losses: such as? Diuretic medications such as? FYI Renal losses: renal disease, adrenal insufficiency Water Excess (sodium dilution) caused by: Fluid Volume Excess, CHF

Composition of Fluid

Intracellular fluid Cations (+) - mostly potassium & small amts. of magnesium & sodium Anions (-) - mostly phosphate & protein w/ small amts. chloride & bicarb Extracellular fluid Cations - mainly sodium w/ small amts of potassium, calcium, & magnesium Anions - mostly chloride, some protein, w/small amts of bicarb, sulfate, & phosphate

Osmolarity of a solution

Isotonic - same concentration of particles as plasma Hypertonic - greater concentration of particles than plasma Hypotonic - lesser concentration of particles than plasma

Lab Assessment

Lab Results H&H: Hemoglobin (Hgb) & Hematocrit (HCT) Electrolytes BUN Urine specific gravity high (>1.025) indicates dehydration low (<1.01) indicates dilute urine and/or excessive diuresis Serum Osmolality - FYI 275-295 mOsm/kg not a routine lab

How to determine ABG

Look at pH, PCO2, & HCO3 1.Check pH (normal 7.35-7.45) to determine if patient is acidotic or alkalotic Acidosis <7.35 Alkalosis >7.45 <6.8 or >7.8 = death Normal pH with high or low CO2 and opposite low or high bicarb indicates patient is compensating 2.Analyze PCO2 & HCO3 to determine if caused by respiratory or metabolic problem (can be both) Normal PCO2 is 35-45mm Hg arterial Increase = resp. acidosis Decrease = resp. alkalosis Normal HCO3 is 22-26mEq/L arterial Increase = metabolic alkalosis Decrease = metabolic acidosis

Physiological Regulation of ABG's

Lungs and kidneys regulate acid-base balance, but if these organs are diseased won't respond right Lungs react within seconds if a change in pH Regulate depth and rate of respiration to retain or excrete CO2 Compensate for metabolic acidosis or alkalosis Kidneys respond more slowly Regulate through excretion or reabsorption of bicarbonate (HCO3- , a base) Also excrete H+ ions by combining with phosphates or ammonia Takes hours to days for kidneys to compensate

'Third Spacing'

Major fluid shift from intravascular to interstitial space. Occurs with extensive surgical procedures, burns, septic shock, liver disease Ascites, severe edema with burns, peritonitis Problems: Causes hypovolemia, hypotension, tachycardia, UOP due to insufficient fluid in vascular space Ascites During surgical recovery, fluid shifts back into vascular space and can cause fluid overload Edema is soooo huge you can't gage how much and it leaks from the pores of the skin, it will peel.

Regulation of Fluid Input

Major illness or injuries may result in F & E imbalance Body fluid volume regulated by intake, output, & hormonal controls Thirst control center in hypothalmus stimulated when serum osmolality increases By eating salty foods, hypertonic fluid intake decrease plasma fluid volume, increase osmolality R/T dehydration, vomiting, diarrhea, hemorrhage, burns Need ~ 2200-2700ml fluid input per day 1200+ from fluids 1000 from solid food 300 from metabolism 2500mL TOTAL

Sodium - Na+

Na+ aids in generation & transmission of nerve impulses Main cation in ECF Many Na imbalances are actually due to fluid imbalance Range 135-145 mEq/L effects osmolality & water distribution between ECF & ICF Kidneys regulate Na levels by excreting/retaining water Aldosterone promotes Na reabsorption by renal tubules Excess or deficit of Na will cause neurological symptoms in CNS Plasma Na levels reflect % concentration Abnormal Na levels may indicate water imbalance or sodium imbalance or both Water Excess &/or Hyponatremia (<135 mEq/L) Water Deficit &/or Hypernatremia (>145mEq/L) Treatment depends on cause & fluid status How can you tell if abnormal Na level is due to fluid or Na imbalance?

High Risk Groups

Need more careful assessment: Elders impaired thirst mechanism ->dehydration & Increase Na increase risk of FVE - Why? Post-op and/or NPO Vomiting / Diarrhea Diuretics Chronic Disease Renal, Cardiac, Endocrine

Metabolic Alkalosis

Occurs w/a loss of acid or gain in bicarbonate prolonged vomiting or gastric suction (lose stomach acid) Excess ingestion of baking soda or IV bicarb Compensation- Lungs retain CO2 by reducing respiratory rate & kidneys excrete bicarb S/Sx: dizziness, irritability, nervousness, confusion, tachycardia, arrhythmias, anorexia, N, V, tremors, muscle cramps, tingling of fingers & toes hypoventilation to compensate (increase acid) FYI Labs: Plasma pH increase , HCO3 increase , Urine pH >6 (comp) PCO2 normal or increase if lungs compensate

Osmolality vs. Osmolarity

Often used interchangeably Osmolality Osmotic force of solute per unit of wt. of solvent mOsm/kg or mmol/kg Describes fluids inside the body Osmolarity Total milliosmoles of solute per unit of volume of solution mOsm/L Describes fluids outside the body

Movement of Fluids

Osmosis Diffusion Filtration Active Transport Body tries to keep osmolality balanced in the compartments by shifting fluid or solutes.

Protein Imbalances

Plasma proteins - albumin - are indicative of plasma volume Protein increases oncotic pressure and pulls fluid inward into vascular space Causes of imbalance include malnutrition, starvation, fad diets or vegetarian diets w/ insufficient protein, massive burns, liver disease, major infection, loss of albumin in renal disease, hemorrhage S/SX: edema from decrease oncotic pressure, slow healing, anorexia, fatigue, anemia, muscle loss

Potassium - K+

Potassium is major cation in ICF Labs: 3.5-5.0 (slightly higher some places) Potassium needed for conduction of nerve impulses, normal cardiac rhythm, & muscle contraction Potassium must be obtained through diet or supplements drops quickly if not replaced Potassium excreted by kidneys, stool, sweat If kidney function impaired, K+ rises

Acid/Base Regulation

Respiratory Compensation is FIRST! To regulate acid/base and make body homeostasis Lungs control amount of CO2 in blood Consider CO2 an acid (carbonic acid is formed by H20 & CO2) Hyperventilation blows off more CO2 and increases pH to compensate for metabolic acidosis Hypoventilation retains CO2, decreases pH to compensate for metabolic alkalosis More PH is alkaloine Less PH is acidic

Nsg Dx & Interventions (hyperkalemia)

Risk for injury R/T LE muscle weakness Potential complication: arrhythmias Interventions Monitor patient - telemetry DC K+ intake increase K+ elimination w/ increase fluid intake, diuretics, dialysis, Kayexalate if severe Force K+ from ECF to ICF using IV insulin & glucose if severe

Nsg Dx & Interventions (hypokalemia)

Risk for injury R/T muscle weakness Potential complications: arrhythmias Interventions - Collaborative Assess for S/S, check labs Give KCl supplement - dietary, oral, or IV Patient Teaching Teach patient & family about action, dose, side effects of meds including those that deplete potassium (loop or thiazide diuretics) Teach s/sx decrease K+, importance of lab tests, supplements Teach dietary sources of K+ Chocolate, dried fruit, nuts, seeds Fresh fruits - oranges, bananas, apricots, cantaloupe, tomatoes Meats & vegetables esp. beans, potatoes, mushrooms, carrots

FVE S/S

Signs & Symptoms *Weight gain VS - ↑ BP, ↑ HR, & ↑RR Pulse quality? dyspnea, orthopnea Pitting edema w/ tight, shiny skin JVD @45 degrees Moist crackles cough Headache, agitation, confusion R/T brain cell swelling Labs - electrolytes, Hct, decrease Decreased Urine specific gravity *Most reliable indicator of fluid volume is quick increased weight: 1L = 2.2 lbs. or 1 kg

Hyponatremia S/S

Sodium Loss w/ fluid loss Labs: Na<135mEq/L CNS: HA, lethargy, irritability, apprehension, confusion, seizures, coma See Table 17-5 Lewis S/SX dehydration VS: Postural hypotension, dizziness Tachycardia w/rapid, thready pulse GI: increase GI motility - N, V, D, cramping MS: Generalized muscle weakness If hyponatremia due to FVE, what s/sx would also be present?

Acid/Base Regulation II

THEN, the kidneys try to compensate: The kidneys influence maintenance of normal acid-base balance by changing rate of excretion or retention of hydrogen and HCO3 ions. Kidneys are slower than lungs to compensate for sudden changes in acid-base status Kidneys handle increase in blood acids by: Increasing excretion of H+ ions into the urine and returning HCO3 ions to the blood Additional serum bicarbonate is made available to absorb more free H+ ions, and normal pH can be reestablished

Regulation of ABG's (Table 14-1, p.200)

The bicarbonate-carbonic acid buffer system is the MOST important buffer system in the body CO2 + H2O <--> H2CO3 (carbonic acid) <--> H+ + HCO3- Reacts within seconds if it detects a change in pH When CO2 increases, more H+ ions are produced. When H+ ions are produced, more CO2 is produced. This lowers pH resulting in acidosis Lungs control CO2 levels produced by metabolism Increase RR to "blow off" CO2 or decrease RR to retain CO2. Kidneys control excretion of H+ and HCO3- ions

Why do you need a stable amount of fluid in vascular space?

To maintain homestatis

Water is the most common substance in the body, making up a

about 55% to 60% of total body weight for healthy younger adults and 50% to 55% of total body weight for healthy older adults. This water (fluid) is divided into two main spaces or compartments—the fluid outside the cells, which is the extracellular fluid (ECF); and the fluid inside the cells, which is the intracellular fluid (ICF).

Hypokalemia

decrease K+ caused by: Thiazide & loop diuretics, GI loss, NGsuction, polyuria Diaphoresis, dialysis, alkalosis, excess aldosterone decrease K+ intake in diet, IVs without K+, starvation S/Sx Fatigue, muscle weakness, leg cramps N,V, ileus, paresthesias, polyuria, hyperglycemia EKG changes, weak & irregular pulse ventricular arrhythmias

Fluids & electrolytes help to maintain

homeostasis in body Chemical reactions in body sustain life Dependent on delicate balance in F & E Slight imbalance ->major effect on cell function

Active transport

molecules move from area of lower to higher concentration, requires energy sodium-potassium pump allows a higher concentration of K+ in ICF & higher concentration of Na+ in ECF

Diffusion

movement of solutes from higher concentration to lower Movement of O2 & CO2 between alveoli & capillaries Facilitated diffusion - movement of glucose across cell membrane requires carrier molecules - by which hormone? INSULIN!

The extracellular fluid (ECF) contains about

one third (about 15 L) of the total body water. The ECF includes interstitial fluid (fluid between cells, sometimes called the "third space"); blood, lymph, bone, and connective tissue water; and the transcellular fluids.

What do blood gases mean?

pH - hydrogen ion (H+) concentration PaCO2 - partial pressure of CO2 reflects depth & rate of ventilation compensates for metabolic acidosis or alkalosis HCO3- - Bicarb is major renal component of acid-base balance & principle buffer of ECF PaO2 - partial pressure of O2 doesn't affect acid-base if normal Normal 80-100mm Hg If < 60, leads to anaerobic metabolism, lactic acid production, & metabolic acidosis e.g. occurs during cardiac arrest give bicarb as part of resuscitation efforts

Transcellular fluids are

the fluids in special body spaces and include cerebrospinal fluid, synovial fluid, peritoneal fluid, and pleural fluid.

Intracellular fluid (ICF) contains

the remaining two thirds (about 25 L) of total body water.