Fluid Volume Excess Nursing Cheat Sheet

Fluid Volume Excess


  • Fluid intake or fluid retention exceeds the fluid needs of the body.
  • Fluid volume excess is also called overhydration or fluid overload.
  • The goal of treatment is to restore fluid balance, correct electrolyte imbalances if present, and eliminate or control the underlying cause of the overload.


  1. Isotonic overhydration
  • Known as hypervolemia, isotonic overhydration results from excessive fluid in the extracellular fluid compartment.
  • Only the extracellular fluid compartment is expanded, and fluid does not shift between the extracellular and intracellular compartments.
  • Isotonic overhydration causes circulatory overload and interstitial edema; when severe or when it occurs in a client with poor cardiac function, heart failure and pulmonary edema can result.
  1. Hypertonic overhydration
  • The occurrence of hypertonic overhydration is rare and is caused by an excessive sodium intake.
  • Fluid is drawn from the intracellular fluid compartment; the extracellular fluid volume expands, and the intracellular fluid volume contracts.
  1. Hypotonic overhydration
  • Hypotonic overhydration is known as water intoxication.
  • The excessive fluid moves into the intracellular space, and all body fluid compartments expand.
  • Electrolyte imbalances occur as a result of dilution.


Fluid volume


  1. Isotonic overhydration
  • Inadequately controlled IV therapy
  • Kidney disease
  • Long-term corticosteroid therapy
  1. Hypertonic overhydration
  • Excessive sodium ingestion
  • Rapid infusion of hypertonic saline
  • Excessive sodium bicarbonate therapy
  1. Hypotonic overhydration
  • Early kidney disease
  • Heart failure
  • Syndrome of inappropriate antidiuretic hormone secretion
  • Inadequately controlled IV therapy e. Replacement of isotonic fluid loss with hypotonic fluids
  • Irrigation of wounds and body cavities with hypotonic fluids


Nursing Interventions:

  • Prevent further fluid overload and restore normal fluid balance.
  • Administer diuretics; osmotic diuretics may be prescribed initially to prevent severe electrolyte imbalances.
  • Restrict fluid and sodium intake as prescribed.
  • Monitor intake and output; monitor weight.
  • Monitor electrolyte values and prepare to administer medication to treat an imbalance if present.

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