Types of Intravenous Fluids

Types of intravenous fluids 1. Isotonic solutions a. Fluids that approximate the osmolarity (280-300 mOsm/L) of normal blood plasma.
Sodium Chloride (0.9%) - Normal Saline
Indications:
Extracellular fluid replacement when Cl- loss is equal to or greater the Na loss. Treatment of matebolic alkalosis. Na depletion Initiating and terminating blood transfusions.
Possible side effects:
Hypernatremia Acidosis Hypokalemia Circulatory overload.
b. Fivepercent dextrose in water (D5W).
Provides calories for energy, sparring body protein and preventing ketosis resulting from fat breakdown.
Indications:
Dehydration Hypernatremia Drug administration
Possible side effects: Hypokalemia
Osmotic diuresis dehydration Transient hyperinsulinism Water intoxication.
c. Fivepercent dextrose in normal saline (D5NS). Prevents ketone formation and loss of potassium and intracellular water. Indications: Hypovolemic shock temporary measure.
Burns Acute adrenocortical insufiency.
Hypernatremia Acidosis Hypokalemia Circulatory overload
d. Isotonic multiple-electrolyte fluids.
Types:
Used for replacement therapy; ionic composition approximates blood plasma.
a. Plasmanate
b. Polysol c. Lactated Ringers
Indications:
Vomiting Diarrhea Excessive diuresis Burns
Circulatory overload. Lactated Ringers is contraindicated in severe metabolic acidosis and/or alkalosis and liver disease. Hypernatremia Acidosis Hypokalemia
2. Hypertonic solutions Fluids with an osmolarity much higher than 310 mOsm (+ 50 mOsm); increase osmotic pressure of blood plasma, thereby drawing fluid from cells. a. Tenpercent dextrose in normal saline
Administered in large vein to dilute and prevent venous trauma.
Indications:
Nutrition Replenish Na and Cl.
Hypernatremia (excess Na) Acidosis (excess Cl) Circulatory overload.
b. Sodium Chloride solutions, 3% and 5% Indications:

3.
Slow administration essential to prevent overload (100 mL/hr) Water intoxication Severe sodium depletion
Hypotonic solutions Fluids whose osmolarity is significantly less than that of blood plasma (-50 mOsm); these fluids lower plasma
osmotic pressure, causing fluid to enter cells. a. 0.45% sodium chloride
Used for replacement when requirement for Na use is questionable.
b. 2.5% dextrose in 0.45% saline, also 5% in 0.2 % NaCl Common rehydrating solution. Indications: Fluid replacement when some Na replacement is also necessary.
Encourage diuresis in clients who are dehydrated.
Evaluate kidney status before instituting electrolyte infusions.
Possible side effects: Hypernatremia
Circulatory overload Used with caution in clients who are edematous, appropriate electrolytes should be given to avoid hypokalemia.
Table of Commonly Used IV Solutions

Name of Solution 0.45% Sodium Chloride Shorthand Notation: NS 0.9% Sodium Chloride Shorthand Notation: NS 3% Sodium Chloride Hypertonic pH 5.0 Hypertonic pH 5.8 Isotonic pH 5.0 513 mEq Sodium 513 mEq Chloride 855 mEq Sodium 855 mEq Chloride 5 grams dextrose (170 calories/liter) Type of Solution Hypotonic pH 5.6 Ingredients in 1-Liter 77 mEq Sodium 77 mEq Chloride Uses hypotonic hydration; replace sodium and chloride; hyperosmolar diabetes isotonic hydration; replace sodium and chloride; alkalosis; blood transfusions (will not hemolyze blood cells) Complications if too much is mixed with blood cells during transfusions, the cells will pull water into them and rupture None known
Isotonic pH 5.7
154 mEq Sodium 154 mEq Chloride
5% Sodium Chloride
symptomatic hyponatremia due to excessive sweating, vomiting, renal impairment, and excessive water intake isotonic hydration; provides some calories
rapid or continuous infusion can result in hypernatremia or hyperchloremia
5% Dextrose in Water Shorthand Notation: D5W 10% Dextrose in Water Shorthand Notation: D10W 5% Dextrose in 1/4 Strength (or 0.25%) Saline Shorthand Notation: D5NS
Hypertonic pH 4.3
10 grams dextrose (340 calories/liter)
may be infused peripherally; hypertonic hydration; provides some calories
water intoxication and dilution of bodys electrolytes with long, continuous infusions
Hypertonic pH 4.4
5 grams Dextrose 34 mEq Sodium 34 mEq Chloride
fluid replacement; replacement of sodium, chloride and some calories
5% Dextrose in 0.45 Sodium Chloride Shorthand Notation: D5NS 5% Dextrose in Normal Saline Shorthand Notation: D5NS RingersInjection, U.S.P.
Hypertonic pH 4.4
hypertonic fluid replacement; replace sodium, chloride, and some calories
vein irritation because of acidic pH, causes agglomeration (clustering) if used with blood transfusions; hyperglycemia with rapid infusion leading to osmotic diuresis
Hypertonic pH 4.4
hypertonic fluid replacement; replace sodium, chloride and some calories
Isotonic
147 mEq Sodium
electrolyte replacement;
rapid administration leads to
pH 5.8
4 mEq Potassium 4 mEq Calcium 155 mEq Chloride
hydration; often used to replace extracellular fluid losses
excessive introduction of electrolytes and leads to fluid overload and congestive conditions; provides no calories and is not an adequate maintenance solution if abnormal fluid losses are present
Lactated Ringers Shorthand Notation: LR
Isotonic pH 6.6
130 mEq Sodium 4 mEq Potassium 3 mEq Calcium 109 mEq Chloride 28 mEq Sodium Lactate (provides 9 calories/liter)
isotonic hydration; replace electrolytes and extracellular fluid losses; mild to moderate acidosis (the lactate is metabolized into bicarbonate which counteracts the acidosis)
5% Dextrose in Lactated Ringers Injection Shorthand Notation: D5LR
Hypertonic pH 4.9
5 grams Dextrose (170 calories/liter) 130 mEq Sodium 4 mEq Potassium 3 mEq Calcium 109 mEq Chloride 28 mEq Sodium Lactate (provides 9 calories/liter)
hypertonic hydration; provides some calories; replace electrolytes and extracellular fluid losses; mild to moderate acidosis (the lactate is metabolized into bicarbonate which counteracts the acidosis), the dextrose minimizes glycogen depletion
not enough electrolytes for maintenance; patients with hepatic disease have trouble metabolizing the lactate; do not use if lactic acidosis is present

Types of Intravenous Fluids

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Types of intravenous fluids 1. Isotonic solutions a. Fluids that approximate the osmolarity (280-300 mOsm/L) of normal blood plasma.

Sodium Chloride (0.9%) - Normal Saline

Possible side effects:

Hypernatremia Acidosis Hypokalemia Circulatory overload.

b. Fivepercent dextrose in water (D5W).

Dehydration Hypernatremia Drug administration

Possible side effects: Hypokalemia

Osmotic diuresis dehydration Transient hyperinsulinism Water intoxication.

Burns Acute adrenocortical insufiency.

Possible side effects:

Hypernatremia Acidosis Hypokalemia Circulatory overload

d. Isotonic multiple-electrolyte fluids.

Used for replacement therapy; ionic composition approximates blood plasma.

b. Polysol c. Lactated Ringers

Vomiting Diarrhea Excessive diuresis Burns

Possible side effects:

Administered in large vein to dilute and prevent venous trauma.

Nutrition Replenish Na and Cl.

Possible side effects:

Hypernatremia (excess Na) Acidosis (excess Cl) Circulatory overload.

b. Sodium Chloride solutions, 3% and 5% Indications:

osmotic pressure, causing fluid to enter cells. a. 0.45% sodium chloride

Used for replacement when requirement for Na use is questionable.

Encourage diuresis in clients who are dehydrated.

Evaluate kidney status before instituting electrolyte infusions.

Possible side effects: Hypernatremia

Table of Commonly Used IV Solutions

154 mEq Sodium 154 mEq Chloride

rapid or continuous infusion can result in hypernatremia or hyperchloremia

10 grams dextrose (340 calories/liter)

may be infused peripherally; hypertonic hydration; provides some calories

5 grams Dextrose 34 mEq Sodium 34 mEq Chloride

fluid replacement; replacement of sodium, chloride and some calories

5 grams Dextrose 77 mEq Sodium 77 mEq Chloride

hypertonic fluid replacement; replace sodium, chloride, and some calories

5 grams Dextrose 154 mEq Sodium 154 mEq Chloride

hypertonic fluid replacement; replace sodium, chloride and some calories

147 mEq Sodium

rapid administration leads to

4 mEq Potassium 4 mEq Calcium 155 mEq Chloride

hydration; often used to replace extracellular fluid losses

Lactated Ringers Shorthand Notation: LR

5% Dextrose in Lactated Ringers Injection Shorthand Notation: D5LR

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