PHARMACOLOGY: IV Fluids

What are IV Fluids?

Intravenous fluids (IV Fluids), also known as intravenous

solutions, are supplemental fluids used in intravenous therapy to
restore or maintain normal fluid volume and electrolyte balance when
the oral route is not possible.
IV fluid therapy is an efficient and effective way of supplying
fluids directly into the intravascular fluid compartment, in replacing
electrolyte losses, and in administering medications and blood
products.
Types of IV Fluids

The most common way to categorize IV fluids is based on their tonicity:

1. Isotonic
Isotonic IV solutions that have the same concentration of solutes as
blood plasma.
2. Hypotonic
Hypotonic solutions have lesser concentration of solutes than plasma.
3. Hypertonic
Hypertonic solutions have greater concentration of solutes than
plasma.
IV solutions can also be classified based on
their purpose:
1. Nutrient solutions. May contain dextrose, glucose, and levulose to make up the
carbohydrate component – and water. Water is supplied for fluid requirements and
carbohydrate for calories and energy. Nutrient solutions are useful in preventing
dehydration and ketosis. Examples of nutrient solutions include D5W, D5NSS.
2. Electrolyte solutions. Contains varying amounts of cations and anions that are used
to replace fluid and electrolytes for clients with continuing losses. Examples of
electrolyte solutions include 0.9 NaCl, Ringer’s Solution, and LRS.
3. Alkalinizing solutions. Are administered to treat metabolic acidosis. Examples: LRS.
4. Acidifying solutions. Are used to counteract metabolic alkalosis. D51/2NS, 0.9 NaCl.
5. Volume expanders. Are solutions used to increase the blood volume after a severe
blood loss, or loss of plasma. Examples of volume expanders are dextran, human
albumin, and plasma.
Crystalloids

Crystalloid IV solutions contain small molecules that flow easily

across semipermeable membranes. They are categorized according to
their relative tonicity in relation to plasma. There are three types:
isotonic, hypotonic, and hypertonic.
Isotonic IV Fluids

Most IV fluids are isotonic

a. They have the same concentration of solutes as blood plasma.
b. When infused, isotonic solutions expand both the intracellular fluid and
extracellular fluid spaces, equally.
c. Such fluids do not alter the osmolality of the vascular compartment.
d. Technically, electrolyte solutions are considered isotonic if the total
electrolyte content is approximately 310 mEq/L.
e. Isotonic IV fluids have a total osmolality close to that of the ECF and do
not cause red blood cells to shrink or swell.
0.9% NaCl (Normal Saline Solution, NSS)
• Normal saline solution (0.9% NaCl) or NSS, is a crystalloid isotonic IV fluid
that contains water, sodium (154 mEq/L), and chloride (154 mEq/L). It has an
osmolality of 308 mOsm/L and gives no calories. It is called normal saline
solution because the percentage of sodium chloride dissolved in the solution is
similar to the usual concentration of sodium and chloride in the intravascular
space. Normal saline is the isotonic solution of choice for expanding the
extracellular fluid (ECF) volume because it does not enter the intracellular fluid
(ICF). It is administered to correct extracellular fluid volume deficit because it
remains within the ECF.
• Normal saline is the IV fluid used alongside the administration of blood products.
It is also used to replace large sodium losses such as in burn injuries and trauma.
It should not be used for heart failure, pulmonary edema, and renal impairment, or
conditions that cause sodium retention as it may risk fluid volume overload.
Nursing
Considerations
for Isotonic IV
Solutions
Nursing Interventions And Considerations
When Administering Isotonic Solutions:
 Document baseline data. Before infusion, assess the patient’s vital signs, edema status, lung sounds, and heart
sounds. Continue monitoring during and after the infusion.
 Observe for signs of fluid overload. Look for signs of hypervolemia such as hypertension, bounding pulse,
pulmonary crackles, dyspnea, shortness of breath, peripheral edema, jugular venous distention, and extra heart
sounds.
 Monitor manifestations of continued hypovolemia. Look for signs that indicate continued hypovolemia such as,
decreased urine output, poor skin turgor, tachycardia, weak pulse, and hypotension.
 Prevent hypervolemia. Patients being treated for hypovolemia can quickly develop fluid overload following
rapid or over infusion of isotonic IV fluids.
 Elevate the head of the bed at 35 to 45 degrees. Unless contraindicated, position the client in semi-Fowler’s
position.
 Elevate the patient’s legs. If edema is present, elevate the legs of the patient to promote venous return.
 Educate patients and families. Teach patients and families to recognize signs and symptoms of fluid volume
overload. Instruct patients to notify their nurse if they have trouble breathing or notice any swelling.
 Close monitoring for patients with heart failure. Because isotonic fluids expand the intravascular space,
patients with hypertension and heart failure should be carefully monitored for signs of fluid overload.
Hypotonic IV Fluids
• Hypotonic IV solutions have a lower osmolality and contain fewer
solutes than plasma. They cause fluid shifts from the ECF into the ICF
to achieve homeostasis, therefore, causing cells to swell and may even
rupture. IV solutions are considered hypotonic if the total electrolyte
content is less than 250 mEq/L. Hypotonic IV fluids are usually used
to provide free water for excretion of body wastes, treat cellular
dehydration, and replace the cellular fluid.
Nursing
Considerations
for Hypotonic IV
Solutions
Nursing Considerations for Hypotonic IV
Solutions
• The following are the general nursing interventions and considerations when administering hypotonic IV
solutions:
• Document baseline data. Before infusion, assess the patient’s vital signs, edema status, lung sounds,
and heart sounds. Continue monitoring during and after the infusion.
• Do not administer in contraindicated conditions. Hypotonic solutions may exacerbate existing
hypovolemia and hypotension causing cardiovascular collapse. Avoid use in patients with liver disease,
trauma, or burns.
• Risk for increased intracranial pressure (IICP). Should not be given to patients with risk for IICP as
the fluid shift may cause cerebral edema (remember: hypotonic solutions make cells swell).
• Monitor for manifestations of fluid volume deficit. Signs and symptoms include confusion in older
adults. Instruct patients to inform the nurse if they feel dizzy.
• Warning on excessive infusion. Excessive infusion of hypotonic IV fluids can lead to intravascular
fluid depletion, decreased blood pressure, cellular edema, and cell damage.
• Do not administer along with blood products. Most hypotonic solutions can cause hemolysis of red
blood cells especially during rapid infusion of the solution.
Hypertonic IV Fluids

• Hypertonic IV solutions have a greater concentration of solutes (375

mEq/L and greater) than plasma and cause fluids to move out of the
cells and into the ECF in order to normalize the concentration of
particles between two compartments. This effect causes cells to shrink
and may disrupt their function. They are also known as volume
expanders as they draw water out of the intracellular space, increasing
extracellular fluid volume.
Hypertonic Sodium Chloride IV Fluids
• Hypertonic sodium chloride solutions contain a higher concentration
of sodium and chloride than normally contained in plasma. Infusion of
hypertonic sodium chloride solution shifts fluids from the intracellular
space into the intravascular and interstitial spaces. Hypertonic
sodium chloride IV solutions are available in the following forms
and strengths:
A. 3% sodium chloride (3% NaCl) containing 513 mEq/L of
sodium and chloride with an osmolality of 1030 mOsm/L.
B. 5% sodium chloride (5% NaCl) containing 855 mEq/L of sodium
and chloride with an osmolality of 1710 mOsm/L.
Hypertonic Dextrose Solutions
• Isotonic solutions that contain 5% dextrose (e.g., D5NSS, D5LRS) are
slightly hypertonic since they exceed the total osmolality of the ECF.
However, dextrose is quickly metabolized and only the isotonic
solution remains. Therefore, any effect on the ICF is temporary.
Hypertonic dextrose solutions are used to provide kilocalories for the
patient in the short term. Higher concentrations of dextrose (i.e.,
D50W) are strong hypertonic solutions and must be administered into
central veins so that they can be diluted by rapid blood flow.
Dextrose 10% in Water (D10W)
• Dextrose 10% in Water (D10W) is an hypertonic IV solution used in
the treatment of ketosis of starvation and provides calories (380
kcal/L), free water, and no electrolytes. It should be administered
using a central line if possible and should not be infused using the
same line as blood products as it can cause RBC hemolysis.

Dextrose 20% in Water (D20W)

• Dextrose 20% in Water (D20W) is hypertonic IV solution an
osmotic diuretic that causes fluid shifts between various compartments
to promote diuresis.
Dextrose 50% in Water (D50W)

• Another hypertonic IV solution used commonly is Dextrose 50% in

Water (D50W) which is used to treat severe hypoglycemia and is
administered rapidly via IV bolus.
Nursing
Considerations for
Hypertonic IV
Fluids
Nursing Interventions And Considerations
When Administering Hypertonic IV Solutions:
• Document baseline data. Before infusion, assess the patient’s vital signs, edema status, lung sounds, and heart sounds. Continue
monitoring during and after the infusion.
• Watch for signs of hypervolemia. Since hypertonic solutions move fluid from the ICF to the ECF, they increase the extracellular
fluid volume and increases the risk for hypervolemia. Look for signs of swelling in arms, legs, face, shortness of breath, high
blood pressure, and discomfort in the body (e.g., headache, cramping).
• Monitor and observe the patient during administration. Hypertonic solutions should be administered only in high acuity areas
with constant nursing surveillance for potential complications.
• Verify order. Prescription for hypertonic solutions should state the specific hypertonic fluid to be infused, the total volume to be
infused, the infusion rate and the length of time to continue the infusion.
• Assess health history. Patients with kidney or heart disease and those who are dehydrated should not receive hypertonic IV
fluids. These solutions can affect renal filtration mechanisms and can easily cause hypervolemia to patients with renal or heart
problems.
• Prevent fluid overload. Ensure that administration of hypertonic fluids does not precipitate fluid volume excess or overload.
• Do not administer peripherally. Hypertonic solutions can cause irritation and damage to the blood vessel and should be
administered through a central vascular access device inserted into a central vein.
• Monitor blood glucose closely. Rapid infusion of hypertonic dextrose solutions can cause hyperglycemia. Use with caution for
patients with diabetes mellitus.
Colloids
• Colloids contain large molecules that do not pass through
semipermeable membranes. Colloids are IV fluids that contain solutes
of high molecular weight, technically, they are hypertonic solutions,
which when infused, exert an osmotic pull of fluids from interstitial
and extracellular spaces. They are useful for expanding the
intravascular volume and raising blood pressure. Colloids are
indicated for patients in malnourished states and patients who cannot
tolerate large infusions of fluid.
Human Albumin
• Human albumin is a solution derived from plasma. It has two strengths: 5%
albumin and 25% albumin. 5% Albumin is a solution derived from plasma and is
a commonly utilized colloid solution. It is used to increase the circulating volume
and restore protein levels in conditions such as burns, pancreatitis, and plasma loss
through trauma. 25% Albumin is used together with sodium and water restriction
to reduce excessive edema. They are considered blood transfusion products and
uses the same protocols and nursing precautions when administering albumin.
• The use of albumin is contraindicated in patients with the following conditions:
severe anemia, heart failure, or known sensitivity to albumin. Additionally,
angiotensin-converting enzyme inhibitors should be withheld for at least 24 hours
before administering albumin because of the risk of atypical reactions, such as
hypotension and flushing.
Dextrans

• Dextrans are polysaccharides that act as colloids. They are available

in two types: low-molecular-weight dextrans (LMWD) and high-
molecular-weight dextrans (HMWD). They are available in either
saline or glucose solutions. Dextran interferes with blood
crossmatching, so draw the patient’s blood before administering
dextran, if crossmatching is anticipated.
Low-molecular-weight Dextrans (LMWD)
• LMWD contains polysaccharide molecules that behave like colloids
with an average molecular weight of 40,000 (Dextran 40). LMWD is
used to improve the microcirculation in patients with poor peripheral
circulation. They contain no electrolytes and are used to treat shock
related to vascular volume loss (e.g., burns, hemorrhage, trauma, or
surgery). On certain surgical procedures, LMWDs are used to prevent
venous thromboembolism. They are contraindicated in patients with
thrombocytopenia, hypofibrinogenemia, and hypersensitivity to
dextran.
High-molecular-weight Dextrans (HMWD)
• HMWD contains polysaccharide molecules with an average molecular
weight of 70,000 (Dextran 70) or 75,000 (Dextran 75). HMWD used
for patients with hypovolemia and hypotension. They are
contraindicated in patients with hemorrhagic shock.
Plasma Protein Fraction (PPF)
• Plasma Protein Fraction is a solution that is also prepared from
plasma, and like albumin, is heated before infusion. It is recommended
to infuse slowly to increase circulating volume.
Nursing
Considerations for
Colloid IV
Solutions
Nursing Interventions And Considerations When Administering Colloid IV
Solutions:

• Assess allergy history. Most colloids can cause allergic reactions, although rare,
so take a careful allergy history, asking specifically if they’ve ever had a reaction to
an IV infusion before.
• Use a large-bore needle (18-gauge). A larger needle is needed when
administering colloid solutions.
• Document baseline data. Before infusion, assess the patient’s vital signs, edema
status, lung sounds, and heart sounds. Continue monitoring during and after the
infusion.
• Monitor the patient’s response. Monitor intake and output closely for signs of
hypervolemia, hypertension, dyspnea, crackles in the lungs, and edema.
• Monitor coagulation indexes. Colloid solutions can interfere with platelet
function and increase bleeding times, so monitor the patient’s coagulation indexes.
Reference:
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