-
0.45% Sodium Chloride
(1/2 NS)
- HYPOTONIC
- USES: hypotonic hydration, replace sodium and chloride, hyperosmolar diabetes
- COMPLICATIONS: if too much is mixed with blood cells during transfusions, the cells will pull water into them and rupture. HYPOnatremia if sodium is normal, rapid reduction of sodium if used in excess or infused too rapidly (can cause cerebral edema, so CAUTION)
-
0.9% Sodium Chloride
(NS)
- ISOTONIC
- USES:
- Isotonic hydration
- replace sodium and chloride
- alkalosis
- blood transfusion (will not hemolyze blood cells)
- no known complications
- principle fluid used for IV resuscitation and replacement of salt loss
- for 100mL blood loss, need to give 300-400mL NS
-
3% Sodium Chloride
- HYPERTONIC
- USES: symptomatic hyponatremia d/t excessive sweating, vomiting, renal impairment, and excessive water intake
- COMPLICATIONS: rapid or continuous infusion can result in hypernatremia or hyperchloremia, intracellular dehydration if used in large volumes
- reserved for plasma expansion with colloids or acute hyponatremia. rarely used.
-
5% Sodium Chloride
- HYPERTONIC
- USES: symptomatic hyponatremia d/t excessive sweating, vomiting, renal impairment, and excessive water intake
- COMPLICATIONS: rapid or continuous infusion can result in hypernatremia or hyperchloremia, intracellular dehydration if used in large volumes
- reserved for plasma expansion with colloids or acute hyponatremia. rarely used.
-
5% Dextrose in Water
(D5W)
- ISOTONIC
- 5 g dextrose (170 cals/L)
- USES: isotonic hydration, provides some calories
- COMPLICATIONS: water intoxications and dilution of body's electrolytes with long, continuous infusion
- primarily used to maintain water balance in pt unable to take in by mouth, commonly used post-op
- edelctolyte free: no Na, K, Cl, Ca
-
10% Dextrose in Water
(D10W)
- HYPERTONIC
- 10g dextrose (340 kcal/L)
- USES: may be infused peripherally, hypertonic hydration, provides some calories
- COMPLICATIONS: water intoxication and dilution of body's electrolytes with long, continuous infusions
-
5% Dextrose in 1/4 Strength (25%) Saline
(D5 1/4 NS)
- HYPERTONIC
- USES: fluid replacement, replacement of sodium, chloride, and some calories
- COMPLICATIONS: vein irritation bc of acidic pH, causes agglomeration if used with blood transfusions, hyperglycemia with rapid infusion
-
Define: Isotonic Solution
- osmolarity falls within (or near) the normal range for serum
- 240-340 mOsm/L
- Hypotonic has lower osmolarity
- hypertonic has higher osmolarity
-
What are some Isotonic Solutions?
- Lactated Ringer's: 275 mOsm/L
- Ringer's Injections: 275 mOsm/L
- 0.9% sodium Chloride: 308 mOsm/L
- 5% dextrose in water: 260 mOsm/L
- 5% albumin: 308 mOsm/L
- Hetastarch: 310 mOsm/L
- Normosol: 295 mOsm/L
-
What are Nursing Considerations for Isotonic Solutions?
- because isotonic solutions expand the intravascular compartment, closely monitor the pt for sx of fluid overload, esp. if pt has HTN or HF
- bc the liver coverts lactate to bicarb, don't give lactated Ringer's solution if the pt exceeds 7.5
- avoid giving D5W to pt at risk for ICP bc it acts like a hypotonic solution. D5W is actually isotonic only in the container. After admin, dextrose is quicly metabolized, leaving only water (a hypotonic fluid)
-
What are some Hypotonic Solutions?
- 0.45% sodium chloride: 154 mOsm/L
- 0.33% sodium chloride: 103 mOsm/L
- 2.5% dextrose in water: (126 mOsm/L)
-
Nursing Considerations for Hypotonic Solutions?
- admin cautiously. cause a fluid shift from BV into cells. Shift could cause cardiovascular collapse from intravascular fluid depletion and increased ICP from fluid shift into brain cells
- dont give to pt at risk for increased ICP form stroke, head trauma, or neurosurgery
- dont give to pt at risk for third-space fluid shifts (abn shifts to the interstitial space) [ex. burns, trauma, low serum protein from malnutrition or liver disease]
-
What are some Hypertonic Solutions?
- 5% dextrose in 0.45% sodium chloride: 406 mOsm/L
- 5% dextrose in 0.9% sodium chloride: 560 mOsm/L
- 5% dextrose in lactated Ringer's: 575 mOsm/L
- 3% sodium chloride: 1025 mOsm/L
- 25% albumin: 1500 mOsm/L
- 7.5% sodium chloride: 2400 mOsm/L
-
Nursing Considerations for Hypertonic Solutions?
- because hypertonic solutions greatly expand the intravascular space, admin them by IV pump and closely monitor the pt for circulatory overload
- hypertonic solutions pull fluid from the interstitial space, so don't giv to a pt with a condition that can cause cellular dehydration, such as DKA
- dont give to a pt with impaired heart or kidney fxn (system can't handle the extra fluid)
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