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Hypotonic Fluids
- 0.45% Saline - treats hypernatremia and uncontrolled hyperglycemia, used as maintenance solution
- 0.33% Saline
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Hypertonic Fluids
- 3%-5% Saline - treats symptomatic hyponatremia and trauma patients with head injury
- D5 in 0.45% Saline - used as maintenance solution
- D5 in 0.9% Saline - used to treat metabolic alkalosis and volume deficits in patients with hyponatremia
- D5LR
- D10W - used in parenteral nutrition
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Isotonic Fluids
- 0.9% Saline - used to expand intravascular volume and replace ECF losses (replacement of fluid and sodium losses)
- D5 in 0.25% Saline - used to replace hypotonic losses and treat hypernatremia
- LR - used to treat hypovolemia, burns, and GI fluid losses (contraindicated in patients with alkalosis or lactic acidosis)
- D5W - treats hypernatremia
- Normosol-R - treats acute losses of ECF - Hypovolemia
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How do Hypotonic solutions act when infused?
- dilutes the ECF
- moves water from ECF into the cells and interstitial spaces
- Treats hypernatremia
- Good for maintenance
- Not good for replacement because they deplete ECF and lower BP
- Monitor for cerebral edema
- D5W (technically isotonic) acts as a hypotonic solution because the dextrose quickly metabolizes. Causes equal expansion of ECF and ICF
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How do Isotonic solutions act when infused?
- expands only ECF, no movement into cells
- ideal treatment for ECF volume deficits (hypovolemia)
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How do Hypertonic solutions act when infused?
- Initially raises the osmolality of ECF and expands volume
- Draws water out of cells
- Treatment of hyponatremia and trauma patients with head injury
- Monitor BP, lung sounds, serum sodium levels due to risk of intravascular fluid volume excess
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Colloids
- AKA volume expanders or plasma expanders
- Contain large molecules that increase oncotic pressure and pull fluid into the blood vessels
- Restores blood volume
- Types of colloids are: human plasma products (albumin, fresh frozen plasma, blood) and semisynthetics (dextran, starches)
- Risk of circulatory overload
- Monitor vital signs and urine output, S&S of fluid volume excess (hypervolemia)
- Anticoagulation properties - semisynthetics more so than human plasma products
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Total parenteral nutrition
- TPN
- A hypertonic solution containing 20% to 50% dextrose, proteins, vitamins, and minerals that is administered into the venous system.
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