Types of IV Solutions
Isotonic Solutions
0.9% NaCl
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Ringer’s Solution: similar to LR
but does not contain lactate
(Not an alkalizing agent)
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Lactated Ringer’s Solution
(LR)*
Contains Na+, K+, Cl-, Calcium
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D5W*
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Hypotonic Solutions
D5W*
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¼ NS (0.225% NS)
½ NS (0.45% NS)
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(These fluids have lower Na
amounts)
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DO NOT GIVE Hypotonic fluids
with patients who have
Increase Cranial Pressure from
stroke, head trauma, or
neurosurgery)
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Action/Use
Increases vascular and ECF
volumes
Used to replace fluid loss from
hemorrhage, severe V & D, etc.
Replaces sodium
Causes no fluid shift
Lactate is metabolized by the
liver to form bicarbonate, which
is useful in treating metabolic
acidosis, but don’t give if pH > 7.5
Provides hydration with
electrolytes
* LR: First line fluids for burn
clients
* LR: Used to treat hypovolemia
due to third spacing fluid loss
Dextrose can increase blood
glucose levels. Too much glucose
in the blood can cause diuresis.
Provides free water for kidneys
Action/Use
Provides calories and free water
Provides glucose for metabolism
Hydrates the cells
Treats hyperkalemia via
dilutional effect
Shifts fluid from the intravascular
space to the intracellular space
Hydrates the cells
Replaces fluids when sodium
intake must be restricted
Shifts fluid out of the
intravascular space into the
intracellular space causing the
cells to swell
Don’t give if at risk for 3rd
spacing. Ex. burns, trauma, or
low serum protein from
malnutrition or liver disease
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Nursing Considerations
May cause fluid overload and
generalized edema especially if they
have hypertension or HF
Dilutes Hgb and lowers Hct levels
May cause electrolyte imbalances
(Hypochloremia)
Inflammatory in high doses
May cause fluid overload and
generalized edema (Overhydration)
Dilutes Hgb & lowers Hct
Use with cautions in patients with
renal insufficiency, CHF and
conditions in which K+ retention is
present
May cause hyperkalemia and
hypernatremia
Excessive administration of LR may
result in metabolic alkalosis
D5W is isotonic when infused and
quickly becomes hypotonic in the
body as the dextrose is metabolized
rapidly
May cause hyperglycemia osmotic
diuresis or both
Nursing Considerations
May cause fluid overload, water
intoxication or both
Check compatibility before adding
medications to dextrose solution
May irritate veins
May worsen hypotension
May increase edema
May cause hyponatremia
May cause fluid overload
May worsen hypotension because
water moves out the vascular space
May increase edema because water
moves into the cells and interstitial
spaces
May cause dilutional hyponatremia
because the sodium content is less
than that of the plasma
Hypertonic Solutions
D5 NS (0.9 % NS)
D5 ½ NS (0.45% NS)
D10 W
D5 LR
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3% NS
5% NS
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Action/Use
Decreases cerebral edema
Provides calories, water, and
electrolytes (D5NS) (D5LR)
Maintenance IV fluid used to
treat hypovolemia (D5 ½ NS)
Provides free water and calories,
but no electrolytes (D10W)
Shifts fluid from the intracellular
compartment into the
intravascular space, expanding
vascular volume
Supplies sodium to the body;
treats hyponatremia
Decreases inflammation
Shifts fluid from the intracellular
compartment into the
intravascular space
Do not give with cellular
dehydration. Ex. diabetic
ketoacidosis
Do not give with impaired heart
or kidney function
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Nursing Consideration
May cause fluid overload
D5NS may cause hypernatremia
related to sodium content
Hypertonic solutions may be
irritating to veins
Check compatibility before adding
meds to dextrose solutions
Monitor blood sugars levels closely
with D10W
Contraindicated in clients with
intracranial hemorrhage
May cause fluid overload
May cause cells to shrink (cellular
dehydration) as fluid is drawn out of
the cells
Hypertonic solutions may be
irritating to veins (use a central line)
May cause hypernatremia
Use with extreme caution
An Isotonic IV solution increases intravascular volume without causing fluid to move into or out of the cells.
This type of fluid has the same electrolytes as plasma (Intravascular fluid).
A Hypotonic IV solution causes fluid to move rapidly out of the intravascular space and into the cells
(intracellular compartment), preventing or correcting cellular dehydration. Cells swell!
A Hypertonic IV solution pulls fluid from the intracellular space and places the fluid into the extracellular space
(Intravascular/Interstitial compartment) via osmosis, which restores intravascular volume and reduces edema
from the interstitial space. Cells shrink!