Hypo/Hyper/Iso Isotonic IV SOLUTION Ringers Solution CONTENTS Isotonic Lactated Ringers Solution Sodium Chloride, Potassium Chloride, Calcium Chloride, and Sodium Lactate Isotonichypotonic D5W (sugar water) 5% dextrose in water (dextrose 5g/L=170cal/L) Hypertonicisotonic D5NS 5% dextrose in water (dextrose 5g/L=170cal/L) and 0.9% saline 5% dextrose in water (dextrose 5g/L=170cal/L) and .45% Saline Hypertonichypotonic D5 ½ NS Saline solutions Blood and Volume expanders Nutrient Solutions Sodium Chloride, Potassium Chloride, Calcium Chloride, and Sodium Bicarbonate 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. 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 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. USED Used for resuscitation, aggressive fluid replacement for dehydration, burn injuries, sepsis, acute pancreatitis, in the OR, metabolic acidosis, fistula drainage and trauma Used for resuscitation, aggressive fluid replacement for dehydration, burn injuries, sepsis, acute pancreatitis, in the OR, metabolic acidosis, fistula drainage and trauma Used to treat hypernatremia, helpful in rehydrating and excretory purposes, hypoglycemia, insulin shock, dehydration, Increase blood volume after severe blood loss or loss of plasma Maintenance fluid, treat diabetic ketoacidosis, hypernatremia, if pt is NPO because of the dextrose, symptoms of hypoglycemia, RATIONAL Isotonic (Iso: same/equal)-The cell has the same concentration on the inside and outside which in normal conditions the cell’s intracellular and extracellular are both isotonic. Isotonic solutions are used: to increase the EXTRACELLULAR fluid volume due to blood loss, surgery, dehydration, fluid loss that has been loss extracellularly Isotonic fluids: 0.9% Saline 5% dextrose in water (D5W)**also used as a hypotonic solution after it is administered because the body absorbs the dextrose BUT it is considered isotonic) 5% Dextrose in 0.225% saline (D5W1/4NS) Lactated Ringer’s Hypotonic (Hypo: “under/beneath”): The cell has a low amount of solute extracellularly and it wants to shift inside the cell to get everything back to normal via osmosis. This will cause CELL SWELLING which can cause the cell to burst or lyses. Hypotonic solutions are used: when the cell is dehydrated, and fluids need to be put back intracellularly. This happens when patients develop diabetic ketoacidosis (DKA) or hyperosmolar hyperglycemia. Hypotonic solutions 0.45% Saline (1/2 NS) 0.225% Saline (1/4 NS) 0.33% saline (1/3 NS) ***Important: Watch out for depleting the circulatory system of fluid since you are trying to push extracellular fluid into the cell to re-hydrate it. Never give hypotonic solutions to patient who are at risk for increased cranial pressure (can cause fluid to shift to brain tissue), extensive burns, trauma (already hypovolemic) etc. because you can deplete their fluid volume. Hypertonic (Hyper: excessive): The cell has an excessive amount of solute extracellularly and osmosis is causing water to rush out of the cell intracellularly to the extracellular area which will cause the CELL TO SHRINK. Hypertonic solutions are used: when cells are very swollen and we need to have pt get rid of it. An example would be a pt with cerebral edema. Hypertonic solutions: 3% Saline 5% Saline 10% Dextrose in Water (D10W) 5% Dextrose in 0.9% Saline 5% Dextrose in 0.45% saline 5% Dextrose in Lactated Ringer’s **When hypertonic solutions are used (very cautiously….most likely to be given in the ICU due to quickly arising side effects of pulmonary edema/fluid over load). In addition, it is preferred to give hypertonic solutions via a central line due to the hypertonic solution being vesicant on the veins and the risk of infiltration(phlebitis).
