0.9 % NaCl (Normal Saline)
Na+ 154 mEq/L
Cl− 154 mEq/L (308 mOsm/L)
Available w/ varying conc. of
dextrose (most common- 5%
dextrose)
-
Lactated Ringer’s solution
Na+ 130 mEq/L
K+ 4 mEq/L
Ca++ 3 mEq/L
Cl− 109 mEq/L
Lactate
(metabolized
to
bicarbonate)
28 mEq/L (274 mOsm/L)
Available w/ varying conc. of
dextrose (most common- 5%
dextrose)
-
5% dextrose in water (D5W)
No electrolytes
50 g of dextrose
-
-
0.45% NaCl (half strength saline)
Na+ 77 mEq/L
Cl− 77 mEq/L (154 mOsm/L)
Available w/ varying conc. of
dextrose (most common - 5%
conc.)
-
-
ISOTONIC SOLUTIONS
Expands the ECF volume
Hypovolemic states, resuscitative efforts, shock, diabetic ketoacidosis,
metabolic alkalosis, hypercalcemia, mild Na+ deficit
Supplies an excess of Na+ and Cl−; causes FVE and hyperchloremic
acidosis if used excessively, particularly in pts with compromised
renal function, heart failure, or edema
170 cal/L.
ONLY sol’n that may be given with blood products
Tonicity similar to plasma
Contains multiple electrolytes in the same conc. in plasma (lacks Mg++);
9 cal/L
Treatment of hypovolemia, burns, fluid lost as bile or diarrhea, and for
acute blood loss replacement
Lactate is rapidly metabolized into HCO3− in the body
Should NOT be used in lactic acidosis because the ability to convert lactate
into HCO3− is impaired
NOT to be given with pH >7.5 because bicarbonate is formed as lactate
breaks down, causing alkalosis
Should NOT be used in kidney injury because it contains K+ and can cause
hyperkalemia
Tonicity similar to plasma
170 cal/L and free water to aid in renal excretion of solutes
Hypernatremia, fluid loss, and dehydration
Should NOT be used:
- Excessive volumes in early postoperative period (when ADH secretion
is increased due to stress reaction)
- Solely in treatment of FVD - dilutes plasma electrolyte conc.
- Head injury  increased ICP
- Fluid resuscitation  hyperglycemia
CAUTION: renal or cardiac disease (risk of fluid overload)
Electrolyte-free solutions  peripheral circulatory collapse, anuria in pts
with Na deficiency, and increased body fluid loss
Converts to hypotonic sol’ n as dextrose is metabolized. Over time, D5W
without NaCl can cause water intoxication (intracellular FVE) because the
sol’ n is hypotonic
Fluid therapy for long periods w/o electrolytes  hypokalemia
HYPOTONIC SOLUTIONS
Provides Na+, Cl−, and free water
Free water - aid kidneys in solute elimination
Lacking in electrolytes other than Na+ and Cl−
When mixed with 5 dextrose - slightly hypertonic to plasma temporarily
until dextrose is metabolized. It leaves a hypotonic solution after dextrose
metabolism
170 cal/L
Hypertonic dehydration, Na+ and Cl− depletion, and gastric fluid loss
Not indicated for third-space fluid shifts or increased ICP
Administer CAUTIOUSLY - causes fluid shifts from vascular system into
cells,  cardiovascular collapse and increased ICP
HYPERTONIC SOLUTIONS
3% NaCl (hypertonic saline)
Na+ 513 mEq/L
Cl− 513 mEq/L (1026 mOsm/L)
5% NaCL
Na+ 855 mEq/L
Cl− 855 mEq/L (1710 mOsm/L)
IV Mannitol 5–25%
(1372 mOsm/L contained in 25%
sol’n)
-
Dextran in NS or D5W
Available in low molecular-weight
(Dextran 40) and high molecularweight (Dextran 70) forms
-
Used to increase ECF volume, decrease cellular swelling
Highly hypertonic solution used ONLY in critical situations to treat
hyponatremia
Must be given SLOWLY and cautiously - intravascular volume overload and
pulmonary edema
Assists in removing ICF excess
Highly hypertonic solution used to treat symptomatic hyponatremia
NO calories
COLLOID SOLUTIONS
Used as volume/plasma expander for intravascular part of ECF
Affects clotting by coating platelets and decreasing ability to clot
Remains in circulatory system up to 24 h
Treat hypovolemia in early shock to increase pulse pressure, cardiac
output, and ABP
Improves microcirculation by decreasing red blood cell aggregation
Contraindicated in hemorrhage, thrombocytopenia, renal disease, and
severe dehydration
Not a substitute for blood or blood product
Fluid Volume
Disturbances
hypovolemia – Fluid Volume
Deficit (FVD)
»
occurs when loss of ECF volume
exceeds the intake of fluid
PATHOPHYSIOLOGY
› results from loss of body fluids and
occurs rapidly when coupled with
decreased fluid intake
› prolonged period of inadequate
intake
› CAUSES:
!
Abnormal
Fluid
Losses
(vomiting,
diarrhea,
GI
suctioning, and sweating)
!