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Isotonic Fluids Same osmolarity as plasma - blood and body fluids. (ICF) 250-375 mOsm/L Cells neither shrink or swell Used to treat fluid loss, dehydration and hypernatremia (sodium excess) 0.9% sodium chloride (normal saline goes w/blood) 5% dextrose in water lactated Ringer's solution Hypotonic Fluids Have osmolarity lower than 250 mOsm/L (lower than plasma) Causes cells to swell Used for: hypertonic dehydration water replacement, diabetic ketoacidosis Hydrate cells and can deplete circulatory system. Water moves from vascular space to intracellular space. Caution: Do not give to patients w/low blood pressure because it will further a hypotensive state. 0.45 % sodium chloride (half-strength saline) 0.33% sodium chloride 2.5% dextrose in water Hypertonic Fluids Have an osmolarity of 375 mOsm/L or higher; higher than plasma Causes cell to shrink 5% dextrose in 0.45% sodium chloride-D5W 0.45 NS 5% dextrose in 0.9% sodium chloride Colloids (albumin 25%, plasma protein fraction, dextran, and hetastarch) Used to: replace electrolytes, treat hypotonic dehydration temporary treatment of circulatory insufficiency shock Are irritating to vein walls; go into Central lines contraindicated in patients w/cardiac or renal disease because of increased risk of CHF and pulmonary edema Give hypertonic solutions slowly to prevent circulatory overload. As acidity of solution increases, irritation to vein wall increases. Goals of PNT Therapy/IV therapy 1. Maintenance therapy for daily body fluid requirements. (Maintain daily requirements) 2. Replacement therapy for present losses - vomiting, diarrhea,hemmorage (Replace previous losses) 3. Providing fluids and electrolytes necessary to replace ongoing losses (restoring homeostasis) - critical losses. (Provide fluids and electrolytes to restore ongoing losses) 225 Nursing Fact Don't play "catch up" if solution infusion is behind schedule. Make sure IV solution does not "run away" and that it does not infuse rapidly into patient. Infuse at prescribed rate. All dextrose solutions are acidic (pH 3.5-5.0) and may cause thrombophlebitis. Assess IV site frequently. 202 Circulatory Overload Crackles in lungs, dyspnea, tachycardia, anxious (not perfusing, check vital signs and pulse Ox), increased HR cyanotic. Dextrose well metabolized by all tissue Always check compatibility before adding medication to dextrose solutions. Advantages of dextrose in water Acts as vehicle for administration of medications Provides nutrition Can be used as treatment for hyperkalemia (using high concentrations of dextrose) Can be used in treatment of patients w/dehydration Provides free water Concentrations higher than 10% of dextrose in water are given through central veins. 5% and 10% dextrose in water can be given peripherally. Disadvantages of dextrose in water vein irritation vein damage thrombosis Hyponatremic encephalopathy (permanent brain damage & death) cellular dehydration w/rapid infusion transient hyperinsulin reaction do not provide electrolytes cannot replace or correct electrolyte deficits cannot be mixed w/blood components - causes hemolysis 20% dextrose provides calories Hypertonic 10%, 20%, 50%, 70% D/W; dont infuse into peripheral vein; goes into Central line 3%, 5% NaCl 10% Mannitol 20% Mannitol Hypotonic 0.225% , 0.33%, 0.45%, NaCl Isotonic 0.9% NaCl 0.25% D and 0.9% NaCl 5%D and 0.225% NaCl Lactated Ringer's solution Ringer's injection Normosol-R D5 and Normosol-M 1/6 M Sodium lactate NaHCO3 Sodium Chloride (NaCl) Initiates or terminates a blood transfusion (the saline solutions are the only solutions to be used with any blood product) Sodium Chloride (NaCl) Disadvantage Can lead to circulatory overload. Isotonic fluids expand the ECF compartment, which can lead to overload of the cardiovascular compartments. Nursing Fast Fact During stress, the body retains sodium, adding to hypernatremia. Dextrose Combined w/ Sodium Chloride D51/2 Carbohydrates and sodium chloride used when excessive loss of fluid through: sweating vomiting gastric suctioning D w/NaCl Advantages Temporarily treats patients w/ circulatory insufficiency Provides early treatment of burns Replaces nutrients and electrolytes Acts as hydrating solution to assist in checking kidney function before replacement of potassium D w/NaCl Disadvantages Hypernatremia acidosis circulatory overload Ringer's solution Isotonic Treatment of any type of dehyration Restoration of fluid balance before and after surgery Replacemnt of fluids resulting from dehydration, GI losses, and fistula drainage Advantages: Tolerated well in patients who have liver disease. May be used as blood replacement for a short period of time Disadvantages: Provide no calories. May exacerbate sodium retention, CHF, and renal insufficiency. Contraindicated in renal failure. Lactated Ringer's Solution Used to replace fluid loss resulting from burns, bile, and diarrhea. Used for: Rehydration in all types of dehydration Restoration of fluid volume deficits Replacement of fluid lost as a result of burns Treatment of mild metabolic acidosis Treatment of salicylate overdose. Colloid Solution 214 Plasma volume expanders Contain protein or starch molecules that remain distributed in the EC space; remain in vascular space for several days Substances whose particles, when submerged in a solvent, cannot form a true solution because their molecules cannot dissolve, but remain suspended and distributed in the fluid. Dextran Albumin Hetastarch Mannitol Gelatin Disadvantages: anaphylaxis or hypersensitivity reactions