Same osmolarity as plasma - blood and body fluids. (ICF)
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
Have osmolarity lower than 250 mOsm/L
(lower than plasma)
Causes cells to swell
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
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)
treat hypotonic dehydration
temporary treatment of circulatory insufficiency
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
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.
Crackles in lungs, dyspnea, tachycardia, anxious (not perfusing, check vital signs and pulse Ox), increased HR cyanotic.
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
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
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
10%, 20%, 50%, 70% D/W; dont infuse into peripheral vein; goes into Central line
3%, 5% NaCl
0.225% , 0.33%, 0.45%, NaCl
0.25% D and 0.9% NaCl
5%D and 0.225% NaCl
Lactated Ringer's solution
D5 and Normosol-M
1/6 M Sodium lactate
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)
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
Carbohydrates and sodium chloride used when excessive loss of fluid through:
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
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
Tolerated well in patients who have liver disease.
May be used as blood replacement for a short period of time
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.
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.
anaphylaxis or hypersensitivity reactions