Fluids - Nursing Considerations

week 1

Hypertonic infusions

Water moves out of cells into fluid.
➢ 3% Sodium Chloride
➢ 5% Sodium Chloride
➢ 10% Dextrose in Water (D10W)

Isotonic infusions

Expands intravascular (extracellular) fluid volume
➢ 0.9% Sodium Chloride (Normal Saline) (NS)
➢ Lactated Ringers (LR)
➢ Plasma-Lyte

Hypotonic infusions

Water moves from fluid into the cells, causing swelling.
➢ 0.45% NS
➢ 5% Dextrose in Water (D5W) (initially isotonic but become hypotonic in body).

Hypertonic fluids can be used to treat:

➢ Severe hyponatremia (*cautiously*)
➢ Cerebral edema
➢ Volume expansion (*cautiously*)

Things to watch for in hypertonicity:

➢ Severe hypovolemia
➢ Hypernatremia
➢ Neurological changes (demyelination)
➢ Intravenous site injury

Isotonic fluids can be used to treat:

➢ Fluid resuscitation
➢ Dehydration
➢ Surgery
➢ Mild hyponatremia

Things to watch for in isotonicity:

➢ Fluid overload (especially in heart failure patients)
➢ Metabolic acidosis (hyperchloremic)

Hypotonic fluids can be used to treat:

➢ Cellular dehydration
➢ Hypernatremia
➢ Renal excretion

Things to watch for in hypotonicity:

➢ Neurological changes (cerebral edema)
➢ Worsening hyponatremia