Parenteral Solutions

What is an example of a hypotonic solution?

0.45% sodium chloride (aka half normal saline)

What are examples of isotonic solutions?

dextrose 5% in water, 0.9% sodium chloride (aka normal saline), Lactated Ringer’s

What are examples of hypertonic solutions?

dextrose 5% in half normal saline, dextrose 5% in normal saline, 2% normal saline, 3% normal saline

What are uses for 0.45% sodium chloride?

water replacement, hypertonic dehydration

What is dextrose 5% in water used for?

fluid loss and dehydration

What is 0.9% sodium chloride (normal saline) used for?

shock, blood transfusions, resuscitation, fluid challenges, hypercalcemia, dehydration

What is Lactated Ringer’s used for?

burns, lower GI tract fluid loss, acute blood loss

What are solutions in the same class as Dextrose 5% in normal saline used for?

hypotonic overhydration

What are special considerations (not including contraindications) for hypotonic solutions?

can cause a sudden fluid shift from blood vessels into cells, resulting in cardiovascular collapse from intravascular fluid depletion and increased ICP from fluid shift into brain cells

What are contraindications for hypotonic solutions?

increased intracellular pressure, cerebrovascular accidents, head trauma, neurosurgery, patients at risk for 3rd space fluid shifts

What are special considerations for Dextrose 5% in water?

while solution is initially isotonic, it becomes hypotonic when metabolized which can cause hyperglycemia (with resuscitation) and fluid overload in renal and cardiac disease

What are special considerations for 0.9% sodium chloride?

since this replaces extracellular fluid, do not use in patients with CHF, edema, hypermatremia, bc of overload risk; closely monitor patient for signs of fluid overload

What are special considerations for Lactated Ringer’s?

contains potassium, do not use with renal failure bc can cause hyperkalemia

do not use in liver disease bc the patient can’t metabolize lactate (functional livers convert lactate into bicarbonate)

do not give if pH is over 7.5

What are special considerations for hypertonic solutions?

do not give to pts with impaired heart or kidney function bc their system cannot handle extra fluid and monitor glucose levels closely