Fluid/Electrolyte Meds

Types of Crystalloid IV fluids

Isotonic: fluid stays where its going to be (0.9% saline/normal saline or lactated ringers)

Hypotonic: solution has less solute than fluid causing fluid to go from blood into cells (vasculature gets smaller) (0.45% saline or ½ normal saline)

Hypertonic: put more minerals to pull into our vasculature space to expand blood volume (3% saline or 10% dextrose/D10)

Crystalloids: Isotonic

what does it do: maintain osmotic gradient

what is it made of: fluid/electrolytes and NO proteins

what is it used for: maintenance fluids, intravascular expansion, manage disturbances, promote urinary flow (help keep kidneys moving), hypoglycemic pts

0.9% Sodium Chloride (Normal Saline)

Crystalloid Isotonic

specific indications: mild sodium depletion

contraindications: fluid overload, pulmonary edema, congestive heart failure, renal failure

5000-6000 mL infused = inc plasma volume by 1000 mL

Lactated Ringers

Crystalloid Isotonic

indications: burn injuries (safe and good at maintaining/managing acidosis)

contraindications: liver dysfunction, fluid overload, congestive HF, renal failure

Hypotonic Solutions

0.45% NaCl (Half normal Saline)

indications: hypernatremia

adverse effects: cerebral edema

rate of correction: 8-15 mEq/L over 8 hrs (not fast)

Hypertonic Crystalloid

3% Normal Saline

Indications: severe hyponatremia (critical conditions) and cerebral edema

adverse effects: central pontine demyelination and brain damage

rate of correction: 6-12 mEq/L over 24 hrs (18mEq/L over 48hrs)

Colloids

albumin, portion of plasma that is donated (reliant on donor participations)

what does it do: inc intravascular pressure to pull fluid into blood vessel

indications: shock, burn, intravascular depletion

contraindications: mindful of allergy (might be allergic to buffer), hypovolemia, and electrolytes (imbalance)

adverse effects: bleeding (impact on clotting function)

Albumin

colloid

pooled/pasteurized product: blood, plasma, serum, placentas

contraindications: hypersensitivity, HF, severe anemia, renal infufficiency

Dextran

collioid

functions similarly to albumin but uses glucose

• expands plasma

• pulls volume into vasculature

contraindications: HF, renal insufficiency, extreme dehydration

• disease processes that have issues with volume

What solution should be used to treat hyernatremia?

0.45% NaCl (Half normal saline)

Hyponatremia

3% (normal saline)

650 mg Tablets

Conivaptan (IV): inhibits ADH, inc water loss or drives normalization of water Na ratio

Sodium Correction Nursing Considerations

laboratory collection (sodium levels and close observation)

fluid overload s/s

neuro assessments (safety and seizure precautions)

Hyperkalemia

Sodium Polystyrene Sulfonate (Kayexalate)

oral, NGT, enema

contraindications: dehydration or GI issues

Side effects: Gi upset, diarrheal, electrolyte abnormalities (hypokalemia)

Potassium IV

Used to treat Hypokalemia

DO NOT flush or push IV or do a rapid infusion (to much pot too fast would cause cardiac function to go kaput)

contraindications: CKD, Rhabdomyolysis, Tumor Lysis

side effects: phlebitis, erythema, hyperkalemia

• potassium is a vesicant, it is highly irritating when put into blood vessels

Potassium (Oral)

Used to treat Hypokalemia

contraindications: CKD, rhabdomyolysis, tumor lysis

side effects: GI irritation and ulcerative lesions

Potassium Nursing Considerations

lab monitoring

cardiac monitoring

safe administration

• prefer central line over PIV because you need rly large needle and IV)

• IV/oral considerations

• rate of administration