IV SOLUTIONS

Hypertonic Solution​

Which is the best description of a hypertonic solution?

A solution with more particles than water

  • D5 NaCl which is Dextrose 5% with 0.9% normal saline​

  • D5 Lactated Ringers (LR) which is Dextrose 5% with Lactated Ringers​

  • D5 0.45% is Dextrose 5% with 0.45% normal saline​

​

HYPOTONIC Solution:

The most common fluids are: 

  • 0.25% NaCl

  • 0.45% NaCl (half normal saline)

  • 2.5% Dextrose

  • 5% Dextrose  (isotonic until it enters the body)

  • 0.33 NS

ISOTONIC SOLUTIONS:

0.9% NS

LR



Hypotonic Fluids

Remember * (Lower osmolality → fluid moves into cells)

Examples:
0.45% Normal Saline (½ NS)
0.33% NS
D2.5W

Indications (When to administer):
Cellular dehydration
Hypernatremia
Diabetic ketoacidosis (after initial isotonic fluids)


Remember Use with caution:
Risk for cerebral edema
Avoid in increased ICP, stroke, or trauma


Isotonic Fluids

Remember *(Same osmolality as plasma → stays in vascular space)

Examples:
0.9% Normal Saline (NS)
Lactated Ringer's (LR)
D5W (isotonic in bag, hypotonic in body)

Indications (When to administer):
Fluid volume deficit / dehydration
Hypovolemia, shock
Post-op fluid replacement
Initial fluid resuscitation


Hypertonic Fluids

Remember *(Higher osmolality → pulls fluid into bloodstream)

Examples:
3% Normal Saline
5% Normal Saline
D5NS, D5½NS

Indications (When to administer):
Severe hyponatremia
Cerebral edema
Third-spacing (burns, ascites)

Monitor closely:
Risk for fluid overload
Usually requires central line and close monitoring

Saline is usually half normal (0.45% by volume) or normal (0.9% by volume). 

Lactated ringers (or ringers lactate), also known as sodium lactate solution, contains sodium chloride, sodium lactate, potassium chloride, calcium chloride, and water. This is given specifically when fluid and electrolyte replacement are necessary, particularly after traumatic events with heavy blood loss.


1/2 Normal saline and 0.25% NaCl are hypotonic. D5 and lactated ringers is hypertonic.


  • Sodium (Na+) alterations cause fluid imbalance and affect neurological functioning. 

  • Potassium (K+) alterations cause irregular cardiac rhythms and affect acid-base balance. 

  • Hypokalemia = alkalosis; hyperkalemia = acidosis 

Solution

Considerations

0.9% NaCl
(normal saline)

  • best for fluid resuscitation in fluid volume deficit

  • may cause fluid volume overload

  • only fluid that can be administered with blood

Lactated Ringer’s
​(LR)

  • best for fluid resuscitation in burn and trauma clients

  • used to treat blood loss (hypovolemia), GI loss, electrolyte loss, and metabolic acidosis

  • contraindicated in lactic acidosis and if pH > 7.5

  • LR contains potassium chloride; watch for hyperkalemia in renal failure

  • also contains sodium chloride, calcium chloride, and sodium lactate

5% dextrose in water
(D5W)

  • both isotonic and hypotonic 

    • As it enters the body, D5W is isotonic 

    • As the cell quickly metabolizes the glucose, however, what remains is hypotonic “free water” that expands both ECF and ICF volumes. 

  • should not be used alone to treat fluid volume deficit because it dilutes plasma electrolyte concentration

  • do not use with known or suspected increased intracranial pressure (ICP)

  • provides some calories but not enough for prolonged nutritional use