Table of Commonly Used IV Solutions Name of Solution 0.45% Sodium Chloride Shorthand Notation: NS 0.

9% Sodium Chloride Shorthand Notation: NS 3% Sodium Chloride Hypertoni c pH 5.0 Hypertoni c pH 5.8 Isotonic pH 5.0 Type of Solution Hypotonic pH 5.6 Ingredients in 1-Liter 77 mEq Sodium 77 mEq Chloride Uses hypotonic hydration; replace sodium and chloride; hyperosmolar diabetes isotonic hydration; replace sodium and chloride; alkalosis; blood transfusions (will not hemolyze blood cells) symptomatic hyponatremia due to excessive sweating, vomiting, renal impairment, and excessive water intake isotonic hydration; provides some calories water intoxication and dilution of body's electrolytes with long, continuous infusions Lactated Ringers Shorthand Notation: LR Isotonic pH 6.6 130 mEq Sodium 4 mEq Potassium 3 mEq Calcium 109 mEq Chloride 28 mEq Sodi um Lacta te (prov ides 9 calori es/lit er) isotonic hydration; replace electrolytes and extracellular fluid losses; mild to moderate acidosis (the lactate is metabolized into bicarbonate which counteracts the acidosis) Complications if too much is mixed with blood cells during transfusions, the cells will pull water into them and rupture None known 5% Dextrose in 0.45 Sodium Chloride Shorthand Notation: D5NS 5% Dextrose in Normal Saline Shorthand Notation: D5NS Ringers Injection, U.S.P. rapid or continuous infusion can result in hypernatremia or hyperchloremia Hypertoni c pH 4.4 5 grams Dextrose 77 mEq Sodium 77 mEq Chloride hypertonic fluid replacement; replace sodium, chloride, and some calories

Isotonic pH 5.7

154 mEq Sodium 154 mEq Chloride

Hypertoni c pH 4.4

5 grams Dextrose 154 mEq Sodium 154 mEq Chloride 147 mEq Sodium 4 mEq Potassium 4 mEq Calcium 155 mEq Chloride

hypertonic fluid replacement; replace sodium, chloride and some calories

leading to osmotic diuresis

513 mEq Sodium 513 mEq Chloride 855 mEq Sodium 855 mEq Chloride 5 grams dextrose (170 calories/liter)

Isotonic pH 5.8

electrolyte replacement; hydration; often used to replace extracellular fluid losses

5% Sodium Chloride

5% Dextrose in Water Shorthand Notation: D5W 10% Dextrose in Water Shorthand Notation: D10W 5% Dextrose in 1/4 Strength (or 0.25%) Saline Shorthand Notation: D5NS

Hypertoni c pH 4.3

10 grams dextrose (340 calories/liter)

may be infused peripherally; hypertonic hydration; provides some calories fluid replacement; replacement of sodium, chloride and some calories

Hypertoni c pH 4.4

5 grams Dextrose 34 mEq Sodium 34 mEq Chloride

vein irritation because of acidic pH, causes agglomeration (clustering) if used with blood transfusions; hyperglycemia with rapid infusion

rapid administration leads to excessive introduction of electrolytes and leads to fluid overload and congestive conditions; provides no calories and is not an adequate maintenance solution if abnormal fluid losses are present not enough electrolytes for maintenance; patients with hepatic disease have trouble metabolizing the lactate; do not use if lactic acidosis is present

5% Dextrose in Lactated Ringers Injection Shorthand Notation: D5LR

Hypertoni c pH 4.9

5 grams Dextrose (170 calories/liter) 130 mEq Sodium 4 mEq Potassium 3 mEq Calcium 109 mEq Chloride 28 mEq Sodium Lactate (provides 9 calories/liter)

hypertonic hydration; provides some calories; replace electrolytes and extracellular fluid losses; mild to moderate acidosis (the lactate is metabolized into bicarbonate which counteracts the acidosis), the dextrose minimizes glycogen depletion

Hypotonic solutions o 0.45% Sodium Chloride (Osmolarity of 155, pH of 5.0 to 5.6) replaces sodium, replaces chloride, and provides free water. Contains 77mEq of sodium and 77mEq of Chloride. Used most often to hydrate patients and to treat hyperosmolar diabetes, metabolic alkalosis where there has been sodium depletion and fluid loss. When used continuously and exclusively, the patient needs to be monitored for hyponatremia and calorie depletion (there are no calories in this solution). Isotonic solutions o 2.5% Dextrose and 0.45% Sodium Chloride (Osmolarity of 280, pH of about 4.0 to 4.5) - provides calories and free water o 5% Dextrose and 0.11% Sodium Chloride (Osmolarity of 290, pH of about 4.3) - provides calories and free water, provides some sodium and chloride o 0.9% Sodium Chloride (Osmolarity of 308, pH of 5.7) - primarily used to replace sodium and chloride, treats hyperosmolar diabetes, metabolic alkalosis where there has been sodium depletion and fluid loss. The reason for it's used with blood transfusion is because it will not hemolyze erythrocytes. Often given as rapid bolus for fluid replacement during resuscitation. o 5% Dextrose and Water (Osmolarity of 253, pH of about 4.5 to 5.0) - provides calories and free water. o Normosol R [Abbott] (Osmolarity of 295, pH of 6.6) - provides electrolytes o Plasmalyte A [Baxter] (Osmolarity of 294, pH of 7.4) - provides electrolytes o Plasmalyte R [Baxter] (Osmolarity of 312, pH of 4.0 to 6.5) provides electrolytes. Also contains sodium lactate which is used in treating mild to moderate metabolic acidosis.

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Isolyte E [McGaw] (Osmolarity of 315, pH of 6.0) - provides electrolytes Ringer's (Osmolarity of 310, pH of 5.5 to 5.8) - it's content is very similar to plasma, but should not be used continuously since it contains no calories and could result in an excessive amount of one or more of the electrolytes it contains. It's components include sodium, chloride, potassium and calcium. It is used to replace electrolytes and to hydrate, often where there has been extracellular fluid loss. Adding Dextrose increases the osmolarity of the solution and lowers it's pH making it a hypertonic solution. Lactated Ringer's [also known as Hartmann's solution] (Osmolarity of 275, pH of 6.5 to 6.6) - as with Ringer's, it's content is very similar to plasma, but should not be used continuously since it could result in an excessive amount of one or more of the electrolytes it contains. It's components include sodium, chloride, potassium, calcium and sodium lactate which is used to replace electrolytes and to hydrate, often used where there has been extracellular fluid loss. It is used in treating mild to moderate metabolic acidosis and hypovolemia. Often given as rapid bolus for fluid replacement during resuscitation. Since lactate is metabolized in the liver it shouldn't be used in patients with hepatic diseases. Using it in a patient with lactic acidosis will overload the person's buffering system. Adding Dextrose also increases the osmolarity of the solution and lowers it's pH making it a hypertonic solution. 2.5% Dextrose in half strength Lactated Ringer's (Osmolarity of 263, pH of 5.0) - provides calories and free water, provides electrolytes. Also contains sodium lactate which is used in treating mild to moderate metabolic acidosis. Also see the information above with Lactated Ringers. 6% Dextran and 0.9% Sodium Chloride (Osmolarity of 308, pH of 4.0 to 4.5) - 6% Dextran is a high molecular weight solution. The NaCl replaces sodium and chloride. Treats hyperosmolar diabetes,

metabolic alkalosis where there has been sodium depletion and fluid loss. It draws fluid into the vascular system. Dextran is a plasma expander that is given for shock or anticipated shock related to trauma, surgery, burns or hemorrhage, and for the prophylactic prevention of venous thrombosis and pulmonary embolism during surgery. It should NOT be used as a blood substitute except in emergencies when blood is not available. It's volume expansion effect lasts for approximately 24 hours during which the dextran is slowly broken down to glucose and metabolized into carbon dioxide and water. Complications with the use of this solution include anaphylactic reaction, wheezing, tightness in the chest, GI problems of nausea and vomiting, circulatory overload and tissue dehydration. If blood transfusion is intended, the type and cross match needs to be done before this solution is started. Because dextran pulls fluid into the vascular system it will result in altered blood tests. 10% Dextran and 0.9% Sodium Chloride (Osmolarity of 252, pH of 4.0 to 4.5) - 10% Dextran is a low molecular weight dextran. It is used in treating shock related to vascular system fluid losses such as in burns, trauma, hemorrhage and surgery. It is also used for the prophylactic prevention of venous thrombosis and pulmonary embolism during surgery. Complications include circulatory overload that results in various kinds of congestion and increased bleeding time. As with the 6% Dextran solutions, subsequent laboratory blood tests will be altered due to it entering the vascular system. This Dextran is excreted through the renal system within 24 hours.

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Hypertonic Solutions o 5% Dextrose and 0.2% Sodium Chloride (Osmolarity of 320, pH of 4.0 to 4.4) - provides calories and water, replaces sodium and chloride. This is given for fluid replacement. o 5% Dextrose and 0.3% Sodium Chloride (Osmolarity of 365, pH of 4.0 to 4.4) - provides calories and water, replaces sodium and chloride o 5% Dextrose and 0.45% Sodium Chloride (Osmolarity of 405, pH of 4.0 to 4.4) - provides calories and water, replaces sodium and chloride. This is given for fluid replacement. o 5% Dextrose and 0.9% Sodium Chloride (Osmolarity of 560, pH of 4.0 to 4.4) - provides calories and water, replaces sodium and chloride. This is given for fluid replacement. o 10% Dextrose and 0.2% Sodium Chloride (Osmolarity of 575, pH of 4.3) - provides calories and water, replaces sodium and chloride o 10% Dextrose and 0.45% Sodium Chloride (Osmolarity of 660, pH of 4.3) - provides calories and water, replaces sodium and chloride o 10% Dextrose and 0.9% Sodium Chloride (Osmolarity of 815, pH of 4.0 to 4.3) - provides calories and water, replaces sodium and chloride o 3% Sodium Chloride (Osmolarity of 1030, pH of 5.0) - used to replace severe sodium and chloride losses. Other conditions it might be used for are excessive sweating, vomiting, renal impairment and excessive water intake where hyponatremia has occurred. o 5% Sodium Chloride (Osmolarity of 1710, pH of 5.0 to 5.8) - used to replace severe sodium and chloride losses. Other conditions it might be used for are excessive sweating, vomiting, renal

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impairment and excessive water intake where hyponatremia has occurred. 10% Dextrose and Water (Osmolarity of 505, pH of 4.3 to 4.5) provides calories and water 50% Dextrose and Water (Osmolarity of 2526, pH of 4.0 to 4.2) - provides calories and water 5% Dextrose in Ringer's (Osmolarity of 562, pH of 4.3) - provides calories and free water, provides electrolytes. Also see the information above with Ringer's 5% Dextrose in Lactated Ringer's (Osmolarity of 527, pH of 4.9) provides calories and free water, provides electrolytes. Also contains sodium lactate which is used in treating mild to moderate metabolic acidosis. Also see the information above with Lactated Ringers. 5% Dextrose and 5% Alcohol (Osmolarity of 1114, pH of 4.5) Provides calories and free water 5% Sodium Bicarbonate Injection (Osmolarity of 1190, pH of 8.0) Is an alkalizing solution that is used to treat metabolic acidosis associated with renal disease and cardiac arrest. The sodium in the solution is an antagonist to the cardiac effects of potassium. It is also used in severe hyperkalemia. It maintains osmotic pressure and acid-base balance. The major complications associated with it's use are related to electrolytes and include metabolic alkalosis, hypocalcemia, hypokalemia, water and sodium retention that cause hypernatremia, other electrolyte imbalances and IV site extravasation that causes chemical cellulitis, necrosis, ulceration and sloughing of the skin. 1/6 M(olar) Sodium Lactate (Osmolarity of 335, pH of 6.5) Contains sodium lactate which is used in treating mild to moderate metabolic acidosis. 10% Mannitol Injection (Osmolarity of 549, pH of 5.7) - Mannitol is a sugar alcohol colloid and a plasma expander. It promotes diuresis by drawing fluid from the cells into the plasma. It acts rapidly and is excreted within 3 hours through the kidneys. It is primarily used for intracranial pressure and cerebral edema where it acts within 15 minutes of being infused. It will also be used during the oliguric phase of acute renal failure to promote the excretion of toxic substances from the body. In high intraocular pressure, it pulls fluid from the anterior chamber of the eye within 30 to 60 minutes of infusion. Complications include frequent and severe fluid and electrolyte imbalances, cell dehydration, fluid overload, skin extravasation and necrosis with infiltration of the IV site, precipitate formation in the IV line and altered laboratory blood tests. The patient's blood tests should be monitored when the patient is receiving mannitol. 15% Mannitol Injection (Osmolarity of 823, pH of 5.7) - Mannitol is a sugar alcohol colloid and a plasma expander. It promotes diuresis by drawing fluid from the cells into the plasma. It acts rapidly and is excreted within 3 hours through the kidneys. It is primarily used for intracranial pressure and cerebral edema where it acts within 15 minutes of being infused. It will also be used during the oliguric phase of acute renal failure to promote the excretion of toxic substances from the body. In high intraocular pressure, it pulls fluid from the anterior chamber of the eye within 30 to 60 minutes of infusion. Complications include frequent and severe fluid and electrolyte imbalances, cell dehydration, fluid

overload, skin extravasation and necrosis with infiltration of the IV site, precipitate formation in the IV line and altered laboratory blood tests. The patient's blood tests should be monitored when the patient is receiving mannitol. 20% Mannitol Injection (Osmolarity of 1098, pH of 5.7) - Mannitol is a sugar alcohol colloid and a plasma expander. It promotes diuresis by drawing fluid from the cells into the plasma. It acts rapidly and is excreted within 3 hours through the kidneys. It is primarily used for intracranial pressure and cerebral edema where it acts within 15 minutes of being infused. It will also be used during the oliguric phase of acute renal failure to promote the excretion of toxic substances from the body. In high intraocular pressure, it pulls fluid from the anterior chamber of the eye within 30 to 60 minutes of infusion. Complications include frequent and severe fluid and electrolyte imbalances, cell dehydration, fluid overload, skin extravasation and necrosis with infiltration of the IV site, precipitate formation in the IV line and altered laboratory blood tests. The patient's blood tests should be monitored when the patient is receiving mannitol.

The higher percentage Dextrose solutions are used to supply the patient with calories and often need to be given via a central IV line. Hypovolemia occurs in acute pancreatitis. Always review your patient's laboratory tests to determine if the IV solution is appropriate, particularly o the BUN (blood urea nitrogen) - Normal: 10-20 mg/dl o serum creatinine - Normal: 0.7-1.5 mg/dl o hematocrit - Normal: 44-52% (male); 39-47% (female) o hemoglobin - Normal: 13.5-18.0 g/dL (male); 12.0-16.0 g/dL o serum osmolality - Normal: 280-295 mOsm/kg o serum electrolytes

Basically

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the Dextrose solutions also serve as diluents for the administration of many IV medications. In general, the electrolyte solutions are isotonic. Adding Dextrose to them makes the resulting solution hypertonic. Sodium deficits occur in head injuries, SIADH (Syndrome of Inappropriate Antidiuretic Hormone) and cirrhosis I boldfaced the solutions with the lowest and highest osmolarity Problems with using IV solutions of strictly Sodium Chloride include o hyponatremia (with continuous infusions of 0.45%) o calorie depletion o hypernatremia (with continuous infusion of the higher percentage NaCl solutions) o peripheral edema o an exhaustion of other body electrolytes o hyperchloremia 5% Dextrose in one liter of water contains 5 grams of dextrose per every 100mL which gives 170 calories per liter of fluid (this was a question on my state board exam in 1975). Free water - The dextrose in IV solutions is metabolized very rapidly since it is a simple sugar which leaves behind plain old water. This water is able to cross all cell and tissue membranes to go into the various fluid compartments where is it needed.

phosphate - Normal: 2.5-4.5 mg/dL, or 1.8-2.6 mEq/liter (adults); 4.0-7.0 mg/dL, or 2.3-4.1 mEq/liter (children) arterial blood gasses for the

sodium - Normal: 135-145 mEq/liter potassium - Normal: 3.5-5.0 mEq/liter chloride - Normal: 97-110 mEq/liter calcium - Normal: 8.9-10.3 mg/dL, or 4.6-5.1 mEq/liter magnesium - Normal: 1.3-2.1 mEq/liter, or 1.8-3.0 mg/dL

pH - Normal: 7.35-7.45 PaO2 - Normal: 80-100 mm Hg PaCO2 - Normal: 38-42 mm Hg bicarbonate - Normal: 22-26 mEq/liter base excess - Normal: -2 to +2

Dehydration may also be called fluid volume deficit or hypovolemia and is due to:

excessive fluid and electrolyte losses from the extracellular compartment loss of GI fluids due to vomiting, diarrhea, suctioning and fistulas fluid lost through the skin as the body attempts to regulate it's temperature or trauma of the skin (burns, large open wounds, cuts). loss of fluid through the renal system (these losses are usually excessive) by polyuria due to hyperglycemia, renal disorders, administration of osmotic diuretics, administration of concentrated IV solutions and tube feedings hemorrhage which causes loss from the intracellular compartment third spacing - the shift of fluid from the circulation to a space where it is trapped and cannot be exchanged with fluid in the extracellular space. There is no actual physical fluid loss but the involved fluid is basically "out of commission". This occurs in intestinal ileus decreased fluid intake due to confusion, coma, very young age or very old age and not recognizing the sense of thirst.

Tonicity refers to the solute concentration of a solution outside a cell and its effect on cellular fluid volume. The osmolarity of the solution determines the direction of water flow into or out of the cell. In normal body situations, solute concentration within and outside of the cell is usually nearly the same (isotonic).

Isotonic: same osmolarity as the cells (270 300 mmol/L). Equal solute and water exact same number of particles in both solutionsno net movement of water. Does not change cell volume.

Higher solute concentration surrounding cells pulls water out of the cells. Hypertonic: higher osmolarity than cells (> 300 mmol/L). Greater solute, less water water moves out of cells. The cell will shrink. Lower solute concentration surrounding cells causes water to move into the cells. Hypotonic: lower osmolarity than cells (< 270 mmol/L). Less solute, more water water moves into cells. The cell will swell. Isotonicity. If the concentrations of electrolytes are the same in the cell and surrounding fluid, the situation is balanced (homeostatic). The cell fluid volume remains the same. Hypertonicity: The cell will shrink (crenation) by loss of its fluid to the surrounding hypertonic environment. High osmotic pressure of surrounding fluid pulls fluid out of the cell. Hypotonicity. In a hypotonic environment, fluid will enter a cell and cause it to swell and burst. The inside of the cell has higher osmotic pressure than the surrounding fluid, so fluid is drawn into the cell. Both hypertonicity and hypotonicity in the extracellular fluids will destroy cells. Need isotonicity for cell homeostasis, for balance.

Definition: excess fluid in the extravascular space, usually the result of increased sodium concentration causing water retention Causes: renal failure, heart failure, liver disease, excessive I.V. fluid intake of sodium-containing fluids Signs and symptoms: confusion, shortness of breath, wheezing, crackles, puffy eyelids, ascites, pulmonary edema, dependent edema, distended neck veins, nausea, constipation, tachycardia, bounding pulse, increased blood pressure, weight gain, polyuria, decreased BUN, decreased serum sodium, decreased urine specific gravity, and moist, taut skin Types of therapy 1. Maintenance therapy o Provides water, electrolytes, glucose, vitamins, and in some instances protein to meet daily requirements. 2. Restoration of deficits o In addition to maintenance therapy, fluid and electrolytes are added to replace previous losses. 3. Replacement therapy o Infusions to replace current losses in fluid and electrolytes. Types of intravenous fluids 1. Isotonic solutions a. Fluids that approximate the osmolarity (280-300 mOsm/L) of normal blood plasma.

Sodium Chloride (0.9%) - Normal Saline Indications:

Extracellular fluid replacement when Cl- loss is equal to or greater the Na loss. Treatment of matebolic alkalosis. Na depletion

NS IV is hypotonic relative to cells. Fluid moves from the vascular space into the cells. When a liter of NS is administered intravenously, it will go into the cells and very little will remain in the blood vessel (since it is hypotonic). If you put two isotonic solutions side by side, no fluid shift occurs. A liter of normal saline or Ringers lactate is limited to the extracellular space and will expand the blood volume. 5% Dextrose in NS is hypertonic compared to cells; pulls water into the vascular space from the cells or interstitium. Fluid deficit (hypovolemia) Definition: excessive fluid and electrolyte depletion of the extracellular space from fluid loss, fluid shifts within the body, or decreased fluid intake Causes: hemorrhage, vomiting, diarrhea, suctioning, fistulas, fever, hyperventilation, skin trauma such as burns and cuts, and polyuria caused by renal disorders, hyperglycemia, diabetes insipidus, and diuretics Signs and symptoms: confusion, dizziness, headache, sunken eyes, flat neck veins, thirst, dry mucous membranes, poor skin turgor, slow filling of hand veins, weight loss, postural hypotension, weak and thready pulse, muscle weakness, nausea and vomiting, decreased urine output, increased blood urea nitrogen (BUN), increased serum sodium, increased hematocrit, and increased urine specific gravity Fluid overload (hypervolemia)

Initiating and terminating blood transfusions. Possible side effects: Hypernatremia Acidosis Hypokalemia

Circulatory overload. b. Five percent dextrose in water (D5W). Provides calories for energy, sparring body protein and preventing ketosis resulting from fat breakdown. Indications: Dehydration Hypernatremia

Drug administration Possible side effects: Hypokalemia Osmotic diuresis dehydration Transient hyperinsulinism

Water intoxication. c. Five percent dextrose in normal saline (D5NS).

Prevents ketone formation and loss of potassium and intracellular water. Indications:

Acute adrenocortical insufiency. Possible side effects:

Hypovolemic shock temporary measure. Burns

Fluids whose osmolarity is significantly less than that of blood plasma (-50 mOsm); these fluids lower plasma osmotic pressure, causing fluid to enter cells. a. 0.45% sodium chloride

Hypernatremia Acidosis Hypokalemia

Used for replacement when requirement for Na use is questionable. b. 2.5% dextrose in 0.45% saline, also 5% in 0.2 % NaCl Common rehydrating solution. Indications:
Fluid replacement when some Na replacement is also necessary. Encourage diuresis in clients who are dehydrated.

Circulatory overload d. Isotonic multiple-electrolyte fluids. Used for replacement therapy; ionic composition approximates blood plasma. a. Plasmanate b. Polysol

Types:

Evaluate kidney status before instituting electrolyte infusions. Possible side effects: Hypernatremia Circulatory overload Used with caution in clients who are edematous, appropriate electrolytes should be given to avoid hypokalemia.

c. Lactated Ringers Indications:

Vomiting Diarrhea Excessive diuresis

Burns Possible side effects: Circulatory overload. Lactated Ringers is contraindicated in severe metabolic acidosis and/or alkalosis and liver disease. Hypernatremia Acidosis

Hypokalemia 2. Hypertonic solutions Fluids with an osmolarity much higher than 310 mOsm (+ 50 mOsm); increase osmotic pressure of blood plasma, thereby drawing fluid from cells. a. Ten percent dextrose in normal saline

Aftercare Regulating IV fluid is an ongoing process from the time that an IV is started until it is completed. Hourly checks of an IV should include assessing the client's response to the IV, the rate of the IV flow, how much fluid has infused, how much fluid remains to be infused, and the condition of the IV insertion site. Adjust the rate if the IV is not flowing at the rate that was ordered. If IV fluid is flowing in slowly, the nurse should check for a kink in the tubing or a positional problem. In addition, the IV could be out of the vein, or a small clot, phlebitis, or infection at the site could be slowing the IV down. If an IV is flowing too rapidly, it may be leaking out around the IV insertion site or may run faster when the patient extends the extremity. The whole system, from the insertion site to the IV bag, should be examined. The physician will assess IV fluid needs and reorder IV therapy daily according to client needs.

Administered in large vein to dilute and prevent venous trauma. Indications:

Replenish Na and Cl. Possible side effects:

Nutrition

Hypernatremia (excess Na) Acidosis (excess Cl)

Circulatory overload. b. Sodium Chloride solutions, 3% and 5% Indications: Slow administration essential to prevent overload (100 mL/hr) Water intoxication

3.

Severe sodium depletion Hypotonic solutions