IsotonicFluids Isotonic fluids are close to the same osmolarity as serum.

They remain inside the intravascular compartment, thus expanding it. They can be helpful in hypotensive or hypovolemic patients, however, they can also be harmful. There is a risk of fluid overloading, especially in patients with congestive heart failure and hypertension. HypotonicFluids Hypotonic fluids have less osmolarity than serum (i.e. less sodium ion concentration than serum). It dilutes the serum, which decreases serum osmolarity. Water is then pulled from the vascular compartment into the interstitial fluid compartment. As the interstitial fluid is diluted, its osmolarity decreases, which draws water into the adjacent cells. Hypotonic fluids can be helpful when cells are dehydrated, such as those of a dialysis patient on diuretic therapy. They may also be used for hyperglycemic conditions such as diabetic ketoacidosis, in which high serum glucose levels draw fluid out of the cells and into the vascular and interstitial compartments. Hypotonic fluids can be dangerous to use because of the sudden fluid shift from the intravascular space to the cells. This can cause cardiovascular collapse and increased intracranial pressure in some patients. HypertonicFluids Hypertonic fluids have a higher osmolarity than serum. They pull fluid and electrolytes from the intracellular and

interstitial compartments into the intravascular compartment and can help stabilize blood pressure, increase urine output and reduce edema. They are rarely used in the pre-hospital setting and care must be taken with their use. Hypertonic fluids can be dangerous in the setting of cell dehydration. There are two main groups of fluids: crystalloid and colloid Crystalloid Crystalloids are isotonic and remain isotonic and are, therefore, effective volume expanders for a short period of time. However, both the water and the electrolytes in the solution can freely cross the semipermeable membranes of the vessel walls (but not the cell membranes) into the interstitial space and will achieve equilibrium in two to three hours. They are ideal for patients who need fluid replacement. When using an isotonic crystalloid for fluid replacement to support blood pressure from blood loss, it should be borne in mind that three milliliters of isotonic crystalloid solution are needed to replace one milliliter of patient blood. This is because approximately two-thirds of the infused crystalloid solution will leave the vascular spaces by about one hour. Generally, a good rule of thumb is that initial crystalloid replacement should not exceed three liters before whole blood is instituted. Continued use of crystalloids runs the very real risk that the fluid that has leaked into the interstitial space will result in edema, primarily in the lungs (pulmonary edema).

Examples are Lactated Ringers, normal saline. Colloid Colloids contain molecules (usually proteins) that are too large to pass out of the capillary membranes and therefore remain in the vascular compartment. The large protein molecules give colloid solutions a very high osmolarity. As a result, they draw fluid from the interstitial and intracellular compartments into the vascular compartment. They work well in reducing edema (as in pulmonary or cerebral edema) while expanding the vascular compartment. Colloids can produce dramatic fluid shifts and place the patient in considerable danger if they are not administered in a controlled settings. Examples are albumin and steroids