[hotshot12345]

I don't understand this. I know of 5DW and 1/2 NS but combining them together? Would this be isotonic, hyper/hypotonic? Can somebody help me figure this out?

thanks

[Daytonite]

This is a standard IV solution. I'm thinking that what may be confusing you is the way it is written. It is written a number of different ways:

• D5 1/2 NS
• D5/0.45 NS
• Dextrose 5% in 0.45% Normal Saline
• Dextrose 5% in 1/2 Normal Saline
• 5% Dextrose in 0.45% Normal Saline
• 5% Dextrose in 1/2 Normal Saline

It is a hypertonic solution. A hypertonic solution is one that has an osmolality greater than 340 mOsm/kg. Hypertonic solutions exert more osmotic pressure than the extracellular fluid so when these solutions are infused, fluid gets pulled into the vascular system. You want to monitor patients receiving any hypertonic solutions for fluid overload, particularly if they are being given at a rapid rate of infusion.

The osmolality of 5DW and 1/2 NS is 405 m/Osm/liter and it's pH is about 4.4. It contains 50 grams of dextrose and 77 mEq of sodium and 77 mEq of chloride. The remainder is just sterile water.

[l.a.m.b]

loved your answer. can you explain to me how hypotonic fluids work and LR?

[Daytonite]

Originally Posted by l.a.m.b

loved your answer. can you explain to me how hypotonic fluids work and LR?

Hypotonic solutions have an osmolality of less than 240 mOsm/liter. They exert less osmotic pressure than the fluid in the extracellular compartment which allows water to be drawn from the extracellular fluid. Blood cells will draw these solutions into them causing the blood cells to swell and burst. There is only one hypotonic solution in common use and that is 0.45% sodium chloride (1/2 Normal Saline). It has an osmolality of 155, a pH of 5.6, and contains 77 mEq of sodium and 77 mEq of chloride. Continuous infusion can cause dilution and depletion of electrolytes because of the small amount of sodium in this particular mixture resulting in hyponatremia. Because there are no calories in the solution, the patient is going to become calorie depleted as well if it is infused for a long period. Isn't it interesting that adding 5% Dextrose to it to make 5% Dextrose in 0.45% Normal Saline makes it a hypertonic solution?

Lactated Ringers solution has an osmolarity of 275 mOsm/liter and a pH of 6.6. It contains 130 mEq of sodium, 4 mEq of potassium, 3 mEq of calcium, 109 mEq of chloride, and 28 grams of lactate. It is an isotonic solution. It is also called Hartmann's solution. It is primarily used to treat hypovolemia and when the patient's oral intake is limited, absent or fluid losses are very high. It does not, however, supply enough electrolytes for maintenance and does not contain any magnesium. The lactate is a buffer that when metabolized produces bicarbonate. Complications connected with the infusion of LR (Lactated Ringers) are overhydration, electrolyte excess (particularly sodium), electrolyte dilution, and calorie depletion. Patient can also develop metabolic alkalosis if LR is run over long periods of time. It shouldn't be used in patients with liver disease because the lactate is metabolized in the liver. You will commonly see LR used for surgical patients. Adding 5% dextrose to LR makes the solution hypertonic.

Isotonic solutions have the same tonicity as plasma so that when they are infused into a vein, water neither enters or leaves the cells. These kinds of IV solutions are used to expand the extracellular fluid volume and do not cause any fluid to move from into or out of the blood cells. Isotonic solutions have an osmolality of 240 to 340 mOsm/liter. Other isotonic solutions are:

• 0.9% Sodium Chloride
• 5% Dextrose and Water
• Ringer's solution
• 2.5% Dextrose in 0.45% Sodium Chloride
• 2.5% Dextrose in 1/2 strength Lactated Ringer's
• 6% Dextran and 0.9% Sodium Chloride
• 10% Dextran and 0.9% Sodium Chloride

The only difference between Ringer's solution and Lactated Ringer's solution is that Lactated Ringer's has the 28 grams of lactate in it. Otherwise, the solutions have the identical other components.