Indications for IV fluids.

[Khaan]

Hi, I'm a BSN student trying to find more information regarding the indications for selection of IV fluids. For example, I'm told that NS is giving with DKA. However, NS is acidic (5.5) d/t the proportion of Cl. I can't find a source anywhere that explains why NS is given for DKA instead of something else.

Overall I'm looking for a book that explains in-depth reasoning, and hopefully on a physiological level, why IV fluids are selected in different clinical situations. Searching for textbooks has gotten me nowhere. Any help is great! Thanks.

[OhioCCRN, MSN, NP]

Fluids and electrolytes made incredibly easy is s good place to start

[AnthonyD]

The more important factor is that it's an isotonic solution. It also doesn't contain other electrolytes or sugars. If you look at most IV fluids, they are going to be on the acidic side.

[Asystole RN]

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[loveofrn, BSN, RN]

Dka pt are hypovolemic and dehydrated with elevated BG. In order to correct the fluid loss, you need to give fluids that will expand intravascular and replace extracellular fluid loss. The only 2 isotonic fluids for replacement are Ns( contains sodium and chloride) and lactated ringer ( contains all electrolyte except magnesium). The pt is hypovolemic and has lost both fluid and electrolyte. You will think the best choice will be lactated ringer, however lactated ringer is contraindicated with pt that has lactate acidosis( common in Dka and hhns pt), So the best choice is NS. I hope this helps

[IVRUS, BSN, RN]

Well,

First of all, the goal in DKA is to restore ECF volume with NS solution. (usually 20ms/kg/hr) When a person is in DKA they suffer from both fluid and sodium deficits. All of that sugar in the blood stream causes diuresis and it must be restored. Once it is, and blood glucose starts to drop to around 200 (Along with adjunctive therapy) then a switch is usually made to a hypotonic fluid such as 0.45% Sodium Chloride to restore ICF fluid loss from the shift from ICF to ECF. Hope this helps!

[MunoRN, RN]

Large volumes of NS can cause a metabolic acidosis, we're talking like 8 liters over 24 hours, this is because the balance of sodium and chloride in NS is different than it is in serum; the chloride exists in a higher ratio to the sodium in NS so giving large amounts that exceeds the body's ability to regain that balance will result in some acidosis.

In DKA patients however there is a relative deficiency of chloride, and the acidosis is due mainly to the presence of ketone bodies, so clearing those ketones will more than cancel out the potentially ph-decreasing effects of replacing chloride levels.

Typically in DKA treatment, NS is only used for initial fluid resuscitation and until glucose levels come down to around 250, at which point fluids should be changed to dextrose containing fluids (D5w, D5 1/2NS, etc) in order to continue to give sufficient insulin to clear the ketones, which one depends on the calculated corrected sodium level.

[Khaan]

Thanks, everyone!