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Help with fluids/electrolytes.

Specializes in ER/Emergency Behavioral Health.... Has 8+ years experience.

I am having some trouble with fluids and electrolytes.

I understand that NSS with any dextrose is hypertonic and contraindicated for those NPO or at risk for dehydration.

I am confused about others like LR and D5W.

Hypertonic, hypertonic, isotonic and what they are used for.

Does anyone know a good online study tool that may help?

I found one for ABG's, but I'm having trouble with electrolytes.

studentnursemon86

Specializes in ER/Emergency Behavioral Health.... Has 8+ years experience.

Thank you :)

KelRN215, BSN, RN

Specializes in Pedi. Has 10 years experience.

Normal saline with any dextrose is most definitely not contraindicated for patients who are NPO. The most common IV fluids you'll probably see in the hospital are D5 NS and D5 1/2 NS and you will administer these to NPO patients all the time.

They're NPO meaning nothing by mouth. It doesn't what goes through their IV. I give D5 1/2 NS + 20K every single day to NPO patients.

studentnursemon86

Specializes in ER/Emergency Behavioral Health.... Has 8+ years experience.

Like I said, I needed some clarification on the fluids.

Thank you for that.

studentnursemon86

Specializes in ER/Emergency Behavioral Health.... Has 8+ years experience.

I looked at those and they really helped. I took my test on Monday and I got an 81% so I passed! All of the fluid/electrolyte and ABG questions I got right except for one. I forgot that TPN is hypertonic. Now I will never forget that :)

Thank you Esme!

studentnursemon86

Specializes in ER/Emergency Behavioral Health.... Has 8+ years experience.

They're NPO meaning nothing by mouth. It doesn't what goes through their IV. I give D5 1/2 NS + 20K every single day to NPO patients.

From what our professor said, this is okay for short term for NPO patients, especially in post op patients.

If given long term, it could actually cause fluid volume deficit.

KelRN215, BSN, RN

Specializes in Pedi. Has 10 years experience.

From what our professor said, this is okay for short term for NPO patients, especially in post op patients.

If given long term, it could actually cause fluid volume deficit.

If you have a patient who's NPO long enough for that to happen, they need a lot more than maintenance IVF and would probably be on TPN.

MattNurse, MSN, RN

Specializes in med-tele/ER. Has 39 years experience.

dextrose is metabolized so technically NS with anything added is hypertonic, the fact that dextrose gets metabolized really makes it an isotonic solution in the body.

From what our professor said, this is okay for short term for NPO patients, especially in post op patients.

If given long term, it could actually cause fluid volume deficit.

As stated before, a patient being NPO for this long would be started on TPN. In my specialty, most of my post op patients that experience this have abdominal distention, no bm, and possible vomiting. We'll usually drop an NGT on these folks, if it doesn't progress by POD 2 then they'll be started on TPN. Some people's bowels I suppose take longer to wake up. They also have to r/o any obstructions or leaks.

dextrose is metabolized so technically NS with anything added is hypertonic, the fact that dextrose gets metabolized really makes it an isotonic solution in the body.

NS with anything added isn't alway hypertonic.

If you have 0.9 NaCl (aka NS) with D5W then you have an isotonic fluid because as you said the dextrose is metabolized and the 0.9% NaCl is isotonic to blood/plasma.

D5 1/2 NS is HYPOtonic.

Whyyy? Because dextrose is metabolized and what's left is 1/2 NS which is hypotonic.

This is great for NPO pts as it pushes fluids into the cells and gives the cells energy (dextrose).

TheNGTKingRN

Specializes in General Surgery.

dextrose is metabolized so technically NS with anything added is hypertonic, the fact that dextrose gets metabolized really makes it an isotonic solution in the body.

Normal Saline refers to 0.9 NaCl.

Keeping this in mind, NS with anything added is not hypertonic.

For example:

D5W with 1/2 NS (aka .45NS) would be Hypotonic.

The dextrose is metabolized, leaving the 1/2 NS - 1/2 NS is hypotonic.

This fluid option is great for NPO patients because you give them some energy in the form of D5 AND...

You PUSH water INTO the cells (the hypotonic 1/2 NS).

D5 + NS will turn ISOtonic because the dextrose is metabolized and the remaining NS (0.9 NaCl) is naturally isotonic.

TheNGTKingRN

Specializes in General Surgery.

From what our professor said, this is okay for short term for NPO patients, especially in post op patients.

If given long term, it could actually cause fluid volume deficit.

Yes, this fluid option cannot be given long term. The cells will swell and the intravascular space will be depleted. This can also mess with their sodium levels.

So usually, patients that must remain NPO for a while post-op are started on TPN. They'll get a PICC line for it. Remember you can only give TPN through a PICC line and nothing else. :yes:

KelRN215, BSN, RN

Specializes in Pedi. Has 10 years experience.

Yes, this fluid option cannot be given long term. The cells will swell and the intravascular space will be depleted. This can also mess with their sodium levels.

So usually, patients that must remain NPO for a while post-op are started on TPN. They'll get a PICC line for it. Remember you can only give TPN through a PICC line and nothing else. :yes:

You can give TPN through any kind of central access, not just a PICC line. Kids on long term TPN (i.e. short gut kids) almost always have broviacs. Kids pull PICCs out way too often for them to be relied upon for long term use.

MattNurse, MSN, RN

Specializes in med-tele/ER. Has 39 years experience.

NS with anything added isn't alway hypertonic.

If you have 0.9 NaCl (aka NS) with D5W then you have an isotonic fluid because as you said the dextrose is metabolized and the 0.9% NaCl is isotonic to blood/plasma.

D5 1/2 NS is HYPOtonic.

Whyyy? Because dextrose is metabolized and what's left is 1/2 NS which is hypotonic.

This is great for NPO pts as it pushes fluids into the cells and gives the cells energy (dextrose).

Normal Saline refers to 0.9 NaCl.

Keeping this in mind, NS with anything added is not hypertonic.

Any normal saline solution with an added ingredient makes it hypertonic. I said technically because of the way it works in the body but that does not change the osmolarity and osmolality of any given solution.

And as I wrote "dextrose gets metabolized really makes it an isotonic solution in the body.", I don't get what makes what I wrote wrong.

Edited by MattNurse
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