Hypertonic solutions??

ckh23, BSN, RN · Feb 13, 2011

I have given it to patients who have low serum sodium levels that are not responding to NSS. I also have given it for people with head injuries because it helps to pull fluid from the brain and helps to prevent/treat cerebral edema.

As far as fluid overload, the only thing that comes to mind is a patient that severely low sodium levels that need to be treated ASAP. Diuretics would be great to get rid of the excess fluid, but what would you do if it's a renal patient or if they are on dialysis? Without knowing the specifics of the patient all we can really do is speculate.

iluvivt, BSN, RN · Feb 14, 2011

Hypertonic solutions raise serum osmolality..so will pull fluids from intracellular and interstitial into the blood vessels. You must use caution with these fluids to prevent circulatory overload. Some examples are the 2.25%.and 3 and 5 %Sodium Chloride used for severe Na depletion. Another example are dextrose in water solutions in concentrations from the 10-70 %. What compartment is the exta fluid in...yes if it is the blood vessels you can cause circulatory overload.

2ndyearstudent, CNA · Feb 14, 2011

Hey everyone!
I'm having a hard time understanding when/who to give hypertonic solutions to?
Since hypertonic solutions cause cells to shrink, why would you give it to someone with fluid volume overload?
I mean, if someone has too much fluid, why would you want to add more? Woudn't you want to avoid IV's all together and use diuretics to get rid of the fluid?
Thanks for any help I can get with this! :)

One thing you may want to do is stop thinking of the problem in terms of "cell swelling" or "cell shrinkage". I know this is the first way we all learn them, but that doesn't help much when thinking of real problems. After all, you are very rarely administering these fluids directly onto say, brain cells.

Try to focus your thinking on where the fluid in the body is and where do you want it to go. Think about the route the fluid is administered and what happens when it gets there.

For example, when a hypertonic solution is delivered IV, does that impart any fluid shifts between the intravascular and interstitial compartments? What kind of a problem could the person be having where they would want fluid pulled into the intravascular space? Or why are they losing intravascular fluid and getting edema?

Now consider a hypotonic solution - or a solution that becomes more hypotonic over time (D5W). Where does the fluid want to go after it gets into the IV space? It "wants" to shift to the interstitial compartments and then to the cells. So if someone is dehydrated, why would you give them hypotonic solutions instead of isotonic or hypertonic.

If you haven't already got it, go buy "Fluid and Electrolytes Made Incredibly EZ." Great discussions of these topics.

Good luck!