IV flulids/solutions and WHY??

Nurses General Nursing

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I really would like someone to EXPLAIN to me, or guide to a resource. Seem to have some confusion as to why a solution is given to a patient. When I ask my preceptor(just started on a med/surg unit), she says "I don't know, different doctors prescribe different solutions, so I don't know why they did it". And that we're not about to page the Dr to ask him/her why the pt is having the solution!!!

Well, aren't we suppose to know why a solution is prescribed and what it does in the body in relation to fluid shifts, electrolytes and cautions?!

I tried to find answers online, but google just lists basic iso/hypo/hyper solutions with no explanations?

Specializes in Hospital Education Coordinator.

I got the Fluids and Electrolytes for dummies book and it is helpful.

Isotonic fluids have tendency to be about equal in blood and in cells

Hypertonic fluids tend to be MORE in the blood (used if fluid loss or edema or burns to dehydrate cells)

Hypotonic fluids tend to be LESS in the blood (to rehydrate).

Salts and sugars are crystals. Water wants to go where crystals are (think sponge). So if the fluid has higher concentrations of salt or sugar then the MD is trying to get the water to a certain site. So a burn would require higher salt/sugar concentration to draw out the fluid from the cells so the bloodstream can help pee it off). A diabetic is generally dehydrated so will need a hypotonic fluid to provide more water to the cells and less in the blood. Over-simplified of course, but a place to start.

Most important to remember that HYPERTONIC fluids are dangerous and should be d/c as soon as possible. People do not generally get 3 days worth of hypertonic fluids at 150 cc/hr. Watch for that

Specializes in Acute Care, CM, School Nursing.
I don't mean to be rude, but this is not really rocket science. There is probably and pretty good explanation in your Med/Surg text from school.

And, yes, we are supposed to know why a solution is prescribed and its effects on fluids shifts and electrolytes, but in most cases we should not need the doctor to spell it out to us.

This is a pretty harsh reply, IMO. OP states that he/she is just starting out in med/surg and already tried to find the info online. Haven't you ever heard "there is no such thing as a stupid question"? Or "the only dumb question is the one not asked"? What is the harm in asking a question? Show some support for a fellow nurse.

I don't have any further info on IV fluids to add to the thread. I think the links and info already posted are excellent.

Best wishes!

Specializes in ER.
LR contains lactate not lactose and there is a huge difference between the two.

It was a joke :)

Specializes in Critical Care.

I think the OP is asking why patients are getting a variety of normotonic crystalloids; such as why the doctor would prescribe NS versus LR or Normosol.

I think a lot has to do with prescriber preference and the institution policies. LR has more electroyles but generally isn't used in long term fluid maintenance as it can induce hypernatremia and hypokalemia if gone unchecked. In addition long(er) term use of lactate products can induce alkalosis (which actually may be why it is prescribed if the patient is starting to go acidemic). Giving LR for burns and trauma is understood.

NS is the standard for fluid replacement and rapid rehydration and compatible with blood products. In essence NS is always a safe bet to prescribe and administer.

Here's a study comparing albumin, NS, and LR for your reading pleasure: http://www.emjournalclub.com/uploads/Ringers_Lactate_vs._Normal_Saline_Schott_1.2010.pdf

ok..psu__213...you have 2 pt's that are fairly stable...both post op several days. One gets D5 1/2 sodium chloride, the other gets LR. Labs both normal. Vs stable. Hemodynamically stable as well. No past medical hx. Healthy adults. Ready for discharge any when dr rounds. I wasn't asking for a rocket science answer. Textbooks ONLY provide basic nursing thinking, not real life practical applications.
Like someone else said, the LR is usually reserved for a patient who needs the electrolyte bump for stability and won't be on fluids very long. An example is someone who had a cardiac cath. "Stable post op patients, ok labs" could be where the similarities end for those two. Maybeeee Patient 1 got Lantus and isn't eating so well just yet. We need more info.

In all fairness, my friend who is taking NP classes is learning about which fluids to give when. Sure, we learned the basics in undergrad but at this stage in the game don't overstress it.

Good Morning, Gil Thanks for taking the time to explain this!! One thing about nursing that I tell people all of the time is......"You don't know what you don't know." It can be simple things like making sure the IV line is not open when you are getting ready to prime it to doing a quick I-STAT to see what the potassium is on a s/p MI Pt to see if that could be an additional reason she is tanking and you are running for the crash cart. Nursing school is a great foundation, but it still amazes me the thing I learn from being on the floor........and all I can think of is "DANG, I did not know that......and not only that I did not KNOW that I NEEDED to know that."

Yipee! I learn something. Well I still have questions but will google them. I definitely don't want to be attack by others who have no patience reading simple or basic nursing. Thanks :)

Specializes in Rehab, critical care.

No problem, 1970 butterfly! Part of the purpose of allnurses is to learn from one another. I am still learning a lot, as well. Like, no matter how busy you are, always take the 2 seconds to check to be sure your IVF are running once you start them (because then you have to run back in since you forgot to unclamp the stupid line, and this is especially true when starting IVPB lol). And, even when there are critical things happening, I always take the 2 seconds to double check meds, concentrations even when there's no time to scan them into the computer. You can do this as you are priming the line, so no excuses, right :)

And, the OP mentioned not asking the doctors questions, I ask the doctors questions if I have them. Like, for instance, "what's the plan of care for this patient?" And, I don't ask this in a snarky way, but if someone has been unresponsive for such and such a time, I want to know what our plan is so that I know, but also so that I can tell the family, and make sure that a patient didn't just fall under the radar as far as discussing withdrawal of life support with the family, etc. That's just part of patient advocacy, nothing wrong with discussing things with doctors (again, I do this briefly when I'm calling for something else, don't spend an hour talking to them lol).

Or, if there is a lab they order that you're unfamiliar with, and you've already googled it, no harm in asking them what they're really looking for in the patient, etc. It definitely is a good thing for the nurse to know what is going on with the patient.

Specializes in ER, progressive care.
LR contains lactate not lactose and there is a huge difference between the two.

LR should not be given to patients with liver problems because of the inability to convert the lactate, resulting in lactic acidosis.

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