Question about IV therapy

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please dont bite my head off.

if someone has low hemoglobin, and we want to increase circulating blood volume would it be correct to give them a hypertonic solution?

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Specializes in Hospice, Palliative Care.

Good day:

Does hemodilution exist? Effects of saline infus... [south Med J. 1996] - PubMed - NCBI might be useful.

Thank you.

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Specializes in LAD.

When I think of low hemoglobin along with hypovolemia, I think excessive bleeding. I would think a blood transfusion would be required to compensate for lost fluids, RBC, etc that is normally in blood. If you put RBC in a hypertonic solution they decrease and a hypotonic solution causes them to swell. So, in all, we are possibly talking about blood loss and not dehydration. I'm just a student, so please help me too if I'm wrong:)

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When I think of low hemoglobin along with hypovolemia, I think excessive bleeding. I would think a blood transfusion would be required to compensate for lost fluids, RBC, etc that is normally in blood. If you put RBC in a hypertonic solution they decrease and a hypotonic solution causes them to swell. So, in all, we are possibly talking about blood loss and not dehydration. I'm just a student, so please help me too if I'm wrong:)

I am STUDENT: PLEASE correct me if I am wrong, as I do not want to give wrong information .. but I do want to try and problem solve this.

I BELIEVE ...

Hypovolemia related to excessive bleeding (as in trauma) will not reflect a low H&H immediately. A low H&H will manifest sometime after the fluid from the 3rd space moves into the intravascular space. This makes perfect sense, if you are bleeding - the percentage will be the same. It will take time for your body to move fluids into the vascular space.

I believe the OP is not telling us the whole scenario.

I feel like there HAS to be more information... LOL.

Why are we considering infusing a hypertonic solution?

If I am not mistaken, a low hemoglobin may be indicative of IRON deficiency anemia.

If I am not mistaken, a low hemoglobin may be indicative of renal failure. (recall from anatomy and physiology one of the functions of the kidney --> look up erythropoietin.

Anyway ...

based off the information: I would say.... it depends.

Hypertonic fluid WILL in essence increase the volume in the intravascular space.

It will cause fluids from the tissues to move into the vascular space in an attempt to dilute the electrolytes - make sense?

I would say a good indication for hypertonic fluids would be HYPOTONIC DEHYDRATION

Hypotonic fluids will definitely not be given (I THINK). Hypotonic fluids will cause water to LEAVE the intravascular space, and into the interstitial space.

*** D5 is a hypotonic fluid that will turn isotonic in the body because the body will metabolize the sugar**

So I go back to the same thing, why are they receiving (potentially) hypertonic solutions? Is this post-op bleeding that had enough time for the blood plasma to be diluted with fluid from the 3rd space... HENCE causing the low hemoglobin?

Once again, anyone ... please feel free to correct me! I really want to know how wrong I was. LOL.

A few months away from graduation ... really need to step up my game. :yes:

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Specializes in Emergency Nursing.

All giving them a hypertonic solution would do is draw fluid back into the intravascular space, possibly correcting a hypovolemic state, but it would do nothing for their hemoglobin and in fact might reduce it further due to hemodilution.

The best and fastest way to correct hypohemoglobinemia is to transfuse packed red blood cells.

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Specializes in Acute Care, Rehab, Palliative.
please dont bite my head off.

if someone has low hemoglobin, and we want to increase circulating blood volume would it be correct to give them a hypertonic solution?

If their hemoglobin is low you would be giving them blood not a maintenece fluid.

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If their hemoglobin is low you would be giving them blood not a maintenece fluid.

I always complicate things. D:

I was thinking blood transfusion BUT I kept wondering if there was another reason besides the blood loss for the low HGB - considering how lol HGB doesn't show up until later.

I should have paid attention to the part that said "increased circulating blood volume" - indicating they did have some sort of blood loss.

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Specializes in Emergency Department.
please dont bite my head off.

if someone has low hemoglobin, and we want to increase circulating blood volume would it be correct to give them a hypertonic solution?

If you're looking simply to increase circulating volume, you'd probably want to give NS or LR. These fluids generally stay in the intravascular space for a while. As fluid is infused, the blood becomes more hemodiluted. This probably isn't exactly beneficial. It is a trade-off. The patient may need volume, but by adding fluid, you might make the patient effectively more anemic... If you're looking to increase circulating volume and start correcting the low H&H, blood would be given. Another way to increase circulating volume would be to infuse a hyperosmolar colloid or hypertonic saline. Either will draw fluid into the vascular space, and neither will increase the number of RBCs circulating in the vasculature... thus resulting in hemodilution while potentially causing some other problems.

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Specializes in Emergency Department.
I always complicate things. D:

I was thinking blood transfusion BUT I kept wondering if there was another reason besides the blood loss for the low HGB - considering how lol HGB doesn't show up until later.

I should have paid attention to the part that said "increased circulating blood volume" - indicating they did have some sort of blood loss.

It's not uncommon for anemic patients to also have a low circulating volume, if they're actively bleeding. Once the bleeding is stopped, the body will try to restore circulating volume on it's own, and probably can increase total volume faster than it can replace lost RBCs, therefore becoming more anemic in the process.

Think of it like this: you have a glass of orange juice. The concentration of stuff stays the same in the glass if you drink half of it. Restore some volume with tap water and the concentration changes. Now it's more watery.

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It's not uncommon for anemic patients to also have a low circulating volume, if they're actively bleeding. Once the bleeding is stopped, the body will try to restore circulating volume on it's own, and probably can increase total volume faster than it can replace lost RBCs, therefore becoming more anemic in the process.

Think of it like this: you have a glass of orange juice. The concentration of stuff stays the same in the glass if you drink half of it. Restore some volume with tap water and the concentration changes. Now it's more watery.

Didn't realize the anemic variation, Thanks!

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I understand the concept of how the body restoring the volume in the intravascular space leads to a shift in concentration, I always believed this happened at a later time though. Hence, if you were to do a CBC on a patient who is actively hemorrhaging you would not notice a low h&h (I guess unless their PMH includes anemia)

Do you think we can infuse fluids that are not blood products a heck of a lot faster than blood? I would assume the answer is yes? But given if it was an emergency with A LOT of blood loss we'd have to infuse blood super fast instead? I would assume so because the oxygen carrying capacity would be diminished anyway.

Can we infuse bloods in one access and fluids somewhere else? lol

I guess it depends... Is this patient actively bleeding? How much? What's their clinical condition? Are they in shock?

like my prof always said in critical care...

"LOOK at YOUR patient .... then look at the labs"

Gotta connect the two!

I've definitely blown this too far ... sorry OP. I really love this stuff though :p

Hope you find the answer.

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Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.

Fluids are just a stop gap measure to support the patient until you are able to replace blood loss with blood....remember...the fluid will not carry oxygen.

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Specializes in ER.

packed rbcs with normal saline (isotonic) is what I usually see done in the hospital... but I'm a relatively new RN...

Hypertonic solutions are rarely used... they're for like, brain swelling or burn victims 'n stuff when you want to encourage fluids to come out of cells and into intravascular spaces. Usually, you don't want to steal fluids from body cells unless the fluids are causing problems in the cells. You don't need to shift fluids per say here, mostly replace lost or never-made blood cells.

:-) hopefully I'm not a stupid tool giving a stupid tool answer LOL

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