REALLY stupid question...

RN BSN 2009 · Dec 24, 2008

When I had NVD and I was in the ER, I got 0.9. I don't know if that's protocol, though!

JessicRN · Dec 24, 2008

ER OBS if it is hyperemisis Gravidarum we give D5NS one liter then .09NS depending on the urine keton

es results. regular dehydration .9NS

miko014 · Dec 25, 2008

Thanks guys. I figured it would just be 0.9 but I didn't know if they ever use any kind of dextrose solution. I know the liver sometimes produces that extra kick to keep blood sugar up when the body is fighting off an illness, but I wasn't sure whether they ever used anything in the IV fluids to help with that as well.

VickyRN, MSN, DNP, RN · Dec 25, 2008

We usually start with NS, then change IV rehydration fluid (if need be) once labs come back.

Spritenurse1210, BSN, RN · Dec 25, 2008

Thanks guys. I figured it would just be 0.9 but I didn't know if they ever use any kind of dextrose solution. I know the liver sometimes produces that extra kick to keep blood sugar up when the body is fighting off an illness, but I wasn't sure whether they ever used anything in the IV fluids to help with that as well.

I just wanted to say that the only stupid question is the one that goes unasked. How are you going to learn if you don't ask.

GrumpyRN63, ADN, RN · Dec 25, 2008

It seems to me the only fluid the ED ever hangs is NS, once the pt is admitted inpt, usually with protracted N/V/D they get D5RL or D5 1/2NS w/ 20 KCL as maint and then tweaked depending on labs

CathyLew · Dec 25, 2008

of course anything that starts with Really Stupid question has to be read! ;-) But no question is stuipid.

we generally use NS. when I was in the Vet Tech field we always used LR or Ringers. seems that back a few years, we used Lactated ringers more on the nursing floors, but not so much anymore. With animals, even if you couldn't get an IV started, you could give the ringers SC

TiredMD · Dec 27, 2008

The overall electrolyte concentration of blood is measured in osmoles (osmolality), and normal range is typically reported as normal if between 275-295 mmol/kg (milimoles per kilogram).

When someone is dehydrated, you want to "refill" their vascular system. However, the osmolality of the fluid in the vascular system will affect whether the fluid you give stays in the vessels (good) or is pushed out into the extravascular space (bad).

Rehydration can be done either slow or fast.

If someone is very dehydrated or symptomatic, you want to do it fast. To do this safely, you need to give a fluid that is isotonic to serum/blood, meaning it must have an osmolality of approximately 275-295 mmol/kg. Normal Saline (NS) and Ringer's Lactate (LR) both fit this bill, and can be run in through an IV, central line, or IO as fast as you like.

However, if you are rehydrating someone slowly, you are not bound by the osmolality of the solution, because the body will self-equilibrate your serum osmolality. Thus, when giving maintenance fluids or a slower rehydration, you can give hypertonic (osmolality >295 mmol/kg) or hypotonic (osmolality

So, in short, to answer your question: for someone who is very dehydrated, you are going to give them NS or LR quickly in 99% of situations. Some physicians will argue over the utility of one over the other (NS is somewhat more acidotic than LR, but LR has a small amount of K and Ca, but LR may cause abdominal compartment syndrome in trauma patients, and on and on . . . ). But at the end of the day, for all practical purposes it really doesn't matter.

For a nice review of this, here's a PowerPoint that breaks it all down: http://docushare.harford.edu/dsweb/Get/Document-237904/IV%20Solutions%20and%20Recommended%20Usage.ppt#1

miko014 · Dec 29, 2008

Just wanted to say thanks again to all who responded! I know no question is stupid...the reason I said I felt stupid is it isn't a question of me learning it...it's a question of me REMEMBERING it, haha! Thankss again!