What type of IV do I give? and/or not give?

[michele08540]

I have a test soon, Fluid and Electrolytes I will be tested on types of fluid solutions, who gets what and who does get what...

For example:

In a Isotonic Solution aka Lactated Ringer (normal saline 0.9% NaCl) you don't give to pt. with CHF, Liver failure or Renal Failure because it is used to increase intravascular space.

Hypotonic Solution: Causes cells to swell - you use this for pt. when Hct is high and pt. using diaretics. (will show low BP)

You never use for head trauma- so what would you use Hypertonic?

Hypertonic- use for pt. with tube feeding - WHY?

Please include anything else I can use for this fluid and electrolyte, Med Admin. and Acid Base Balance that may be useful.

Test is Friday 11/4/05

Thanks

[VickyRN, MSN, DNP, RN]

Hypotonic Solutions (

Provides more water than electrolytes, diluting the ECF.

Movement of water from the ECF to the cells (ICF).

Examples: 0.45% saline; D5W (after the dextrose is metabolized).

Provide free water for cellular hydration and renal excretion (hydrate the kidneys).

Not for clients with increased ICP or third-space fluid shifts.

Hypotonic solutions are used to provide free water and treat cellular dehydration. Hypotonic solutions provide greater amount of water than electrolytes, and have decreased osmotic pressure. This causes an increase in intracellular fluid. The fluid leaves the intravascular space and rehydrates the cells. These solutions also promote waste elimination by the kidneys.

Out of one liter of fluid, only about 85 ml stay in the intravascular space.

Maintenance fluids are usually hypotonic solutions, because normal daily losses are hypotonic.

D5W is an example of a hypotonic solution. It does not provide any electrolytes. It is isotonic on initial administration. Once the dextrose is metabolized, however, (in about 5 minutes), it provides free water for renal excretion and promptly leaves the intravascular space to expand the intracellular fluid volume. It also provides 170 calories/L for metabolism.

Hypotonic solutions should not be administered to patients with increased intracranial pressure because it can increase cerebral edema. Also, not for clients with third-space fluid shift.

Hypotonic solutions should be given at a slower rate than isotonic solutions. One of the best guides to a safe rate of flow is the reaction of the patient. Therefore, the nurse must observe signs and symptoms carefully (such as shortness of breath, dyspnea, coughing, cyanosis, increased respiratory rate—all symptoms of pulmonary edema).

Isotonic (270-300 mmol/L)

Expands only the ECF.

No net loss or gain from the ICF.

Fluid replacement for a patient with an ECF volume deficit.

Examples: NS (0.9% saline), LR.

Used to expand vascular volume.

Assess for hypervolemia (bounding pulse, SOB).

An isotonic solution stays in the extracellular compartment and is used to expand the intravascular volume. 1 liter isotonic IV solution will expand the intravascular space by about 250 mL. Approximately 400 cc of isotonic IV fluid (NS, LR) is required to compensate for each 100 cc of blood loss.

Since isotonic solutions remain in the extracellular space, assess clients carefully for signs of hypervolemia such as bounding pulse and shortness of breath.

0.9% saline is a percentage of milligrams per deciliter (100 ml). Normal saline is 0.9 grams (900 mg) of NaCl in 100 ml of water. Normal saline is a balanced electrolyte solution. NS = 154 mEq/L Na+ and 154 mEq/L Cl-

Lactated Ringer’s solution is an isotonic electrolyte solution. It contains sodium, chloride, potassium, calcium and lactate in water. LR = 130 mEq/L Na+, 4 mEq/L K+, 109 mEq/L Cl-, 28 mEq/L lactate, 3 mEq/L Ca++

Lactate is oxidized by the liver to bicarbonate. LR is contraindicated in severe metabolic acidosis or alkalosis, in liver disease, anorexia, or anoxic states. Lactic acidosis may occur in association with an underlying disease, such as diabetes mellitus, severe iron-deficiency anemia, liver diseases, alcoholic ketoacidosis, pancreatitis, malignancy (eg, leukemias, lymphomas, lung cancer), alkalosis, infections (malaria, cholera), renal failure, pheochromocytoma, thiamine deficiency, short gut syndrome and other carbohydrate malabsorption syndromes. Lactated ringers should also be avoided in these circumstances.

Hypertonic (>300 mmol/L)

Raises the osmolarity of ECF and expands it.

Draws water out of the cells (ICF) into the ECF.

Examples: D5½NS, D5NS, D5LR, 3% NaCl, TPN

Not for clients with kidney or heart disease or who are dehydrated.

Assess for hypervolemia.

Hypertonic solutions draw water out of the intracellular and interstitial compartments into the vascular compartment, expanding vascular volume.

Hypertonic solutions must be administered slowly and with extreme caution, because they may cause dangerous intravascular volume overload and pulmonary edema. These require frequent monitoring of blood pressure, lung sounds, and serum sodium levels.

Do not administer to clients with kidney or heart disease or clients who are dehydrated. Watch for signs of hypervolemia.

Administration of IV Fluids: Guidelines

Give isotonic fluids (NS, LR) for isotonic dehydration.

Give hypotonic fluids - (0.45% saline, D5W) SLOWLY to treat hypertonic dehydration.

Give NS or hypertonic fluids (D5/0.9% saline, D5/LR) to treat hypotonic dehydration.

[stressgal, RN]

From yet another student trying to wrap their brain around fluids and electrolytes...THANK YOU!

[michele08540]

Thanks a bunch.

[Cahoon BSN RN, BSN, RN]

Thanks for the explanation! So much information...so little brain space left. :)

[Dazglue, ADN, BSN, MSN, RN]

Thanks alot VickyRN! That even helped me!

[angileej, ADN, BSN]

Big help for my test tomorrow. Thanks a million.