Manuel III Miguel L.

Rafanan
BSN-1

Skill 16: FLUID, ELECTROLYTE & ACID-BASE BALANCE

Student Activity

I. Identify the different types of intravenous solutions, indicate the purpose of each type and provide
examples
-Crystalloid solutions: contain small particles that that pass easily from the bloodstream to cells and
tissues. There are three types of crystalloids, given according to their tonicity, the ability to make water
move into or out of a cell by osmosis.
 Hypotonic: When the extracellular fluid has fewer solutes (osmolarity) than the fluid in the cells. Water
will move from extracellular space into the cells.
 Hypertonic: When the extracellular fluid has more solutes (osmolarity) than within the cells, water flows
out of the cells.
 Isotonic: Both the extracellular and intracellular fluids have the same osmolarity, so there is no
movement of water between them.

-Lactated Ringers: The IV solution most similar to blood plasma concentration, it is the fluid of
choice for burn and trauma patients. It used for acute blood loss; hypovolemia from third-space
fluid shifts; electrolyte imbalance; and metabolic acidosis. LR is an isotonic crystalloid
containing sodium chloride, potassium chloride, calcium chloride, and sodium lactate in sterile
water. It is contraindicated in patients with a pH > 7.5, patients with liver disease who are unable
to metabolize lactate, or for any patient with lactic acidosis. Use with extreme caution in cases of
renal failure.

-5% Dextrose in Water (D5 or D5W): A crystalloid that is both isotonic and hypotonic,
administered for hypernatremia and to provide free water for the kidneys. Initially hypotonic, D5
dilutes the osmolarity of the extracellular fluid. Once the cells have absorbed the dextrose, the
remaining water and electrolytes become an isotonic solution. D5 should not be used as the sole
treatment of fluid volume deficit, because it dilutes plasma electrolyte concentrations. It is
contraindicated in resuscitation, early post-op recovery, cardiac and renal conditions, and in any
case of suspected increased intracranial pressure. Because the solution contains calories, due to
dextrose (a form of glucose) as the solute, it does provide very limited nutrition.

-0.45% Normal Saline (Half Normal Saline, 0.45NaCl, .45NS): A hypotonic crystalloid
solution of sodium chloride dissolved in sterile water, administered to treat hypernatremia or
diabetic ketoacidosis.. It is contraindicated in patients with burns, trauma, or liver disease due to
depletion of intravascular fluid volumes. Half normal saline may result in fluid overload and
subsequent decreased electrolyte concentrations or pulmonary edema. Infusing too quickly can
cause hemolysis of red blood cells.
 II. Short answers
1. In D5LR, what does D5 mean?
- A crystalloid that is both isotonic and hypotonic, administered for hypernatremia and to provide
free water for the kidneys. Initially hypotonic, D5 dilutes the osmolarity of the extracellular
fluid. Once the cells have absorbed the dextrose, the remaining water and electrolytes become an
isotonic solution.
2. Why is NSS administered to a patient who had blood transfusion?

-Background: It is standard practice at many hospitals to follow blood component transfusions

with a normal saline (0.9% NaCl) flush. This serves the dual purpose of administering to the
patient any residual blood left in the administration set (up to 40 mL), and it flushes the line for
later use.

3. What is the difference between a hypotonic and hypertonic solution?

 Hypertonic refers to a greater concentration. In biology, a hypertonic solution is one with

a higher concentration of solutes outside the cell than inside the cell.
 Hypotonic refers to a lesser concentration. In biology, a hypotonic solution has a lower
concentration of solutes outside the cell than inside the cell.

III. Compute the following.

1. A patient with lower UTI is prescribed with D5NM 1L to consume in 8 hours. The IVF
started at 9 in the evening. What is the flow rate of the IV fluid? How much is the hourly
consumption?
TV(ML)
Time (mins)
=1L =1000mL
8 hours x 60 mins= 480 mins
=1000ML =2.833x 155DF= 31.25
480mins
round off
=31gtts/min.

1000 mL = 125ml/hr
8 hours
2. A 19 year-old male patient was admitted due to severe dehydration. The doctor ordered
D5LR 1Liter, fast drip 300cc the consume the remaining in 4 hours. At 10am, 300cc of
fluid was consumed. At what rate should you regulate the remaining fluid to be able to
administer it in 4 hours? Compute for the hourly consumption.
700 mL
4hours x 60 min
=700mL = 2.9166x15(SDF)
240 min
=43.75 or 44 gtts/min
 Hourly consumption

700mL = 175 mL/hr

4 hours

IV. Time taping. Based on the above problems, illustrate how the IVFs should be time taped
in order to ensure the patients receive the appropriate amount.