Isotonic, Hypotonic, and Hypertonic IV 0.

25% normal saline (¼ NS)

2.5% dextrose in water and 5% dextrose in water (D5W)
Fluid Solution
Balance of fluids and electrolytes mostly refers to the
Isotonic in the bag but hypotonic in the body after the
volume and concentration of solutes inside the cell
cells consume the glucose
referred to as intracellular fluid (ICF) and the volume and
Should be used with caution for clients with
concentration outside the cell called extracellular fluid
hyperglycemia (e.g. diabetics)
(ECF). Clients may have too much or too little water in
Should not be use in clients with high intracranial
either of these parts of the body. When practitioners are
pressure (ICP)
diagnosing the imbalance, they generally are looking at
the levels of the ECF where their labs are assessed. If
Isotonic solutions: Contains approximately the same
fluid levels in the ECF are high it is called hypervolemic
percentage of solute to solution as in the human body.
and if the levels are low, it is called hypovolemic. If fluid
These are used in situations where fluid levels need to
levels are balanced it is called isovolumic.
be replenished without shifting the fluids in or out of the
cell. Isotonic solutions are very commonly used as these
Hypertonic solutions: higher concentrations of solutes
are effective at rehydrating clients. Examples of isotonic
than what is observed in the body. These solutions are
solutions includes...
generally utilized when clients have low lab values (e.g.
Normal saline (0.9% NS)
low sodium, low glucose, etc.) Hypertonic solutions can
Lactated ringers
also draw water from the ICF to the ECF which can be
Use with caution in renal impairment
useful for clients with edema. These solutions may also
Contains potassium (can affect ECG)
be used for clients with heat exhaustion (where too
Contraindicated in liver impairment (cirrhosis, hepatitis)
many electrolytes were wasted) or peritonitis
as the liver is needed to metabolize lactate
(inflammation of the peritoneal cavity. Examples of
D5W
hypertonic solutions includes...
Isotonic in the bag but hypotonic in the body
3% normal saline (3% NS)
5% normal saline (5% NS)
10% dextrose in water (D10W)
5% dextrose in water with ½ normal saline (D5 ½ NS)
5% dextrose with lactated ringers (D5LR)
50% dextrose in water (D50W)

Hypotonic solutions: lower concentrations of solutes

relative to the water in the bag. Hypotonic solution are
used when clients already have high values of
electrolytes especially hypernatremia (serum sodium >
145 mEq/L). Clients with elevated sodium and are given
an isotonic or hypertonic solution this can exacerbate
their hypernatremia and cause serious side effects. The
main function of hypotonic solutions are to treat cellular
dehydration which results from hyperosmolar conditions
(e.g. hypernatremia, hyperkalemia, hyperglycemia, etc.)
Diabetic clients may require this therapy in the event of
uncontrolled blood sugar as the body will increase the
excretion of glucose and water as a result. Clients with
HHNS or diabetic ketoacidosis are prime examples of
situations where hypotonic solutions may be
administered. of Examples of hypotonic solutions
includes...
0.45% normal saline (½ NS)
0.33% normal saline (½ NS)