Miomio, Juliet Marie L.

BSN-2D NCM 109

DIFFERENT TYPES IV FLUIDS AND PURPOSE/USAGE

Isotonic Solutions
Isotonic solutions are IV fluids that have a similar concentration of dissolved particles as
blood. An example of an isotonic IV solution is 0.9% Normal Saline (0.9% NaCl).
Because the concentration of the IV fluid is similar to the blood, the fluid stays in the
intravascular space and osmosis does not cause fluid movement between
compartments. for an illustration of isotonic IV solution administration with no osmotic
movement of fluid with cells. Isotonic solutions are used for patients with fluid volume
deficit (also called hypovolemia) to raise their blood pressure. However, infusion of too
much isotonic fluid can cause excessive fluid volume (also referred to as hypervolemia).

Hypotonic Solutions
Hypotonic solutions have a lower concentration of dissolved solutes than blood. An
example of a hypotonic IV solution is 0.45% Normal Saline (0.45% NaCl). When
hypotonic IV solutions are infused, it results in a decreased concentration of dissolved
solutes in the blood as compared to the intracellular space. This imbalance causes
osmotic movement of water from the intravascular compartment into the intracellular
space. For this reason, hypotonic fluids are used to treat cellular dehydration. hypotonic
IV solution is administered, causing lower concentration of solutes (pink molecules) in
the bloodstream compared to within the cell.
Hypertonic Solutions
Hypertonic solutions have a higher concentration of dissolved particles than blood. An
example of hypertonic IV solution is 3% Normal Saline (3% NaCl). When infused,
hypertonic fluids cause an increased concentration of dissolved solutes in the
intravascular space compared to the cells. This causes the osmotic movement of water
out of the cells and into the intravascular space to dilute the solutes in the blood. for an
illustration of osmotic movement of fluid out of a cell when hypertonic IV fluid is
administered due to a higher concentration of solutes (pink molecules) in the
bloodstream compared to the cell.
When administering hypertonic fluids, it is essential to monitor for signs of hypervolemia
such as breathing difficulties and elevated blood pressure. Additionally, if hypertonic
solutions with sodium are given, the patient’s serum sodium level should be closely
monitored.
 Type IV Solution Uses Nursing
Considerations

Isotonic 0.9% Normal Saline Fluid resuscitation Monitor closely for

(0.9% NaCl) for hemorrhaging, hypervolemia,
severe vomiting, especially with
diarrhea, GI heart failure or
suctioning losses, renal failure.
wound drainage,
mild hyponatremia,
or blood
transfusions.

Isotonic Lactated Ringer’s Fluid resuscitation, Should not be used

Solution (LR) GI tract fluid losses, if serum pH is
burns, traumas, or greater than 7.5
metabolic acidosis. because it will
Often used during worsen alkalosis.
surgery. May elevate
potassium levels if
used with renal
failure.

Isotonic 5% Dextrose in Provides free water Should not be used

Water (D5W) to help renal for fluid
*starts as isotonic excretion of resuscitation
and then changes solutes, because after
to hypotonic when hypernatremia, and dextrose is
dextrose is some dextrose metabolized, it
metabolized supplementation. becomes hypotonic
and leaves the
intravascular
space, causing
brain swelling.
Used to dilute
plasma electrolyte
concentrations.
Hypotonic 0.45% Sodium Used to treat Monitor closely for
Chloride (0.45% intracellular hypovolemia,
NaCl) dehydration and hypotension, or
hypernatremia and confusion due to
to provide fluid for fluid shifting into the
renal excretion of intracellular space,
solutes. which can be life-
threatening. Avoid
use in patients with
liver disease,
trauma, and burns
to prevent
hypovolemia from
worsening. Monitor
closely for cerebral
edema.

Hypotonic 5% Dextrose in Provides free water Monitor closely for

Water (D5W) to promote renal hypervolemia,
excretion of solutes hypernatremia, and
and treat associated
hypernatremia, as respiratory distress.
well as some Do not use it with
dextrose patients
supplementation. experiencing heart
failure, renal failure,
or conditions
caused by cellular
dehydration
because it will
worsen these
conditions.

Hypertonic 5% Dextrose and Used to treat Monitor closely for

Lactated Ringer’s severe hypervolemia,
(D5LR) hyponatremia and hypernatremia, and
D10 cerebral edema. associated
respiratory distress.
Do not use it with
patients
experiencing heart
failure, renal failure,
or conditions
caused by cellular
 dehydration
because it will
worsen these
conditions.

Hypertonic 3% Sodium Used to treat Monitor closely for

Chloride (3% NaCl) severe hypervolemia,
hyponatremia and hypernatremia, and
cerebral edema. associated
respiratory distress.
Do not use it with
patients
experiencing heart
failure, renal failure,
or conditions
caused by cellular
dehydration
because it will
worsen these
conditions.

Hypertonic 5% Dextrose and Used to treat Monitor closely for

0.45% Sodium severe hypervolemia,
Chloride (D50.45% hyponatremia and hypernatremia, and
NaCl) cerebral edema. associated
respiratory distress.
Do not use it with
patients
experiencing heart
failure, renal failure,
or conditions
caused by cellular
dehydration
because it will
worsen these
conditions.