LECTURE 1: IV SOLUTIONS, TYPES AND PURPOSES

When patients experience deficient fluid volume, intravenous (IV) fluids are often prescribed. IV
fluid restores fluid to the intravascular compartment, and some IV fluids are also used to
facilitate the movement of fluid between compartments due to osmosis. There are three types of
IV fluids: isotonic, hypotonic, and hypertonic.

ISOTONIC SOLUTION: 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 like the blood, the fluid stays in the intravascular space and
osmosis does not cause fluid movement between compartments.

EXAMPLE:

0.9% NaCl (Normal saline) infusion is used for extracellular fluid replacement (e.g., dehydration,
hypovolemia, hemorrhage, sepsis), treatment of metabolic alkalosis in the presence of fluid loss,
and for mild sodium depletion

Lactated Ringer's injection is used to replace water and electrolyte loss in patients with low
blood volume or low blood pressure. It is also used as an alkalinizing agent, which increases the
pH level of the body.

Dextrose 5% in water is used to treat low blood sugar (hypoglycemia), insulin shock, or
dehydration (fluid loss). 

See Figure, 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 SOLUTION:

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. 

EXAMPLE:

5% Sodium Chloride (0.45% NaCl)

 Sodium chloride 0.45% (1/2 NS), also known as half-strength normal saline, is a
hypotonic IV solution used to replace water in patients with hypovolemia hypernatremia.
 Excess use may lead to hyponatremia due to the dilution of sodium, especially in
patients prone to water retention.
 It has an osmolality of 154 mOsm/L and contains 77 mEq/L sodium and chloride.
 Hypotonic sodium solutions are used to treat hypernatremia and other hyperosmolar
conditions.

225% Sodium Chloride (0.225% NaCl)

 0.225% Sodium Chloride Solution used as a maintenance fluid for pediatric patients as it
is the most hypotonic IV fluid available at 77 mOsm/L. Used together with dextrose.

5% Dextrose in Water (D2.5W)

 Another standard hypotonic IV solution is 2.5% dextrose in water (D2.5W).
 This solution used to treat dehydration and decrease sodium and potassium levels.
 Do not administer with blood products as it can cause hemolysis of red blood cells.

See Figure, for an illustration of the osmotic movement of fluid into a cell when a
hypotonic IV solution is administered, causing lower concentration of solutes (pink
molecules) in the bloodstream compared to within the cell. However, if too much fluid
moves out of the intravascular compartment into cells, cerebral edema can occur. It is
also possible to cause worsening hypovolemia and hypotension if too much fluid moves
out of the intravascular space and into the cells. Therefore, patient status should be
monitored carefully when hypotonic solutions are infused.
HYPERTONIC SOLUTION:

A solution that contains more dissolved particles (such as salt and other electrolytes) than is
found in normal cells and blood. For example, hypertonic solutions are used for soaking
wounds.

Hypertonic solutions have a higher concentration of dissolved particles than blood. An example

of hypertonic IV solution is D5NsCl . 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.

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.

EXAMPLES:

 D5NsCl
 D5 in Lactated Ringers
 D5 0.45% NaCl

See Figure 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.