IV SOLUTIONS

HYPOTONIC SOLUTIONS
Hypotonic Isotonic (equal) Hypertonic 0.45% sodium chloride 154 m0sm/L
Causes fluid to shift into Causes no fluid shift Causes fluid to shift 0.33% sodium chloride 103 m0sm/L
cells and interstitial out of cells
2.5% dextrose in water 126 m0sm/L
compartments

Do NOT use 0.45 % saline for burns, liver disease, or

Normal osmolality trauma

270 300 m0sm/L

0.45 % Saline Hypotonic Solutions
Treat: Patients at risk:
Hypotonic Isotonic Hypertonic
DKA ― after saline and Elevated ICP,
103 m0sm/L 260 m0sm/L 308 m0sm/L 406 m0sm/L before dextrose infusi- head trauma,
0.33% sodium 5% dextrose in 0.9% normal 5% dextrose in ons cerebrovascular
chloride water (D5W) saline (sodium 0.45% sodium accident (CVA),
chloride) chloride Gastric fluid loss from
neurosurgery
126 m0sm/L 275 m0sm/L long-term NG suctioning/
2.5% dextrose in water Lactated Ringer‘s 310 m0sm/L 560 m0sm/L vomiting Third spacers ―
Hetastarch 5% dextrose in burns, trauma,
154 m0sm/L 295 m0sm/L Hypertonic dehydration
0.9% sodium low serum protein
0.45% sodium chloride Normosol (water loss > salt loss)
chloride

0.9 % Normal Saline Lacted Ringer‘s 5 % Dextrose in Water

ISOTONIC SOLUTIONS This is used to increase Liver converts lactate Not good for patients
0.9% normal saline (sodium chloride) 308 m0sm/L circulating volume (does to bicarbonate Patients with elevated ICP, CHF,
not carry oxygen): with liver disease cannot or early in the post-op
Lacted Ringer‘s 275 m0sm/L metabolize lactate well. period (surgical stress
Watch for fluid overload
5% dextrose in water (D5W) 260 m0sm/L may cause increase in
and hypokalemia/hyper- Not good for alkalosis -
antidiuretic hormone
Hetastrach 310 m0sm/L natremia. buffers pH (liver converts
[ADH])
Normosol 295 m0sm/L lactate to bicarbonate).
Contains Na - be careful
Can be used for fluid
with renal disease, glu- Given as a fluid and
loss and dehydration or
D5W is Isotonic only in the bag. Dextrose is rapid- cocorticoids! electrolyte replenisher
hypernatremia (dilutes
ly metabolized and becomes hypotonic water. the extra sodium in the
extracellular fluid)

Hypertonic Solutions 5 % Dextrose in 5 % Dextrose in 0.9 % Saline

HYPERTONIC SOLUTIONS Shift fluid from cells and
0.45 % Saline Treat:
(D5 ½ NS) the interstitial spaces One of the fluids used in Hypotonic dehydration
5% dextrose in 0.45% sodium chloride 406 m0sm/L into the extracellular DKA (after NS and (salt loss > water loss)
fluid ½ NS as needed) and
(D5 NS) Possible causes: diuretics,
glucose is lower (< 250)
5% dextrose in 0.9% sodium chloride 560 m0sm/L Used to replace elec- impaired kidneys,
trolytes Helps to minimize decreased fluid intake
Do NOT use D5NS with patients who have renal effects of fast and
Post-op: reduce the Syndrome of inappropriate
issues or CHF - there is an increased risk of fluid drastic decrease in se-
risk of edema, stabilize antidiuretic hormone secre-
overload, heart failure, and pulmonary edema rum osmolality (cerebral
the blood pressure, and tion (SIADH)
edema and hypoglyce-
regulate urine output
mia) Addisonian crisis

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