Types of IV Fluids

Pereyra| 2025
 CRYSTALLOIDS
Hypotonic Fluid
Hypotonic crystalloids can be used to correct free water deficits and
as a maintenance fluid if there is free water loss.
These intravenous solutions increase fluid levels within cells. This is
particularly helpful for conditions such as diabetes, which may
reduce levels of cellular fluid.
 
Clinical applications:
 Correction of free water deficit (hypernatremia)
 Maintenance fluid therapy in specific causes such as patients
with ketosis secondary to alcohol or fasting: hypoglycemia
 Solvent for IV drugs (e.g. noradrenaline infusions)
 
Examples:
 0.45% Sodium Chloride (0.45% NaCl)
 0.33% Sodium Chloride (0.33% NaCl)
 0.225% Sodium Chloride (0.225% NaCl)
 2.5% Dextrose in Water (D2.5W)
Isotonic Fluid CRYSTALLOIDS
Best solution for IV fluid resuscitation
Most IV fluids are isotonic, meaning, they have the same
concentration of solutes as blood plasma. When infused,
isotonic solutions expand both the intracellular fluid and
extracellular fluid spaces, equally.
 
Clinical applications:
 Fluid resuscitation
 Maintenance fluid therapy
 Treatment of hypovolemic hyponatremia (nonsevere
cases – Normal saline)
 Solvent for IV drugs (Normal saline)
Examples:
 0.9% NaCl (Normal Saline Solution)
 Dextrose 5% in Water (D5W)
 Lactated Ringer’s 5% Dextrose in Water (D5LRS)
 Ringer’s Solution
 CRYSTALLOIDS
Hypertonic Fluid
Hypertonic sodium chloride solutions contain a higher
concentration of sodium and chloride than normally contained in
plasma. Infusion of hypertonic sodium chloride solution shifts
fluids from the intracellular space into the intravascular and
interstitial spaces.
 
Clinical applications:
 Hyponatremia
 Treatment of cerebral edema
Examples:
 Dextrose 10% in Water (D10W)
 Dextrose 20% in Water (D20W)
 Dextrose 50% in Water (D50W)
 3% NaCl
 5% NaCl
Colloids

Albumin
A naturally occurring colloid and the most abundant protein in
plasma.
Responsible for 80% of plasma oncotic pressure
 
Albumin is the only commonly used colloid in clinical practice:
 Primarily used for specific indications rather than volume
expansion
More expensive than crystalloids and without commensurate
benefit

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Colloids

Synthetic Colloids
Hydroxyethyl starches, dextrans, and gelatins
Developed for use as volume expanders due to the
hypothetical benefit of remaining within the intravascular
volume 
 
Not commonly used in practice:
 Colloid solutions are not clinically superior to crystalloid
solutions for volume expansion (despite remaining
exclusively in the intravascular space).
 Expensive
 Hydroxyethyl starches have been associated with acute
kidney injury.
 Unlike
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specific indications for use.
Electrolyte
Composition of IV
Fluids
Carbonilla| 2025
 Body Composition
Na K Ca Cl HCO3

142 4 5 103 0

Lactate Glucose mOsm/L pH

0 0 280-310 7.4
 Na K Ca Cl HCO3 Lactate Glucose mOsm/L pH

Normal BF 142 4 5 103 27 0 0 280- 310 7.4

Normal 154 154 308 5.7

Saline
(0.9%
NaCl)
½ NaCl 77 77 154 5.6
Dextrose 50g/L 252 5
(D5W)
D5 ½ NS 77 77 50g/L 406 4.4

Lactated 130 4 3 109 28 28 273 6.75

Ringers
Plasmalyte 140 5 0 98 294 7.4
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Reference
Tintinali’s Emergency Medicine