Types of Intravenous Fluids

Types of intravenous fluids 1.

Isotonic solutions

a. Fluids that approximate the osmolarity (280-300 mOsm/L) of normal blood plasma. 

Sodium Chloride (0.9%) - Normal Saline

Indications: 

Extracellular fluid replacement when Cl- loss is equal to or greater the Na loss.

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Treatment of matebolic alkalosis.

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Na depletion

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Initiating and terminating blood transfusions.

Possible side effects: 

Hypernatremia

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Acidosis

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Hypokalemia

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Circulatory overload.

b. Fivepercent dextrose in water (D5W). 

Provides calories for energy, sparring b ody protein and preventing ketosis resulting from fat breakdown.

Indications: 

Dehydration

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Hypernatremia

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Drug administration

Possible side effects: 

Hypokalemia

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Osmotic diuresis  – dehydration

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Transient hyperinsulinism

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Water intoxication.

c. Fivepercent dextrose in normal saline (D5NS). 

Prevents ketone formation and loss of potassium and intracellular water.

Indications: 

Hypovolemic shock – temporary measure.

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Burns



Acute adrenocortical insufiency.

Possible side effects: 

Hypernatremia

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Acidosis

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Hypokalemia

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Circulatory overload

d. Isotonic multiple-electrolyte fluids. 

Used for replacement therapy; ionic composition approximates blood plasma.

Types: 

a. Plasmanate

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b. Polysol

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c. Lactated Ringers

Indications: 

Vomiting

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Diarrhea

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Excessive diuresis

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Burns

Possible side effects: 

Circulatory overload.

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Lactated Ringers is contraindicated in severe metabolic acidosis and/or alkalosis and liver disease.

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Hypernatremia

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Acidosis

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Hypokalemia

2. Hypertonic solutions 

Fluids with an osmolarity much higher than 310 mOsm (+ 50 mOsm); increase osm otic pressure of blood plasma, thereby drawing fluid from cells.

a. Tenpercent dextrose in normal saline 

Administered in large vein to dilute and prevent venous trauma.

Indications: 

Nutrition



Replenish Na and Cl.

Possible side effects: 

Hypernatremia (excess Na)

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Acidosis (excess Cl)

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Circulatory overload.

b. Sodium Chloride solutions, 3% and 5% Indications:

3. 



Slow administration essential to prevent overload (100 mL/hr)

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Water intoxication

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Severe sodium depletion

Hypotonic solutions Fluids whose osmolarity is significantly less than that of blood plasma (-50 mOsm); these fluids lower plasma osmotic pressure, causing fluid to enter cells.

a. 0.45% sodium chloride 

Used for replacement when requirement for Na use is questionable.

b. 2.5% dextrose in 0.45% saline, also 5% in 0.2 % NaCl 

Common rehydrating solution.

Indications: 

Fluid replacement when some Na replacement is also necessary.

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Encourage diuresis in clients who are dehydrated.

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Evaluate kidney status before instituting electrolyte infusions.

Possible side effects: 

Hypernatremia

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Circulatory overload

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Used with caution in clients who are edematous, appropriate electrolytes should be g iven to avoid hypokalemia.

Table of Commonly Used IV Solutions Name of Solution

Type of Solution Hypotonic pH 5.6

Ingredients in 1-Liter 77 mEq Sodium 77 mEq Chloride

Isotonic pH 5.7

154 mEq Sodium 154 mEq Chloride

Hypertonic pH 5.0

513 mEq Sodium 513 mEq Chloride

5% Sodium Chloride

Hypertonic pH 5.8

5% Dextrose in Water

Isotonic pH 5.0

0.45% Sodium Chloride Shorthand Notation: ½NS 0.9% Sodium Chloride

Uses

Complications

hypotonic hydration; replace sodium and chloride; hyperosmolar diabetes

if too much is mixed with blood cells during transfusions, the cells will pull water into them and rupture

isotonic hydration; replace sodium and chloride; alkalosis; blood transfusions (will not hemolyze blood cells)

None known

855 mEq Sodium 855 mEq Chloride

symptomatic hyponatremia due to excessive sweating, vomiting, renal impairment, and excessive water intake

rapid or continuous infusion can result in hypernatremia or hyperchloremia

5 grams dextrose (170 calories/liter)

isotonic hydration; provides some calories

Shorthand Notation: NS 3% Sodium Chloride

Shorthand Notation: D5W 10% Dextrose in Water

Hypertonic pH 4.3

10 grams dextrose (340 calories/liter)

may be infused peripherally; hypertonic hydration; provides some calories

Hypertonic pH 4.4

5 grams Dextrose 34 mEq Sodium 34 mEq Chloride

fluid replacement; replacement of sodium, chloride and some calories

Hypertonic

5 grams Dextrose 77 mEq Sodium 77 mEq Chloride

hypertonic fluid replacement; replace sodium, chloride, and some calories

Hypertonic pH 4.4

5 grams Dextrose 154 mEq Sodium 154 mEq Chloride

hypertonic fluid replacement; replace sodium, chloride and some calories

Isotonic

147 mEq Sodium

electrolyte replacement;

Shorthand Notation: D10W 5% Dextrose in 1/4 Strength (or 0.25%) Saline

water intoxication and dilution of body’s electrolytes with long, continuous infusions

Shorthand Notation: D5¼NS

5% Dextrose in 0.45 Sodium Chloride

pH 4.4

Shorthand Notation: D5½NS 5% Dextrose in Normal Saline

vein irritation because of acidic pH, causes agglomeration (clustering) if used with blood transfusions; hyperglycemia with rapid infusion leading to osmotic diuresis

Shorthand Notation: D5NS Ringer’sInjection, U.S.P.

rapid administration leads to

Lactated Ringer’s

pH 5.8

4 mEq Potassium 4 mEq Calcium 155 mEq Chloride

hydration; often used to replace extracellular fluid losses

Isotonic pH 6.6

130 mEq Sodium 4 mEq Potassium 3 mEq Calcium 109 mEq Chloride

isotonic hydration; replace electrolytes and extracellular fluid losses; mild to moderate acidosis (the lactate is metabolized into bicarbonate which counteracts the acidosis)

Shorthand Notation: LR

28 mEq Sodium Lactate (provides 9 calories/liter)

5% Dextrose in Lactated Ringer’s Injection Shorthand Notation: D5LR

Hypertonic pH 4.9

5 grams Dextrose (170 calories/liter) 130 mEq Sodium 4 mEq Potassium 3 mEq Calcium 109 mEq Chloride 28 mEq Sodium Lactate (provides 9 calories/liter)

hypertonic hydration; provides some calories; replace electrolytes and extracellular fluid losses; mild to moderate acidosis (the lactate is metabolized into bicarbonate which counteracts the acidosis), the dextrose minimizes glycogen depletion

excessive introduction of electrolytes and leads to fluid overload and congestive conditions; provides no calories and is not an adequate maintenance solution if abnormal fluid losses are present

not enough electrolytes for maintenance; patients with hepatic disease have trouble metabolizing the lactate; do not use if lactic acidosis is present