Intravenous Fluids and Body Responses
Common hypotonic IV solutions
0.45% Normal Saline (½ NS)
Common hypotonic IV solutions
0.33% Normal Saline
Common hypotonic IV solutions
0.225% Normal Saline
Common hypotonic IV solutions
D5W (acts hypotonic once glucose is metabolized)
When do we use hypotonic solutions?
Cellular dehydration
(cells are shriveled → need water)
When do we use hypotonic solutions?
Hypernatremia
(high sodium pulls water out of cells → hypotonic fluids push water back in)
When do we use hypotonic solutions?
Diabetic ketoacidosis (after initial isotonic fluids)
Avoid hypotonic fluids in
Isotonic Solutions
primarily to increase circulating volume
common Isotonic IV Solutions
0.9% Normal Saline (NS)
common Isotonic IV Solutions
Lactated Ringer’s (LR)
common Isotonic IV Solutions
⚠️ NCLEX note:
D5W becomes
hypotonic once glucose is metabolized.
When do we use isotonic solutions?
Indications
➡️ Think: “Circulation first”
Risks & nursing considerations
Isotonic fluids expand circulating volume without
causing cell size changes.
A hypertonic solution has
MORE solute than blood.
Water moves OUT of the cells and INTO the bloodstream
What happens to the cells with hypertonic solutions
Common hypertonic IV solutions
3% Normal Saline
Common hypertonic IV solutions
5% Normal Saline
Common hypertonic IV solutions
D5NS
Common hypertonic IV solutions
D5½ NS
Common hypertonic IV solutions
D10W
What is the goal for hypertonic solutions?
Pull water OUT of cells and INTO circulation
When do we use hypertonic solutions?
Severe hyponatremia
When do we use hypertonic solutions?
Cerebral edema
When do we use hypertonic solutions?
Increased intracranial pressure
When do we use hypertonic solutions?
Fluid shifting into tissues (third spacing)
Plasma is the
water make-up of your blood
Body fluids are distributed between
intracellular fluid(ICF) and extracellular fluid(ECF)
intracellular fluid(ICF) lies within body cells and constitutes
two thirds of the total body fluids in adults
extracellular fluid(ECF) is made up of
intravascular(plasma), interstitial(fluids that surround the cell), lymph, and transcellular fluids(cerebrospinal, pericardial, pancreatic, pleural, intraocular, biliary, peritoneal, and synovial fluids
fluid can move between compartments(through selectively permeable membranes) by a variety of methods which include
diffusion, active transport, filtration, and osmosis in order to maintain homeostasis
Isotonic Fluid Volume Deficit (FVD) / Hypovolemia means
Common causes of isotonic fluid volume deficit include
Excessive gastrointestinal(GI) loss: vomiting, diarrhea, nasogastric suctioning
Common causes of isotonic fluid volume deficit include
Excessive Skin Loss: excessive sweating(diaphoresis), without sodium replacement
Common causes of isotonic fluid volume deficit include
Excessive renal system losses: diuretic therapy (water pill), kidney disease, adrenal insufficiency (keeps sodium and water in the body)
Common causes of isotonic fluid volume deficit include
burns(swelling somewhere unusual)
Common causes of isotonic fluid volume deficit include
Hemorrhage or plasma loss
Common causes of isotonic fluid volume deficit include
anorexia, nausea, impaired swallowing, confusion, NPO, decreased intake of water and sodium
causes of dehydration
prolonged fever
causes of dehydration
Hyperventilation or excessive sweating without water replacement
causes of dehydration
diabetic ketoacidosis (A life-threatening complication of diabetes (usually Type 1) caused by not enough insulin.
causes of dehydration
insufficient water intake
causes of dehydration
diabetes insipidus (A condition where the body can’t concentrate urine because of a problem with ADH (antidiuretic hormone).
causes of dehydration
Excess solutes in the urine pull water with them, causing large urine output.
causes of dehydration
excessive intake of salt, salt tablets, or hypertonic IV fluids