IV Fluids - HYPOTONIC & HYPERTONIC

HYPOTONIC - Types

0.45% NaCl 0.33% NaCl 2.5% dextrose water

HYPERTONIC - D5 ½ NS, D5LR, D10W, D50- Why

Adds calories to Na, electrolytes or water. D50 used in severe hypoglycemia.

HYPERTONIC - 3% NaCl - What it does

Draws water out of the intracellular space, increasing extracellular fluid volume. Because of this property, hypertonic solutions are used as volume expanders. Hypertonic solutions affect renal filtration mechanisms and can cause hypervolemia.

HYPOTONIC - What is does

Infusion causes an unequal solute concentration among the fluid compartments -- lowers the serum osmolality within the vascular space, causing fluid to shift from the intravascular space to both the intracellular and interstitial spaces. These solutions will hydrate cells, although their use may deplete fluid within the circulatory system.

HYPERTONIC - 3% NaCl - Why

Severe hyponatremia and patients with cerebral edema; will raise Na in bloodstream while osmosis removes water from intracellular space causing volume expansion.

HYPOTONIC - Nursing considerations

Can worsen hypovolemia and hypotension; can cause vascular collapse; monitor for volume deficit; older adults may show confusion or dizziness. NEVER give to increased ICP, liver disease, trauma or burns due to potential for hypovolemia.

HYPOTONIC - Why

Helps kidneys excrete excess fluids and electrolytes; provide free water and NaCl; treats intracellular dehydration (DKA, hyperosmolar hyperglycemia); shifts fluid from vascular bed into cells and interstitial spaces

HYPERTONIC - 3% NaCl - Nursing considerations

Used in critical situations; give slowly to avoid fluid overload and pulmonary edema. Store hypertonic NaCl solutions away from other floor stock and monitor for s/o hypervolemia due to fluid shifts; Do not give to renal or cardiac conditions who are dehydrated; Do not give to pts with cellular dehydration such as DKA (diabetic ketoacidosis).