Isotonic Solutions: Ringer's, Lactated Ringer's & D5W

Isotonic Solutions

• Increases vascular and ECF volumes
• Replaces sodium
• Causes no fluid shift
• May cause fluid overload and generalized edema
• Dilutes Hgb and lowers Hct levels
• May cause electrolyte imbalances
• Inflammatory in high doses

Ringer's Solution & Lactated Ringer's Solution (LR)

• Lactate is metabolized by the liver to form bicarbonate
• Useful in treating metabolic acidosis
• Provides hydration with electrolytes
• May cause fluid overload and generalized edema (Overhydration)
• Dilutes Hgb & lowers Hct
• Use with cautions in patients with renal insufficiency, CHF and conditions in which K+ retention is present
• May be contraindicated in patient with hyperkalemia and hypernatremia
• Excessive administration of LR may result in metabolic alkalosis

D5W

• Dextrose can increase blood glucose levels, too much glucose in the blood can cause diuresis
• D5W is isotonic when infused and quickly becomes hypotonic in the body as the dextrose is metabolized rapidly
• May cause hyperglycemia osmotic diuresis or both

Hypotonic Solutions

• Provides calories and free water
• Provides glucose for metabolism
• Hydrates the cells
• Treats hyperkalemia via dilutional effect
• Shifts fluid from the intravascular space to the intracellular space
• May cause fluid overload, water intoxication or both
• Check compatibility before adding medications to dextrose solution
• May irritate veins
• May worsen hypotension
• May increase edema
• May cause hyponatremia

0.225% NS & 0.45% NS

• Hydrates the cells
• Replaces fluids when sodium intake must be restricted
• Shifts fluid out of the intravascular space into the intracellular space causing the cells to swell
• May cause fluid overload
• May worsen hypotension because water moves out of the vascular space
• May increase edema because water moves into the cells and interstitial spaces
• May cause dilutional hyponatremia because the sodium content is less than that of the plasma
• DO NOT GIVE Hypotonic fluids with patients who have Increased Cranial Pressure

Hypertonic Solutions

• Decreases cerebral edema
• Replaces electrolytes
• Shifts fluid from the intracellular compartment into the intravascular space, expanding vascular volume
• May cause fluid overload
• D5NS may cause hypernatremia related to sodium content
• Hypertonic solutions may be irritating to veins
• Check compatibility before adding meds to dextrose solutions

3% NS & 5% NS

• Supplies sodium to the body; treats hyponatremia
• Decreases inflammation and increases capillary permeability
• Shifts fluid from the intracellular compartment into the intravascular space
• May cause fluid overload
• May cause cells to shrink (cellular dehydration) as fluid is drawn out of the cells
• Hypertonic solutions may be irritating to veins
• May cause hypernatremia
• Use with extreme caution

Osmosis & IV Solutions

• Isotonic IV solution increases intravascular volume without causing fluid to move into or out of the cells as it has the same osmolarity/tonicity as body plasma (Intravascular fluid)
• Hypertonic IV solution pulls fluid from the intracellular space and places the fluid into the extracellular space (Intravascular/Interstitial compartment) via osmosis, which restores intravascular volume and reduces edema from the interstitial space. Cells shrink! Higher osmotic pressure/osmolality/tonicity.
• Hypotonic IV solution causes fluid to move rapidly out of the intravascular space and into the cells (intracellular compartment) preventing or correcting cellular dehydration. Cells swell! Lower osmotic pressure/osmolality/tonicity.

Nursing Considerations

• Monitor daily weights & then vital signs, as well as other signs and symptoms that are specific for the condition that they have.

Colloid Solutions

• Colloid solutions (Volume expanders) are large particles which do NOT pass-through semipermeable membranes, causing them to remain in the blood vessels
• They work by drawing fluid from the interstitial space into the vessels through higher oncotic pressure

Albumin

• Albumin (5%, 25%) can be used for moderate protein replacement in malnourished clients or clients who cannot tolerate large amounts of IV fluids
• Albumin is considered a blood transfusion product. Nursing precautions and protocol need to be followed when administering albumin
• Contraindicated in clients with severe anemia, and heart failure