IV fluid solutions can be very overwhelming to study, but we broke each part down so that it is simplified!

The last thing you want to do is just be a robot that follows orders. You need to be aware of which IV fluid solutions you are administering to your patients. As a nurse, you should know if the solution is hypertonic, isotonic, or hypotonic.

Common IV fluid solution packagings come in different sizes, such as 50mL, 100mL, 250mL, 500mL, and 1000mL. The IV fluid solutions are considered sterile. When you open the packaging and you notice that the bag is wet or you see a leak, it must be discarded because the IV fluid solution is considered contaminated.

Nursing Management of IV Fluid Solutions

  • Assess for response to IV Fluid Therapy
  • Monitor intake and output
  • Elevate head of bed, unless directed otherwise
  • Elevate legs if edema is present
  • Assess for potential hypervolemia
  • Treat IV fluids as a medication by observing for allergy response, administering to the right patient, right dosage, right route, right order, and at the right time

Signs and Symptoms of Hypervolemia

  • Hypertension
  • Bounding pulse
  • Pulmonary crackle
  • Dyspnea
  • Shortness of breath
  • Jugular venous distention

You should know understand and be aware of signs and symptoms of hypovolemia:

  • Poor urine output
  • Poor skin turgor
  • Tachycardia
  • Hypotension
  • Dehydration

Fluid therapy can be lifesaving and is given when there is a loss of body water. Remember that it can cause a lot of harm when give in the wrong situation.

Hypertonic, isotonic, and hypotonic are subcategories of crystalloid.

Hypertonic
Osmolarity is greater than body fluid

Isotonic
Osmolarity is equal to body fluid

Hypotonic
Osmolarity is less than body fluid

To understand hypertonic, isotonic, and hypotonic, you must understand the process of osmosis. With osmosis, just remember LOW to HIGH.

Osmosis is the process of molecules moving from a less concentrated solution to a higher concentrated solution by passing through a semipermeable membrane.

Water is vital for the body to function. 60% of the total body weight is the total body fluid, which can be divided into intracellular and extracellular.

2/3 of the total body water is intracellular fluid so the remaining 1/3 of the total body water is the extracellular fluid. Extracellular fluid is categorized as interstitial, intravascular, and 3rd space.

Types of Fluid

Fluids are categorized as colloids, crystalloids, and blood products.

1. Colloid

Large molecules are inside the solutions that will not be able to pass the cell membranes. Thus, the large molecules will remain in the intravascular compartment.

Types of Colloid Solutions

5% albumin (Human albumin solution)

  • Most commonly used colloid solutions
  • Expensive
  • Limited due to the number of human donors

Cannot be given for those with:

  • Severe anemia
  • Heart failure
  • Albumin sensitivity

Hydroxyethalstarches

Hydroxyethalstarches is less expensive than 5% albumin and can be used after a major surgery and severe burns.

What You Need to Know About Using Colloid Solutions:

  • Risk for fluid volume overload – watch for signs and symptoms
  • Use 18-gauge needles when administering colloid solutions
  • Can cause increased bleeding time

2. Crystalloid

Small molecules in the solutions that will be able to flow across the cell membranes. The small molecules can transfer from the bloodstream into the cells.


Subcategories of Crystalloid:

  • Isotonic
  • Hypotonic
  • Hypertonic

Isotonic Solution

Isotonic solution is also known as normal saline solution. Isotonic solution is given to ensure that the cells remain in the extracellular compartment. Goal is to increase the intravascular volume. We want to treat low extracellular fluid so it makes sense that we’d use isotonic solution to keep cells in the extracellular compartment.

Isotonic solutions are given for:

  • Hemorrhage
  • Diarrhea
  • Vomiting
  • Fistulas (Dialysis)
  • Wounds
  • GI suction
  • Shock
  • Metabolic acidosis
  • Fluid used with administering blood products

Types of Isotonic Solutions:

0.9% sodium chloride (0.9% NaCl)

  • Replaces extracellular fluid
  • Use cautiously for those with cardiac or renal disease
  • Observe for fluid volume overload

Lactated Ringer’s solution

  • Most adaptable fluid
  • Electrolyte content is closest to body’s blood serum and plasma composition
  • First choice of fluid for burn injuries
  • Do not give to patients with kidney failure due to the amount of potassium LR’s solution contains. Kidney cannot excrete the potassium well.
  • Do not administer when pH is greater than 7.5

5% dextrose in water (D5W)

  • D5W Solution is isotonic until dextrose is metabolized.
  • After dextrose is metabolized, the D5W solution becomes hypotonic. (Fluid shift into cells.)
  • Does not replace electrolytes.
  • Contraindicated with renal failure or cardiac disease.
  • Contraindicated with intracranial pressure or risk for intracranial pressure.
  • Do not mix dextrose with blood due to hemolysis potential.

Ringer’s solution

  • Contains sodium, potassium, calcium, and chlorine.
  • Does not contain lactate like LR.

Hypotonic Solution

Hypotonic solutions have a lower concentration of solutes.

Hypotonic solution hydrate the cells, but causes fluid depletion in the circulatory system. (Fluid shift from intravascular space to intracellular and interstitial spaces.)

Hypotonic solutions lower serum sodium levels so it’s essential to monitor sodium levels.

Types of Hypotonic Solutions:

  • 45% sodium chloride (0.45% NaCl)
  • 33% sodium chloride
  • 2% sodium chloride
  • 5% dextrose in water

Hypotonic solutions are given for conditions causing intracellular dehydration such as:

  • Hypernatremia
  • Diabetic ketoacidosis
  • Hyperosmolar hyperglycemic state

Contraindications of hypotonic solutions:

  • Increased intracranial pressure
  • Cerebral edema
  • Liver disease
  • Trauma
  • Burns
  • Low blood pressure – Blood pressure will continue to drop

Hypertonic Solution

Hypertonic solutions have a higher solute concentration.

Hypertonic solutions assist in restoring the circulating volume by bringing the water out of the intracellular space causing the extracellular fluid volume to increase. Hypertonic solutions are volume expanders.

Giving hypertonic solutions can cause a risk for hypernatremia and volume overload. Watch out for pulmonary edema and fluid volume overload.

Hypertonic solutions are given for hypovolemia and hyponatremia.

Types of Hypertonic Solutions:

  • D5W 1/2 NS (D5W 0.45% NS)
  • D5W 0.09% NS (D5W NS)
  • 3% sodium chloride (3% NaCl)

3% NaCl hypertonic solution’s given for severe hyponatremia or cerebral edema.