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Saturday, January 24, 2015

Everything You Need to Know About IV Fluids


IV fluids aren't nearly as luxurious as that graphic, but knowing these quick facts will keep you golden.

And no. That wasn't a reference to pee.

Purpose of IV Fluids

  • Replace abnormal fluid losses
  • Provide fluid maintenance
  • Correct existing imbalances
In nursing we will all have patients receiving fluids. It is imperative that you understand everything you need to know about IV fluids.

Usual Maintenance Needs

  • 2000 - 3000 mL of fluid/day
  • 50 - 150 mEq of Na/day
  • 40 - 60 mEq of K/day

Replacing Fluid Losses


What causes fluid loss? Vomiting, excessive sweating, diarrhea, hyperventilation, gastric suctioning, shock, trauma, and sepsis are all possible ways that your patient can be losing fluids. Depending upon their electrolytes dictates which solution to use.


Isotonic

The solution has the same salt concentration as cells and blood so movement of water in and out of the cells are balanced.

Hypotonic

The solution has a lower concentration than that found in cells and blood. The concentration of water is higher outside of the cell. Water moves into the cell and causes it to swell. So the cell can burst.

Hypertonic

The solution has a higher concentration than that found in cells and blood. The concentration of water is higher inside the cell verses outside. Water moves from the cell to outside the cell. Thus, we need to monitor these patients more closely for pulmonary edema, changes in neuro status, and serum sodium levels. Used in hemorrhagic shock, burn, or sepsis.

Quick Table Guide to IV Solutions


Type
Description
Osmolality
Use
Other
Normal
Saline
0.9% NaCl in Water

Crystalloid
Isotonic

308 mOsm/L
Increases circulating blood volume

Ideal for FVD with coexisting hyponatremia, hypochloremia, and matabolic alkalosis (vomiting, gastric suction)
Caution in patients with renal issues (because of sodium)

ONLY solution to be used when giving blood transfusion
1/2 Normal Saline
0.45% NaCl in Water

Crystalloid
Hypotonic

154 mOsm/L
Raise fluid volume

Ideal for hypovolemic patients with hypernatremia, or diabetics (contains no glucose)
Caution the excessive use can cause hyponatremia (especially in those that retain fluids)
Lactate
Ringers
Normal Saline with Electrolytes
Isotonic

274 mOsm/L
Replaces fluids and buffers pH

Used to increase plasma volume when hypovolemia is due to third - spacing
Often seen in surgery

Contains Na, Cl, K, Ca
D5W
Dextrose 5% in Water

Crystalloid
Isotonic (in the bag)

252 mOsm/L
Increases fluid volume

Given to provide free water
Caution can cause severe hyponatremia because it turns hypotonic when the dextrose is metabolized in the body
D5NS
Dextrose 5% in 0.9% NS
Hypertonic

560 mOsm/L
Rehydrates

Replaces sodium,  chloride, and dextrose

D5 1/2 NS
Dextrose 5% in 0.45% NS
Hypertonic

406 mOsm/L
Common for daily maintenance

Replaces sodium,  chloride, and dextrose
Most common post-op fluid
D5LR
Dextrose 5% in Lactated Ringers
Hypertonic

575 mOsm/L
Provides electrolytes and dextrose
Gluscose, Na, Cl, Ca, K

OK. That's a lot to digest!!

I hope that helps give a better understanding as to what's happening in our patients' bodies.

Here are some other posts you might find useful:
Overview of Hypernatremia

Is there a topic that you'd like for me to post on?? Leave a comment or send me an email!

Xoxo,

Nightingale

3 comments:

  1. I am a CVT and this has been so helpful! Thank you!

    ReplyDelete
  2. I am a CVT and this has been so helpful! Thank you!

    ReplyDelete
  3. Oh, good! I am glad that you found it helpful! Thanks for reading :)

    ReplyDelete