What type of iv fluids

Hypotonic crystalloids can be used to correct free water deficits and as a maintenance fluid if there is free water loss. Maintenance fluid therapy with hypotonic solutions can cause iatrogenic hyponatremia and cerebral edema.

Hypertonic saline solutions must be administered with extreme caution because of the risk of rapid osmotic changes. When administering hypertonic saline , frequent serum sodium controls must be conducted so that treatment can be adjusted accordingly. A rapid increase in serum sodium can lead to osmotic demyelination syndrome.

The following list is not exhaustive, but it includes some very commonly used formulations. The tonicity of a mixed solution is determined by the concentration of solutes that cannot cross the membranes freely e. Concentrated crystalloids are typically administered like medications rather than fluids, e.

Avoid the use of colloids unless guided by a specialist or under specific circumstances e. The use of artificial colloids is controversial because their advantage over crystalloids has not been proven and their side effects, e.

They should only be prescribed in consultation with a specialist. The flow rate is subject to Poiseuille's law : The flow rate is 16 times slower if a lumen's diameter is halved, but flow rate doubles if the catheter's length is halved!

References: [26]. Intravenous fluid management is one of the most common in-hospital interventions. Patients may present with multiple indications for IV fluid therapy, which can evolve over the course of their illness and response to treatment.

These include: [2] [3]. Hypovolemic patients with significant or active bleeding should receive transfusions of blood products as soon as possible. Parenteral fluids are only a temporizing measure in the management of hemorrhage. Monitoring and evaluation include baseline evaluations and frequent reassessments of clinical e.

Consider a fluid challenge to differentiate between hypovolemia and euvolemia if other clinical signs are unclear or cannot be assessed. Hypovolemic shock. Immediate hemodynamic support with aggressive IV fluid resuscitation. Hypovolemia or dehydration without shock. Judicious fluid replacement e. Replacement of ongoing fluid loss. Correction of free water deficit. Maintenance fluid therapy.

De-escalation of IV fluid therapy. Patients in shock require monitoring of hemodynamic parameters , e. Fluids are also indicated in the postresuscitation phase , when the patient is no longer hypovolemic but still has ongoing abnormal fluid loss that cannot be compensated for by oral intake alone.

Replacement of free water is indicated to treat hypernatremia organ support phase. For most patients that require maintenance IV fluids, dextrose in isotonic crystalloids is a reasonable choice that prevents starvation ketosis as well as iatrogenic hyponatremia. However, maintenance fluids alone with dextrose do not fulfill a patient's nutritional requirements. The maintenance fluid requirement per kg of weight is higher in children than in adults. De-escalate IV fluids in patients who are stable e.

Interested in the newest medical research, distilled down to just one minute? Expand all sections Register Log in. Trusted medical expertise in seconds. Find answers fast with the high-powered search feature and clinical tools.

Try free for 5 days Evidence-based content, created and peer-reviewed by physicians. Read the disclaimer. Intravenous fluid therapy. Summary Intravenous fluid therapy involves the intravenous administration of crystalloid solutions and, less commonly, colloidal solutions.

Types of parenteral fluids Definitions [1] [2] Crystalloids : solutions that contain small molecular weight solutes e. Isotonic IV crystalloids [2] [8] [9] Normal saline 0. Clinical assessment of volume status Volume status Clinical signs Hypovolemia fluid deficit Clinical signs of significant dehydration e. Orthostasis Oliguria e. Fluid challenge [2] [27] [28] Steps Variables 1. Choose the type of fluid. Lactated Ringer's preferred in most clinical scenarios Normal saline 2.

Choose fluid rate and volume. Hypertonic sodium chloride solutions contain a higher concentration of sodium and chloride than normally contained in plasma. Infusion of hypertonic sodium chloride solution shifts fluids from the intracellular space into the intravascular and interstitial spaces. Hypertonic sodium chloride IV solutions are available in the following forms and strengths:.

Hypertonic sodium chloride solutions are used in the acute treatment of sodium deficiency severe hyponatremia and should be used only in critical situations to treat hyponatremia. They need to be infused at a very low rate to avoid the risk of overload and pulmonary edema.

If administered in large quantities and rapidly, they may cause an extracellular volume excess and precipitate circulatory overload and dehydration.

Therefore, they should be administered cautiously and usually only when the serum osmolality has decreased to critically low levels. Some patients may need diuretic therapy to assist in fluid excretion. It is also used in patients with cerebral edema. However, dextrose is quickly metabolized and only the isotonic solution remains. Therefore, any effect on the ICF is temporary. Hypertonic dextrose solutions are used to provide kilocalories for the patient in the short term.

Higher concentrations of dextrose i. It should be administered using a central line if possible and should not be infused using the same line as blood products as it can cause RBC hemolysis. The following are the general nursing interventions and considerations when administering hypertonic IV solutions:. Colloids contain large molecules that do not pass through semipermeable membranes. Colloids are IV fluids that contain solutes of high molecular weight, technically, they are hypertonic solutions, which when infused, exert an osmotic pull of fluids from interstitial and extracellular spaces.

They are useful for expanding the intravascular volume and raising blood pressure. Colloids are indicated for patients in malnourished states and patients who cannot tolerate large infusions of fluid.

Human albumin is a solution derived from plasma. It is used to increase the circulating volume and restore protein levels in conditions such as burns , pancreatitis , and plasma loss through trauma.

They are considered blood transfusion products and uses the same protocols and nursing precautions when administering albumin. The use of albumin is contraindicated in patients with the following conditions: severe anemia , heart failure, or known sensitivity to albumin. Additionally, angiotensin-converting enzyme inhibitors should be withheld for at least 24 hours before administering albumin because of the risk of atypical reactions, such as hypotension and flushing.

Dextrans are polysaccharides that act as colloids. They are available in either saline or glucose solutions. LMWD contains polysaccharide molecules that behave like colloids with an average molecular weight of 40, Dextran LMWD is used to improve the microcirculation in patients with poor peripheral circulation. They contain no electrolytes and are used to treat shock related to vascular volume loss e.

On certain surgical procedures, LMWDs are used to prevent venous thromboembolism. They are contraindicated in patients with thrombocytopenia, hypofibrinogenemia, and hypersensitivity to dextran.

HMWD contains polysaccharide molecules with an average molecular weight of 70, Dextran 70 or 75, Dextran HMWD used for patients with hypovolemia and hypotension. They are contraindicated in patients with hemorrhagic shock. These solutions are derived from starch and are used to increase intravascular fluid but can interfere with normal coagulation. When hypotonic IV solutions are infused, it results in a decreased concentration of dissolved solutes in the blood as compared to the intracellular space.

This imbalance causes osmotic movement of water from the intravascular compartment into the intracellular space. For this reason, hypotonic fluids are used to treat cellular dehydration.

However, if too much fluid moves out of the intravascular compartment into cells, cerebral edema can occur.

It is also possible to cause worsening hypovolemia and hypotension if too much fluid moves out of the intravascular space and into the cells. Therefore, patient status should be monitored carefully when hypotonic solutions are infused.

Hypertonic solutions have a higher concentration of dissolved particles than blood. When infused, hypertonic fluids cause an increased concentration of dissolved solutes in the intravascular space compared to the cells. This causes the osmotic movement of water out of the cells and into the intravascular space to dilute the solutes in the blood.

When administering hypertonic fluids, it is essential to monitor for signs of hypervolemia such as breathing difficulties and elevated blood pressure. Table D10 Used to treat severe hyponatremia and cerebral edema.

Monitor closely for hypervolemia, hypernatremia, and associated respiratory distress. Do not use it with patients experiencing heart failure, renal failure, or conditions caused by cellular dehydration because it will worsen these conditions. Osmolarity is defined as the proportion of dissolved particles in an amount of fluid and is generally the term used to describe body fluids. As the dissolved particles become more concentrated, the osmolarity increases.

Osmolality refers to the proportion of dissolved particles in a specific weight of fluid. The terms osmolarity and osmolality are often used interchangeably in clinical practice. Skip to content When patients experience deficient fluid volume, intravenous IV fluids are often prescribed.