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IV FLUIDS

IV FLUIDS. E Stanton RN MSN/ED, CEN, CCRN, CFRN. There are three main types of fluids. ISOTONIC HYPOTONIC HYPERTONIC. Isotonic fluids .

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IV FLUIDS

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  1. IV FLUIDS E Stanton RN MSN/ED, CEN, CCRN, CFRN

  2. There are three main types of fluids • ISOTONIC • HYPOTONIC • HYPERTONIC

  3. Isotonic fluids  • Close to the same osmolarity as serum. They stay inside the intravascular compartment, thus expanding it. Can be helpful in hypotensive or hypovolemic patients. Can be harmful. There is a risk of fluid overloading, especially in patients with CHF and hypertension. Isotonic fluids contain an approximately equal number of molecules (blue dots) SEE NEXT SLIDE as serum so the fluid stays within the intravascular space. Remember that fluid flows from an area of lower concentration of molecules to an area of high concentration of molecules (osmosis) to achieve equilibrium (fluid balance). In this example, there is no fluid flow into or out of the intravascular space.

  4. Examples: Lactated Ringer's (LR), 0.9 NS

  5. Hypotonic fluids  • Have less osmolarity than serum (i.e., it has less sodium ion concentration than serum). It dilutes the serum, which decreases serum osmolarity. Water is then pulled from the vascular compartment into the interstitial fluid compartment. Then, as the interstitial fluid is diluted, its osmolarity decreases which draws water into the adjacent cells.  Can be helpful when cells are dehydrated such as a dialysis patient on diuretic therapy. May also be used for hyperglycemic conditions like diabetic ketoacidosis, in which high serum glucose levels draw fluid out of the cells and into the vascular and interstitial compartments. Can be dangerous to use because of the sudden fluid shift from the intravascular space to the cells. This can cause cardiovascular collapse and increased intracranial pressure (ICP) in some patients

  6. D5NS.45 (5% dextrose in 1/2 normal saline). Hypotonic fluids contain a lower number of molecules than serum so the fluid shifts from the intravascular space to the interstitial space (represented by the green arrows). This decreases the interstitial space osmolarity (because of the increase of fluid and constant number of molecules within it), which then causes fluid to move into the cellSsNote that the green arrows represent fluid movement, not molecule movement.

  7. Hypertonic fluids  • Have a higher osmolarity than serum. Pulls fluid and electrolytes from the intracellular and interstitial compartments into the intravascular compartment. Can help stabilize blood pressure, increase urine output, and reduce edema.  Rarely used in the prehospital setting. Care must be taken with their use. Dangerous in the setting of cell dehydration.

  8. Table of Commonly Used IV Solutions(MOST COMMON HIGHLIGHTED IN YELLOW)

  9. Examples: 9.0% NS, blood products, and albumin. Hypertonic fluids Contain a higher number of molecules than serum so the fluid shifts from the interstitial space to the intravascular space (represented by the green arrows). This increases the interstitial space osmolarity (because of the loss of fluid and constant number of molecules within it) that then causes fluid to leak out of the cells. • *

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