What are IV Fluids?  Volume expanders.

Are solutions used to

Intravenous fluids (IV Fluids), also known increase the blood volume after a severe
as intravenous solutions, are supplemental fluids blood loss, or loss of plasma. Examples of
used in intravenous therapy to restore or maintain volume expanders are dextran, human
normal fluid volume and electrolyte balance when albumin, and plasma.
the oral route is not possible. IV fluid therapy is an
efficient and effective way of supplying fluids directly Crystalloids
into the intravascular fluid compartment, in Crystalloid IV solutions contain small molecules that
replacing electrolyte losses, and in administering flow easily across semipermeable membranes. They
medications and blood products. are categorized according to their relative tonicity in
relation to plasma. There are three types: isotonic,
Types of IV Fluids hypotonic, and hypertonic.
There are different types of IV fluids and different
ways on how to classify them. Isotonic IV Fluids
Most IV fluids are isotonic, meaning, they have the
The most common way to categorize IV fluids is same concentration of solutes as blood plasma.
based on their tonicity: When infused, isotonic solutions expand both the
intracellular fluid and extracellular fluid spaces,
 Isotonic. Isotonic IV solutions that have the same equally. Such fluids do not alter the osmolality of the
concentration of solutes as blood plasma. vascular compartment. Technically, electrolyte
solutions are considered isotonic if the total
 Hypotonic. Hypotonic solutions have lesser electrolyte content is approximately 310 mEq/L.
concentration of solutes than plasma. Isotonic IV fluids have a total osmolality close to that
of the ECF and do not cause red blood cells to shrink
 Hypertonic. Hypertonic solutions have greater or swell.
concentration of solutes than plasma.
0.9% NaCl (Normal Saline Solution, NSS)
IV solutions can also be classified based on their Normal saline solution (0.9% NaCl) or NSS, is a
purpose: crystalloid isotonic IV fluid that contains water,
sodium (154 mEq/L), and chloride (154 mEq/L). It has
 Nutrient solutions. May contain an osmolality of 308 mOsm/L and gives no calories.
dextrose, glucose, and levulose to make up It is called normal saline solution because the
the carbohydrate component – and water. percentage of sodium chloride dissolved in the
Water is supplied for fluid requirements and solution is similar to the usual concentration of
carbohydrate for calories and energy. sodium and chloride in the intravascular
Nutrient solutions are useful in space. Normal saline is the isotonic solution of
preventing dehydration and ketosis. choice for expanding the extracellular fluid (ECF)
Examples of nutrient solutions include D5W, volume because it does not enter the intracellular
D5NSS. fluid (ICF). It is administered to correct
extracellular fluid volume deficit because it remains
 Electrolyte solutions. Contains varying within the ECF.
amounts of cations and anions that are
used to replace fluid and electrolytes for Normal saline is the IV fluid used alongside the
clients with continuing losses. Examples of administration of blood products. It is also used to
electrolyte solutions include 0.9 NaCl, replace large sodium losses such as in burn injuries
Ringer’s Solution, and LRS. and trauma. It should not be used for heart failure,
pulmonary edema, and renal impairment, or
 Alkalinizing solutions. Are administered to conditions that cause sodium retention as it may risk
treat metabolic acidosis. Examples: LRS. fluid volume overload.

 Acidifying solutions. Are used to counteract Dextrose 5% in Water (D5W)

metabolic alkalosis. D51/2NS, 0.9 NaCl. D5W (dextrose 5% in water) is a crystalloid isotonic
IV fluid with a serum osmolality of 252 mOsm/L.
D5W is initially an isotonic solution and provides free Continue monitoring during and after the
water when dextrose is metabolized (making it a infusion.
hypotonic solution), expanding the ECF and the ICF.  Observe for signs of fluid overload. Look for
It is administered to supply water and to correct an signs of hypervolemia such as hypertension,
increase in serum osmolality. A liter of D5W provides bounding pulse, pulmonary
fewer than 200 kcal and contains 50g of glucose. It crackles, dyspnea, shortness of breath,
should not be used for fluid resuscitation because peripheral edema, jugular venous
hyperglycemia can result. It should also be avoided distention, and extra heart sounds.
to be used in clients at risk for increased intracranial
pressure as it can cause cerebral edema.  Monitor manifestations of continued
hypovolemia. Look for signs that indicate
Lactated Ringer’s 5% Dextrose in Water (D5LRS) continued hypovolemia such as, decreased
Lactated Ringer’s Solution (also known as Ringer’s urine output, poor skin turgor, tachycardia,
Lactate or Hartmann solution) is a crystalloid isotonic weak pulse, and hypotension.
IV fluid designed to be the near-physiological
solution of balanced electrolytes. It contains 130  Prevent hypervolemia. Patients being
mEq/L of sodium, 4 mEq/L of potassium, 3 mEq/L treated for hypovolemia can quickly
of calcium, and 109 mEq/L of chloride. It also develop fluid overload following rapid or
contains bicarbonate precursors to prevent acidosis. over infusion of isotonic IV fluids.
It does not provide calories or magnesium and has
limited potassium replacement. It is the most  Elevate the head of the bed at 35 to 45
physiologically adaptable fluid because its electrolyte degrees. Unless contraindicated, position
content is most closely related to the composition of the client in semi-Fowler’s position.
the body’s blood serum and plasma.
 Elevate the patient’s legs. If edema is
Lactated Ringer’s is used to correct dehydration, present, elevate the legs of the patient to
sodium depletion, and replace GI tract fluid losses. It promote venous return.
can also be used in fluid losses due to burns, fistula
drainage, and trauma. It is the choice for first-line  Educate patients and families. Teach
fluid resuscitation for certain patients. It is often patients and families to recognize signs and
administered to patients with metabolic acidosis. symptoms of fluid volume overload. Instruct
Lactated Ringer’s solution is metabolized in the liver, patients to notify their nurse if they have
which converts the lactate to bicarbonate, therefore, trouble breathing or notice any swelling.
it should not be given to patients who cannot
metabolize lactate (e.g., liver disease, lactic acidosis).  Close monitoring for patients with heart
It should be used in caution for patients with heart failure. Because isotonic fluids expand the
failure and renal failure. intravascular space, patients
with hypertension and heart failure should
Ringer’s Solution be carefully monitored for signs of fluid
Ringer’s solution is another isotonic IV solution that overload.
has content similar to Lactated Ringer’s Solution but
does not contain lactate. Indications are the same Hypotonic IV Fluids
for Lactated Ringer’s but without the Hypotonic IV solutions have a lower osmolality and
contraindications related to lactate. contain fewer solutes than plasma. They cause fluid
shifts from the ECF into the ICF to achieve
Nursing Considerations for Isotonic IV Solutions homeostasis, therefore, causing cells to swell and
The following are the general nursing interventions may even rupture. IV solutions are considered
and considerations when administering isotonic hypotonic if the total electrolyte content is less than
solutions: 250 mEq/L. Hypotonic IV fluids are usually used to
provide free water for excretion of body wastes,
 Document baseline data. Before infusion, treat cellular dehydration, and replace the cellular
assess the patient’s vital signs, edema fluid.
status, lung sounds, and heart sounds.
  Risk for increased intracranial pressure
(IICP). Should not be given to patients with
risk for IICP as the fluid shift may cause
0.45% Sodium Chloride (0.45% NaCl) cerebral edema (remember: hypotonic
Sodium chloride 0.45% (1/2 NS), also known as half- solutions make cells swell).
strength normal saline, is a hypotonic IV solution
used for replacing water in patients who have  Monitor for manifestations of fluid volume
hypovolemia with hypernatremia. Excess use may deficit. Signs and symptoms
lead to hyponatremia due to the dilution of sodium, include confusion in older adults. Instruct
especially in patients who are prone to water patients to inform the nurse if they feel
retention. It has an osmolality of 154 mOsm/L and dizzy.
contains 77 mEq/L sodium and chloride. Hypotonic
sodium solutions are used to treat hypernatremia  Warning on excessive infusion. Excessive
and other hyperosmolar conditions. infusion of hypotonic IV fluids can lead to
intravascular fluid depletion,
0.33% Sodium Chloride (0.33% NaCl) decreased blood pressure, cellular edema,
0.33% Sodium Chloride Solution is used to allow and cell damage.
kidneys to retain the needed amounts of water and
is typically administered with dextrose to increase  Do not administer along with blood
tonicity. It should be used in caution for patients products. Most hypotonic solutions can
with heart failure and renal insufficiency. cause hemolysis of red blood cells especially
during rapid infusion of the solution.
0.225% Sodium Chloride (0.225% NaCl)
0.225% Sodium Chloride Solution is often used as a Hypertonic IV Fluids
maintenance fluid for pediatric patients as it is the Hypertonic IV solutions have a greater concentration
most hypotonic IV fluid available at 77 mOsm/L. of solutes (375 mEq/L and greater) than plasma and
Used together with dextrose. cause fluids to move out of the cells and into the ECF
in order to normalize the concentration of particles
2.5% Dextrose in Water (D2.5W) between two compartments. This effect causes cells
Another hypotonic IV solution commonly used to shrink and may disrupt their function. They are
is 2.5% dextrose in water (D2.5W). This solution is also known as volume expanders as they draw water
used to treat dehydration and decreased the levels out of the intracellular space, increasing extracellular
of sodium and potassium. It should not be fluid volume.
administered with blood products as it can cause
hemolysis of red blood cells. Hypertonic Sodium Chloride IV Fluids
Hypertonic sodium chloride solutions contain a
Nursing Considerations for Hypotonic IV Solutions higher concentration of sodium and chloride than
The following are the general nursing interventions normally contained in plasma. Infusion of hypertonic
and considerations when administering hypotonic IV sodium chloride solution shifts fluids from the
solutions: intracellular space into the intravascular and
Document baseline data. Before infusion, assess the interstitial spaces. Hypertonic sodium chloride IV
patient’s vital signs, edema status, lung sounds, and solutions are available in the following forms and
heart sounds. Continue monitoring during and after strengths:
the infusion.
3% sodium chloride (3% NaCl) containing 513 mEq/L
 Do not administer in contraindicated of sodium and chloride with an osmolality of 1030
conditions. Hypotonic solutions may mOsm/L.
exacerbate existing hypovolemia
and hypotension causing cardiovascular 5% sodium chloride (5% NaCl) containing 855 mEq/L
collapse. Avoid use in patients with liver of sodium and chloride with an osmolality of 1710
disease, trauma, or burns. mOsm/L.
Hypertonic sodium chloride solutions are used in the  Document baseline data. Before infusion,
acute treatment of sodium deficiency (severe assess the patient’s vital signs, edema
hyponatremia) and should be used only in critical status, lung sounds, and heart sounds.
situations to treat hyponatremia. They need to be Continue monitoring during and after the
infused at a very low rate to avoid the risk of infusion.
overload and pulmonary edema. If administered in  Watch for signs of hypervolemia. Since
large quantities and rapidly, they may cause an hypertonic solutions move fluid from the
extracellular volume excess and precipitate ICF to the ECF, they increase the
circulatory overload and dehydration. Therefore, extracellular fluid volume and increases the
they should be administered cautiously and usually risk for hypervolemia. Look for signs of
only when the serum osmolality has decreased to swelling in arms, legs, face, shortness of
critically low levels. Some patients may breath, high blood pressure, and discomfort
need diuretic therapy to assist in fluid excretion. It is in the body (e.g., headache, cramping).
also used in patients with cerebral edema.
 Monitor and observe the patient during
Hypertonic Dextrose Solutions administration. Hypertonic solutions should
Isotonic solutions that contain 5% dextrose (e.g., be administered only in high acuity areas
D5NSS, D5LRS) are slightly hypertonic since they with constant nursing surveillance for
exceed the total osmolality of the ECF. However, potential complications.
dextrose is quickly metabolized and only the isotonic
solution remains. Therefore, any effect on the ICF is  Verify order. Prescription for hypertonic
temporary. Hypertonic dextrose solutions are used solutions should state the specific
to provide kilocalories for the patient in the short hypertonic fluid to be infused, the total
term. Higher concentrations of dextrose (i.e., D50W) volume to be infused, the infusion rate and
are strong hypertonic solutions and must be the length of time to continue the infusion.
administered into central veins so that they can be
diluted by rapid blood flow.  Assess health history. Patients
with kidney or heart disease and those who
Dextrose 10% in Water (D10W) are dehydrated should not receive
Dextrose 10% in Water (D10W) is an hypertonic IV hypertonic IV fluids. These solutions can
solution used in the treatment of ketosis of affect renal filtration mechanisms and can
starvation and provides calories (380 kcal/L), free easily cause hypervolemia to patients with
water, and no electrolytes. It should be administered renal or heart problems.
using a central line if possible and should not be
infused using the same line as blood products as it  Prevent fluid overload. Ensure that
can cause RBC hemolysis. administration of hypertonic fluids does not
precipitate fluid volume excess or overload.
Dextrose 20% in Water (D20W)
Dextrose 20% in Water (D20W) is hypertonic IV  Do not administer peripherally. Hypertonic
solution an osmotic diuretic that causes fluid shifts solutions can cause irritation and damage to
between various compartments to promote the blood vessel and should be
diuresis. administered through a central vascular
Dextrose 50% in Water (D50W) access device inserted into a central vein.
Another hypertonic IV solution used commonly
is Dextrose 50% in Water (D50W) which is used to  Monitor blood glucose closely. Rapid
treat severe hypoglycemia and is administered infusion of hypertonic dextrose solutions
rapidly via IV bolus. can cause hyperglycemia. Use with caution
for patients with diabetes mellitus.
Nursing Considerations for Hypertonic IV Fluids
The following are the general nursing interventions Colloids
and considerations when administering hypertonic Colloids contain large molecules that do not pass
IV solutions: through semipermeable membranes. Colloids are IV
fluids that contain solutes of high molecular weight, thrombocytopenia, hypofibrinogenemia, and
technically, they are hypertonic solutions, which hypersensitivity to dextran.
when infused, exert an osmotic pull of fluids from
interstitial and extracellular spaces. They are useful High-molecular-weight Dextrans (HMWD)
for expanding the intravascular volume and raising HMWD contains polysaccharide molecules with an
blood pressure. Colloids are indicated for patients in average molecular weight of 70,000 (Dextran 70) or
malnourished states and patients who cannot 75,000 (Dextran 75). HMWD used for patients with
tolerate large infusions of fluid. hypovolemia and hypotension. They are
contraindicated in patients with hemorrhagic shock.
Human Albumin
Human albumin is a solution derived from plasma. It Etherified Starch
has two strengths: 5% albumin and 25% albumin. 5% These solutions are derived from starch and are used
Albumin is a solution derived from plasma and is a to increase intravascular fluid but can interfere with
commonly utilized colloid solution. It is used to normal coagulation. Examples include EloHAES,
increase the circulating volume and restore protein HyperHAES, and Voluven.
levels in conditions such as burns, pancreatitis, and
plasma loss through trauma. 25% Albumin is used Gelatin
together with sodium and water restriction to Gelatins have lower molecular weight than dextrans
reduce excessive edema. They are considered blood and therefore remain in the circulation for a shorter
transfusion products and uses the same protocols period of time.
and nursing precautions when administering
albumin. Plasma Protein Fraction (PPF)
Plasma Protein Fraction is a solution that is also
The use of albumin is contraindicated in patients prepared from plasma, and like albumin, is heated
with the following conditions: severe anemia, heart before infusion. It is recommended to infuse slowly
failure, or known sensitivity to albumin. Additionally, to increase circulating volume.
angiotensin-converting enzyme inhibitors should be
withheld for at least 24 hours before administering Considerations for Colloid IV Solutions
albumin because of the risk of atypical reactions, The following are the general nursing interventions
such as hypotension and flushing. and considerations when administering colloid IV
solutions:
Dextrans
Dextrans are polysaccharides that act as colloids.  Assess allergy history. Most colloids can
They are available in two types: low-molecular- cause allergic reactions, although rare, so
weight dextrans (LMWD) and high-molecular-weight take a careful allergy history, asking
dextrans (HMWD). They are available in either saline specifically if they’ve ever had a reaction to
or glucose solutions. Dextran interferes with blood an IV infusion before.
crossmatching, so draw the patient’s blood before
administering dextran, if crossmatching is  Use a large-bore needle (18-gauge). A larger
anticipated. needle is needed when administering
colloid solutions.
Low-molecular-weight Dextrans (LMWD)
LMWD contains polysaccharide molecules that  Document baseline data. Before infusion,
behave like colloids with an average molecular assess the patient’s vital signs, edema
weight of 40,000 (Dextran 40). LMWD is used to status, lung sounds, and heart sounds.
improve the microcirculation in patients with poor Continue monitoring during and after the
peripheral circulation. They contain no electrolytes infusion.
and are used to treat shock related to vascular
volume loss (e.g., burns, hemorrhage, trauma,  Monitor the patient’s response.
or surgery). On certain surgical procedures, LMWDs Monitor intake and output closely for signs
are used to prevent venous thromboembolism. They of hypervolemia, hypertension, dyspnea,
are contraindicated in patients with crackles in the lungs, and edema.
 Monitor coagulation indexes. Colloid
solutions can interfere with platelet
function and increase bleeding times, so
monitor the patient’s coagulation indexes.