Intravenous Solutions and Plasma Expanders for Nursing Exams

Intravenous-Solutions-and-Plasma-ExpandersWe are daily using different Intravenous Solutions for various patients suffering with different medical conditions. We don’t even look for their content, concentration and other things written on the label that these solutions are having. But for your kind information, examiners will definitely look into those small details and questions will be asked. Those questions will be very simple but will be confusing. Nurseshere.com, through this article is trying to sort out this issue. Lets study in detail about various intravenous solutions in use.

Before going into deep, let us learn the basics.

TYPES OF SOLUTIONS

There are three types of solutions. They are Hypotonic solutions, Hypertonic solutions and Isotonic solutions. Osmosis is the basic principle that lie behind this classification. Osmosis is the process of diffusion of water molecules from an area of higher concentration to an area of lower concentration through a semipermeable membrane.

Hypotonic solution – In hypotonic solution – “Solute concentration is less and water concentration is more”. So in turn cell increases in size as water enters the cell. Eg. Raisin getting bigger in water

Mnemonic – Hypo – Cell is going to blow

Isotonic solution – In isotonic solution – “Solute concentration is equal to cell and water moves in and out of the cell frequently”. The cell remains the same size. Eg. Red blood Cell

Mnemonic – Iso – In is the Same as Out

Hypertonic solution – In hypertonic solution – “Solution has less water and cell has more water”. As a result water leaves the cell making it shrink in size.

Eg. Carrot in salt water

Intravenous solutions

  1. Normal Saline – Normal saline is 0.9% Nacl in water. It is a crystalloid and isotonic solution. Osmolarity – 308 mOsm

Uses – Increases circulating plasma volume when red cells are adequate. Used in case of shock, Diabetic Ketoacidosis (fluid replacement), blood transfusions, Resuscitation, Metabolic alkalosis and Hypercalcemia.

Contraindications – Use with caution in case of patients with Heart Failure, Oedema, Hypernatremia (Reason – Fluid overload)

     2.  1/2 Normal Saline – 0.45% NaCl in water. This is a crystalloid hypotonic solution with 154 mOsm.

Uses – Used in Water replacement, increasing fluid volume, Hypertonic dehydration, Sodium and Chloride depletion, Gastric fluid loss from nasogastric sucioning or vomiting.

Contraindications and special considerations – Do no use for Liver diseases, trauma or burns. Can cause cardiovascular collapse and increase in ICP. Used in fluid replacement of diabetic patients.

3.  Ringer Lactate Solution – Content is Normal saline with electrolytes and buffer. Isotonic solution with osmolality of 275mOsm.

Uses – Replaces fluid and buffers pH. Used in Hypovolemia, Dehydration, Burns, Lower GI Tract fluid loss and Acute Blood loss.

Special Considerations – Has pottassium, so don’t use for patient with renal faliure as it can cause hyperkalemia. Don’t use in liver diseases as patient can’t metabolize lactate. (Normally lactate gets converted into bicarbonate in healthy liver) Except of Magnesium, Ringer Lactate Solution is similar to human serum.

4. 5% Dextrose Solution – This is 5% dextrose in water crystalloid, isotonic sloution. But physiologically it is hypotonic with osmolality of 260 mOsm.

Uses – Raises total fluid volume, Helps in rehydration and excretion and solves hypernatremia.

Special Considerations

Solution will become hypotonic when dextrose is metabolized

Causes fluid overload in patients with renal and cardiac disease.

Provides 170-200 calories/1L of 5% Dextrose

5. DNS Solution – DNS Solution is 5% dextrose in 0.9% Saline. It is a hypertonic solution with osmolality value of 560 mOsm

Uses – In hypotonic dehydration, replaces fluid sodium, chloride and calories, Second drug of choice in circulatory insufficiency (first being plasma expanders), Used in case od SIADH and Addisonian crisis.

Special Considerations

Use with caution in patients with Cardiac and Renal failure.

Watch for signs of fluid volume overload.

6. D51/2NS – Dextrose 5% in 0.45% saline. Hypertonic solution with 406 osmolality.

Uses – Most common postoperative fluid

7. D5LR – Dextrose 5% in Lactated Ringer’s. Hypertonic solution with 575 mOsm.

Uses – Same as RL solution, but provides more calories

Contraindications – Newborns due to risk of fatal ceftriaxone – calcium salt precipitation.

8. Normosol-R – Isotonic solution with 295mOsm

Uses – Replaces fluid and buffers pH, Indicated in burns, surgery, trauma and shock.

Intravenous Solutions

Now you have an idea about common crystalloids used for fluid and electrolyte balance in body. But this article is not complete without telling about Colloids.

What are colloids?

Colloids are given to preserve a high colloid osmotic pressure in blood. Colloids increase the intravascular volume. They are of two types – One is commonly used Hydroxyethyl starch and other one is Gelovusine.

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