Parenteral solutions are classified according to their tonicity relative to normal blood plasma. Here's how the three fluid types act in the body. That's why isotonic solutions such as 0. Because these solutions expand the intravascular compartment, closely monitor the patient for signs and symptoms of fluid overload, especially if he has a history of hypertension or heart failure.
Although D 5 W is isotonic in the bag, it acts like a hypotonic solution once it enters the bloodstream because simple sugars such as dextrose are the preferred energy source for cells.
The low concentration of dextrose in D 5 W is quickly consumed by the cells lining the vein and circulating in the bloodstream. Use this solution with caution in patients at risk for increased intracranial pressure ICP. The liver converts lactate to bicarbonate, so don't give lactated Ringer's solution if the patient has a serum blood pH above 7.
Potassium chloride may be added in low concentrations to replace losses from the gastrointestinal system. When a hypotonic solution is administered, it puts more water in the serum than is found inside cells. As a result, water moves into the cells, causing them to swell. Although hypotonic solutions help replace intracellular fluid, the extra water also moves into the cells of the tunica intima of the vein at the catheter insertion site.
This may cause the cells to swell and burst, exposing the vein's basement membrane and potentially leading to phlebitis and infiltration.
Watch all I. Because hypotonic solutions have the potential to cause sudden fluid shifts from blood vessels into cells, don't administer them indefinitely.
Stop infusing a hypotonic solution once the patient can drink enough to meet his fluid needs. Failing to do so could cause cardiovascular collapse from intravascular fluid depletion and increased ICP from fluid shift into brain cells.
Don't give hypotonic fluids to patients already at risk for increased ICP, such as those being treated for stroke or head trauma and those who've had neurosurgery. Also avoid giving hypotonic solutions to patients at risk for third-space fluid shifts, such as those with severe burns, traumatic injuries, or low-serum protein levels from malnutrition or liver disease. An example of a hypotonic IV solution is 0.
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. Hypotonic solutions are used when the cell is dehydrated and fluids need to be put back intracellularly.
This happens when patients develop diabetic ketoacidosis DKA or hyperosmolar hyperglycemia. Important : Watch out for depleting the circulatory system of fluid since you are trying to push extracellular fluid into the cell to re-hydrate it. Never give hypotonic solutions to patient who are at risk for increased cranial pressure can cause fluid to shift to brain tissue , extensive burns , trauma already hypovolemic etc.
When hypertonic solutions are used very cautiously…. In addition, it is prefered to give hypertonic solutions via a central line due to the hypertonic solution being vesicant on the veins and the risk of infiltration.
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