Normal Saline

Composition: Each 100ml contains:

Sodium Chloride B.P ...................... 0.9g
Water for Injection ......................... Quantity Sufficient (q.s)

This composition results in:

 Sodium concentration: 154 mEq/L or 154 mmol/L

 Chloride concentration: 154 mEq/L or 154 mmol/L

The solution has an osmolarity of about 308 mOsm/L, Isotonic.

Available Strengths: 1000ml,500ml,100ml

Brand: Sterifuild-NS
Indications:  Fluid replacement:

 To treat or prevent dehydration

 To restore blood volume in cases of hypovolemia or shock

 Electrolyte replacement:

 To correct sodium and chloride deficiencies

 Intravenous (IV) therapy:

 As a vehicle for administering medications or other fluids

 For maintaining IV-line patency

 Wound care:

 Cleansing and irrigating wounds

 Moistening wound dressings

 Nasal irrigation:

 To clear nasal passages and sinuses

 Eye irrigation:

 To flush out foreign bodies or chemicals from eyes

 Nebulizer treatments:

 As a diluent for respiratory medications

 Dialysis procedures:
  Used in haemodialysis and peritoneal dialysis

 Surgical procedures:

 Irrigation during surgery

 Rinsing surgical instruments

 Laboratory use:

 As a control solution in various experiments

 For cell culture and tissue preservation

 Emergency situations:

 Initial fluid resuscitation in trauma or severe blood loss

Contraindications:  Fluid overload:

 Patients with congestive heart failure

 Those with severe renal impairment
 Cases of pulmonary edema

 Hypertonic states:

 Hypernatremia (high sodium levels)

 Severe hyperchloremia

 Metabolic alkalosis:

 Normal saline can worsen this condition due to its chloride content

 Severe hypertension:

 Caution is needed as fluid administration may increase blood pressure

 Certain types of edema:

 Peripheral edema
 Conditions with sodium retention

 Known hypersensitivity:

 Rare cases of allergy to components of the solution

Side effects:  Fluid overload:

 Edema
 Shortness of breath
 Increased blood pressure
 Electrolyte imbalances:

 Hypernatremia (high sodium levels)

 Hyperchloremia (high chloride levels)

 Metabolic acidosis:

 Due to the high chloride content, especially with large volume infusions

 Dilutional effects:

 Decreased hematocrit
 Lowered serum protein concentrations

 Infusion-related reactions:

 Fever
 Chills
 Phlebitis at the infusion site

Precautions:  Patient assessment:

 Evaluate the patient's fluid status, electrolyte balance, and underlying medical
conditions before administration

 Monitoring:

 Regularly check vital signs, including blood pressure and heart rate
 Monitor for signs of fluid overload or electrolyte imbalances
 Assess urine output

 Infusion rate:

 Control the rate of administration, especially in patients with cardiac or renal

impairment
 Use infusion pumps for precise control when necessary

 Volume:

 Calculate and administer only the required volume

 Be cautious with large volume infusions, particularly in elderly or critically ill
patients

 Electrolyte checks:

 Regularly monitor serum electrolytes, especially in prolonged therapy

Dextrose
Composition: Each 100ml contains:
Dextrose Anhydrous .................... 10g or 5g
Water for Injection ....................... Q.S (Quantity Sufficient)

 Osmolarity varies with concentration (e.g., D5W is 252 mOsm/L, isotonic to slightly
hypotonic)
 pH is typically slightly acidic (3.5-6.5)
 Does not contain electrolytes
 Provides calories (3.4 kcal/g of dextrose)
Available Strengths: 5%W/V,10%W/V.
Brand: Sterifluid-10
Indications:  Hypoglycemia management:

 Rapid correction of low blood sugar, especially with higher concentrations like D50W

 Fluid replacement:

 D5W for mild dehydration, particularly when electrolyte replacement isn't needed

 Caloric supplementation:

 Providing carbohydrate calories in patients unable to eat or drink

 Parenteral nutrition:

 As a component of total parenteral nutrition (TPN) solutions

 Drug dilution:

 As a vehicle for administering various medications

 Perioperative management:

 Maintaining blood glucose levels during surgery

 Diabetic ketoacidosis (DKA) treatment:

 Used in later stages of treatment to prevent hypoglycemia

 Hyperkalemia treatment:

 To shift potassium into cells when combined with insulin

 Infant feeding:

 In certain neonatal conditions requiring glucose supplementation

 Diagnostic use:

 In glucose tolerance tests

Contraindications:  Hyperglycemia:

 Uncontrolled diabetes mellitus

 Diabetic coma
 Hyperosmolar hyperglycemic state

 Thiamine deficiency:

 Risk of precipitating or worsening Wernicke's encephalopathy, especially in

alcoholics

 Glucose-6-phosphate dehydrogenase deficiency:

 High concentrations may potentially trigger hemolysis

Side effects:  Hyperglycemia:

 Elevated blood glucose levels

 Risk of osmotic diuresis

 Fluid and electrolyte imbalances:

 Hyponatremia (especially with D5W)

 Hypokalemia
 Hypophosphatemia

 Osmotic effects:

 Cellular dehydration
 Increased osmolarity of blood

 Venous irritation:

 Phlebitis, especially with higher concentrations

 Pain at infusion site

 Metabolic acidosis:

 Due to metabolism of dextrose to lactic acid

 Rebound hypoglycemia:

 Particularly in diabetic patients or after high-concentration infusions

 Refeeding syndrome:
  In malnourished patients, rapid dextrose infusion can cause severe electrolyte shifts

 Hyperinsulinemia:

 Excessive insulin response, especially in diabetics

Precautions:  Patient assessment:

 Evaluate the patient's glycemic status, fluid balance, and underlying medical
conditions before administration

 Blood glucose monitoring:

 Regularly check blood glucose levels, especially in diabetic patients

 Electrolyte monitoring:

 Monitor serum electrolytes, particularly sodium, potassium, and phosphate

 Infusion rate:

 Control the rate of administration, especially for higher concentrations

 Use infusion pumps for precise control when necessary

 Concentration selection:

 Choose the appropriate concentration based on the patient's needs and condition

 Venous access:

 Use an appropriate size catheter and vein for the concentration being administered
 Higher concentrations may require central venous access

 Compatibility checks:

 Ensure compatibility when mixing with medications or other solutions

 Sterility:

 Maintain strict aseptic technique during preparation and administration

 Thiamine supplementation:

 Consider thiamine administration before dextrose in malnourished or alcoholic

patients

 Refeeding syndrome prevention:

 Start with lower concentrations and volumes in malnourished patients

 Fluid balance:

 Monitor input and output, especially in patients at risk for fluid overload

 Extravasation precautions:

 Check IV site regularly, especially with higher concentrations

 Paediatric considerations:

 Adjust concentration and volume based on age and weight

 Diabetic management:

 Coordinate with insulin therapy in diabetic patients

Reference
National Institutes of Health (NIH)