IV Solutions and

Recommended Usage
By: Donna Hess RN, MS

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 Contents:
• Fluid Volume Deficit 3
• Fluid Volume Excess 4
• Isotonic Solutions 5
• Hypotonic Solutions 6
• Hypertonic Solutions 7
• Intravenous Solutions 8-10

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 Fluid Volume Deficit
DESCRIPTION: CAUSE: SYMPTOMS: LAB FINDINGS: TREATMENT &
NURSING CARE:
-occurs when the body VOMITING WEIGHT LOSS Elevated BUN &
loses water & DIARRHEA (1PINT=1 POUND) creatinine *Restrict I&O
electrolytes in the GI SUCTIONING DECREASE SKIN
same proportion as in
SWEATING TURGOR Increase serum *Replace fluids
the normal body fluids isotonically (oral
(isotonically) INADEQUATE OLIGURIA osmolality
preferred)
FLUID INTAKE CONCENTRATED
-serum electrolyte MASSIVE EDEMA URINE Elevated Hgb & Hct
*REMEMBER: water
levels remain normal (BURNS) DRY/STICKY MUCOS
Is hypotonic
ASCITES MEMBRANES
-state in which the ELDERLY-FORGET TO POSTURAL
body loses water & *IV hydration with
DRINK HYPOTENSION isotonic fluids:
serum sodium levels
WEAK/RAPID -0.9% normal saline
increase (dehydration)
PULSE -Lactated Ringers
-D5W (rarely used)

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 Fluid Volume Excess:
DESCRIPTION: CAUSE: SYMPTOMS: LAB FINDINGS: TREATMENT &
NURSING CARE:
-occurs when the body CONGESTIVE HEART PERIPHERAL EDEMA Decreased BUN, Hgb,
retains water and FAILURE (CHF) INCREASE PULSE Hct, serum osmolality, *Diuretics
electrolytes urine osmolality, urine
RENAL FAILURE BOUNDING PULSE
isotonically specific gravity
CIRRHOSIS ELEVATED BP *Fluid restriction
LIVER FAILURE DISTENDED NECK
-state in which the
EXCESSIVE SALT VEINS *Strict I&O
body retains water &
serum sodium levels INGESTION DYSPNEA
decrease OVER-HYDRATION MOIST LUNG *Sodium-restricted
diet
WITH SODIUM CRACKLES
FLUIDS ATTENTION LOSS
POOR CONTROL OF CONFUSION *Daily weight
IV THERAPY APHASIA
*Monitor serum K+
(YOUNG/ELDERLY) CHANGE IN LOC

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 Isotonic Solutions:
DESCRIPTION: SOLUTIONS: TREATMENT: COMMENTS:

-have an osmolality close to NORMAL SALINE *Intravascular dehydration

extracellular fluids (275- (0.9% NS) (running, labor, fever, ect.)
295)
LACTATED RINGERS
-do not cause RBC to swell (LR)
or shrink

D5W (SOME SOURCES *AVOID D5W in clients at

-indicated for intravascular
CLASSIFY AS risk for Increase
dehydration Intracranial Pressure
HYPOTONIC)

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 Hypotonic Solutions:
DESCRIPTION: SOLUTIONS: TREATMENT: COMMENTS:

-have an osmolality lower 0.5% Normal Saline *Treat intracellular

than the extracellular fluid (HNS or 0.45% NS) dehydration:
( < 275) -Prolonged dehydration
0.33% Normall Saline -Prolonged TPN
-causes fluid to move from ( 1/3 NS)
the extracellular space into **Not commonly seen
the intracellular space
2.5% Dextrose in 0.45%
Saline **Not for use in clients at
-indicated for cellular risk for Increase
dehydration Intracranial Pressure

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 Hypertonic Solutions:
DESCRIPTION:
-have an osmolality higher
than the extracellular fluid
( > 295)7 7 (D5LR)
-indicated for intravascular
dehydration with interstitial
or cellular overhydration
-use with EXTREME
CAUTION
-high concentrations of
dextrose are given for
caloric replacement (TPN,
PPN)
-hypertonic saline solutions
are used only when serum
osmolality is dangerously low
SOLUTIONS: TREATMENT: COMMENTS:
5% DEXTROSE IN *Treat intravascular
LACTATED RINGERS dehydration with cellular or
interstitial overhydration
5% DEXTROSE IN 0.45% *Treat post-operative
SALINE dehydration from blood loss
(D5 ½ NS)
*Treat ascites
5% DEXTROSE IN 0.9%
SALINE *Treat 3rd Spacing
(D5NS)
**AVOID in client with
kidney or heart failure
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 Intravenous Solution
Table:
Solution D5W 0.45% NS 0.9% NS
mOsm/L 280 155 308
Na+ 0 77 154
Cl- 0 77 154
K+ 0 0 0
Ca++ 0 0 0
Mg++ 0 0 0
Lactate 0 0 0
Dextrose 50 g/L 0 0
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 Intravenous Solutions
Table:
Solution D5 ½ NS D5NS Ringers
mOsm/L 406 561 309
Na+ 77 154 147
Cl- 77 154 156
K+ 0 0 4
Ca++ 0 0 4.0-4.5
Mg++ 0 0 0
Lactate 0 0 0
Dextrose 50 g/L 50 g/L 0 9
 Intravenous Solutions
Table:
Solution LR D5LR 3% NS
mOsm/L 275 525 1025
Na+ 130 130 513
Cl- 109 109 513
K+ 4 4 0
Ca++ 3 3 0
Mg++ 0 0 0
Lactate 28 28 0
Dextrose 0 50 g/L 0 10
 References:
• HESI NCLEX RN Review (2006)
• Fluids, Electrolytes, and Acid-Base Balance
(2003) Hogan & Wane
• Fundamentals of Nursing Concepts,
Process, and Practice (2004) Kozier, Erb,
Berman, Snyder
• Handbook of Critical Care (1997) Kirby,
Taylor, Civetta

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