Fluid and Electrolyte Therapy Posted by: Lhynnelli, RN December 4, 2009 Leave a Comment Types of therapy 1.

. Maintenance therapy Provides water, electrolytes, glucose, vitamins, and in some instances protein to meet daily requirements. 2. Restoration of deficits In addition to maintenance therapy, fluid and electrolytes are added to replace previous losses. 3. Replacement therapy Infusions to replace current losses in fluid and electrolytes. Types of intravenous fluids 1. Isotonic solutions a. Fluids that approximate the osmolarity (280-300 mOsm/L) of normal blood plasma. Sodium Chloride (0.9%) - Normal Saline Indications: Extracellular fluid replacement when Cl- loss is equal to or greater the Na loss. Treatment of matebolic alkalosis. Na depletion Initiating and terminating blood transfusions. Possible side effects: Hypernatremia Acidosis Hypokalemia Circulatory overload. b. Five percent dextrose in water (D5W). Provides calories for energy, sparring body protein and preventing ketosis resulting from fat breakdown. Indications: Dehydration Hypernatremia

Drug administration

Possible side effects: Hypokalemia Osmotic diuresis dehydration Transient hyperinsulinism Water intoxication. c. Five percent dextrose in normal saline (D5NS). Prevents ketone formation and loss of potassium and intracellular water. Indications: Hypovolemic shock temporary measure. Burns Acute adrenocortical insufiency. Possible side effects: Hypernatremia Acidosis Hypokalemia Circulatory overload d. Isotonic multiple-electrolyte fluids. Used for replacement therapy; ionic composition approximates blood plasma. Types:

a. Plasmanate b. Polysol c. Lactated Ringers

Indications: Vomiting Diarrhea Excessive diuresis Burns Possible side effects: Circulatory overload. Lactated Ringers is contraindicated in severe metabolic acidosis and/or alkalosis and liver disease.

Hypernatremia Acidosis Hypokalemia

2. Hypertonic solutions Fluids with an osmolarity much higher than 310 mOsm (+ 50 mOsm); increase osmotic pressure of blood plasma, thereby drawing fluid from cells. a. Ten percent dextrose in normal saline Administered in large vein to dilute and prevent venous trauma. Indications: Nutrition Replenish Na and Cl. Possible side effects: Hypernatremia (excess Na) Acidosis (excess Cl) Circulatory overload. b. Sodium Chloride solutions, 3% and 5% Indications: Slow administration essential to prevent overload (100 mL/hr) Water intoxication Severe sodium depletion 3. Hypotonic solutions Fluids whose osmolarity is significantly less than that of blood plasma (-50 mOsm); these fluids lower plasma osmotic pressure, causing fluid to enter cells. a. 0.45% sodium chloride Used for replacement when requirement for Na use is questionable. b. 2.5% dextrose in 0.45% saline, also 5% in 0.2 % NaCl Common rehydrating solution. Indications:

Fluid replacement when some Na replacement is also necessary. Encourage diuresis in clients who are dehydrated. Evaluate kidney status before instituting electrolyte infusions.

Possible side effects: Hypernatremia Circulatory overload Used with caution in clients who are edematous, appropriate electrolytes should be given to avoid hypokalemia. Table of Commonly Used IV Solutions Name of Type of Ingredient Uses Solution Solution s in 1-Liter 0.45% Hypotoni 77 mEq hypotonic Sodium c Sodium hydration; Chloride pH 5.6 77 mEq replace Chloride sodium and Shorthand chloride; Notation: hyperosmol NS ar diabetes 0.9% Sodium Isotonic Chloride pH 5.7 Shorthand Notation: NS 154 mEq Sodium 154 mEq Chloride isotonic hydration; replace sodium and chloride; alkalosis; blood transfusions (will not hemolyze blood cells) Complicatio ns if too much is mixed with blood cells during transfusions, the cells will pull water into them and rupture None known

3% Sodium Chloride

symptomati rapid or c continuous hyponatrem infusion can ia due to result in excessive hypernatremi 5% Sodium Hypertoni 855 mEq sweating, a or Chloride c Sodium vomiting, hyperchlore pH 5.8 855 mEq renal mia Chloride impairment, and excessive water intake 5% Dextrose Isotonic 5 grams isotonic in Water pH 5.0 dextrose hydration; (170 provides Shorthand calories/lite some water Notation: r) calories intoxication D5W and dilution of bodys electrolytes 10% Hypertoni 10 grams may be with long, Dextrose in c dextrose infused Water pH 4.3 (340 peripherally continuous infusions calories/lite ; Shorthand r) hypertonic Notation: hydration; D10W provides some calories

Hypertoni 513 mEq c Sodium pH 5.0 513 mEq Chloride

5% Dextrose Hypertoni 5 grams in 1/4 c Dextrose Strength (or pH 4.4 34 mEq 0.25%) Sodium Saline 34 mEq Chloride Shorthand Notation: D5NS

fluid replacemen t; replacemen t of sodium, chloride and some vein irritation calories because of acidic pH, causes agglomeratio 5% Dextrose Hypertoni 5 grams hypertonic n (clustering) if used with in 0.45 c Dextrose fluid Sodium 77 mEq replacemen blood pH 4.4 Chloride Sodium t; replace transfusions; hyperglycemi 77 mEq sodium, a with rapid Shorthand Chloride chloride, Notation: and some infusion leading to D5NS calories osmotic 5% Dextrose Hypertoni 5 grams hypertonic diuresis in Normal c Dextrose fluid Saline pH 4.4 154 mEq replacemen Sodium t; replace Shorthand 154 mEq sodium, Notation: Chloride chloride and D5NS some calories RingersInjec Isotonic 147 mEq electrolyte rapid tion, U.S.P. pH 5.8 Sodium replacemen administratio 4 mEq t; hydration; n leads to Potassium often used excessive 4 mEq to replace introduction Calcium extracellula of 155 mEq r fluid electrolytes Chloride losses and leads to fluid overload and congestive

conditions; provides no calories and is not an adequate maintenance solution if abnormal fluid losses are present Lactated Ringers Shorthand Notation: LR Isotonic pH 6.6 130 mEq Sodium 4 mEq Potassium 3 mEq Calcium 109 mEq Chloride isotonic hydration; replace electrolytes and extracellular fluid losses; mild to moderate acidosis 28 mEq (the lactate not enough Sodium is electrolytes Lactate (provides 9 metabolized for maintenance; calories/lite into bicarbonate patients with r) which hepatic counteracts disease have the trouble acidosis) metabolizing

5% Dextrose Hypertoni 5 grams hypertonic the lactate; in Lactated c Dextrose hydration; do not use if Ringers (170 provides lactic pH 4.9 Injection calories/lite some acidosis is r) calories; present Shorthand 130 mEq replace Notation: Sodium electrolytes D5LR 4 mEq and extraPotassium cellular fluid 3 mEq losses; mild Calcium to moderate 109 mEq acidosis Chloride (the lactate 28 mEq is Sodium metabolized Lactate into (provides 9 bicarbonate calories/lite which r) counteracts the acidosis), the dextrose minimizes glycogen depletion

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