Tonicity of IV Fluids

Definition: The tonicity of an IV solution relates to how the red blood cells respond when
the solution is added.

Fluid is moving equally into and out of the compartments

Fluid moves from the vascular space into the cells.

The major problems with administering hypotonic IV solutions

Fluid is pulled out of the cells and into the vascular system, s

Phases of IV Replacement Therapy:

Emergency: emergency replacement of circulating blood volume

Replacement phase: replacing continuing abnormal losses

Maintenance phase: replacing normal ongoing losses

Considerations when administering IV Therapy

5% Dextrose in Water (D5W): This solution is a little sneaky. If you look up the
osmolarity, it is 278, which is isotonic. However, when it gets into the blood stream the
dextrose is rapidly metabolized, leaving only water (hypotonic). Therefore, although the
osmolarity is isotonic, physiologically D5W is hypotonic. Receiving D5W can lead to
cerebral edema because of the movement of water from the vascular system into the cells.

0.9% sodium chloride: Used to replace sodium and chloride and treat metabolic alkalosis.
Use with caution in patients who are at risk for fluid retention.