NORMAL SALINE (NS)
0.9% NaCl in Water
Isotonic (308 mOsm)
- Increases circulating plasma volume when red cells are adequate
- Fluid replacement in patients with diabetic ketoacidosis
- Blood transfusions
- Metabolic alkalosis
- Replaces losses without altering fluid concentrations.
- Do not use in patients with heart failure, edema, or hypernatremia, because NS replaces extracellular fluid and can lead to fluid overload.
1/2 NORMAL SALINE (1/2 NS)
- 0.45% NaCl in Water
- Crystalloid Solution
- Hypotonic (154 mOsm
- Water replacement
- Raises total fluid volume
- DKA after initial normal saline solution and before dextrose infusion
- Hypertonic dehydration
- Sodium and chloride depletion
- Gastric fluid loss from nasogastric suctioning or vomiting.
- Useful for daily maintenance of body fluid, but is of less value for replacement of NaCl deficit.
- Helpful for establishing renal function.
- Use cautiously; may cause cardiovascular collapse or increase in intracranial pressure.
- Don’t use in patients with liver disease, trauma, or burns
LACTATED RINGER’S (LR) OR RINGER’S LACTATE (RL)
- Normal saline with electrolytes and buffer
- Isotonic (275 mOsm)
- Replaces fluid and buffers pH
- Hypovolemia due to thirdspace shifting.
- Lower GI tract fluid loss
- Acute blood loss
- Don’t use in liver disease because the patient can’t metabolize lactate; a functional liver converts it to bicarbonate; don’t give if patient’s pH > 7.5.
- Has potassium therefore don’t use to patients with renal failure as it can cause hyperkalemia
D5W (5%DEXTROSE WATER) OR 5% DEXTROSE
- Dextrose 5% in water Crystalloid solution
- Isotonic (in the bag)
- *Physiologically hypotonic (260 mOsm) (the dextrose is metabolized quickly so that only water remains – a hypotonic fluid )
- Raises total fluid volume.
- Helpful in rehydrating and excretory purposes.
- Fluid loss and dehydration
- Provides 170-200 calories/1,000cc for energy
- Use in caution to patients with renal or cardiac disease, can cause fluid overload