Selected IV Solutions

Fundamental Review 16-2

Selected IV Solutions

Solution	Comments
Isotonic Solutions
Total osmolality close to that of the ECF; replace the ECF
0.9% NaCl (normal saline)	Not desirable as routine maintenance solution because it provides only Na⁺ and Cl^-, which are provided in excessive amounts May be used to expand temporarily the extracellular compartment if circulatory insufficiency is a problem; also used to treat hypovolemia, metabolic alkalosis, mild hyponatremia, hypercalcemia Used with administration of blood transfusions
Lactated Ringer solution	Contains multiple electrolytes in about the same concentrations as found in plasma (note that this solution is lacking in Mg²⁺) Used in the treatment of hypovolemia, burns, and fluid lost from GI sources
Hypotonic Solutions
Hypotonic to plasma; replace ICF
0.33% NaCl (1/3-strength normal saline)	Provides Na⁺, Cl^-, and free water Na⁺ and Cl^- allows kidneys to select and retain needed amounts Free water desirable as aid to kidneys in elimination of solutes Used in treating hypernatremia
0.45% NaCl (½-strength normal saline)	A hypotonic solution that provides Na⁺, Cl^-, and free water Used as a basic fluid for maintenance needs Often used to treat hypernatremia (because this solution contains a small amount of Na⁺, it dilutes the plasma sodium while not allowing it to drop too rapidly)
Hypertonic Solutions
Hypertonic to plasma
5% dextrose in Lactated Ringer solution	Supplies fluid and calories to the body Replaces electrolytes; shifts fluid from the intracellular compartment into the intravascular space, expanding vascular volume
5% dextrose in 0.9% NaCl	Used to treat SIADH Can temporarily be used to treat hypovolemia if plasma expander is not available

Source: Adapted from Hale, A., & Hovey, M. J. (2014). Fluid, electrolyte, and acid-base imbalances. F.A. Davis Company; Hinkle, J. L., Cheever, K. H., & Overbaugh, K. (2022). Brunner & Suddarth's Textbook of medical-surgical nursing (15th ed.). Wolters Kluwer; and Willis, L. M. (Ed.). (2020). Fluids & electrolytes made incredibly easy! (7th ed.). Wolters Kluwer.

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Fundamental Review 16-2