IV FLUID REPLACEMENT THERAPY

INTRODUCTION:A. OVERVIEW of intravenous (IV) fluid replacement therapy 1. IV fluid replacement changes the composition of the serum by adding fluids

and electrolytes.2. Consequently, the nurse must administer IV fluid replacement with caution to

avoid adverse reaction , which can include :a. Fluid volume excess (FVE).b. Fluid volume deficit (FVD).c. Fluid shifts .d. Decreased or increased electrolyte levels.B. INDICATIONS :1. Replacement of abnormal fluid and electrolyte losses , such as may result from

surgery , trauma , burns , or gastrointestinal (GI ) bleeding .2. Maintenance of daily fluid and electrolyte needs (e.g. in situations in which

the patient is unable to take in or tolerate oral food and fluid due to GI disorders , or the patient’s status is nothing by mouth).

3. Correction of fluid disorders.4. Correction of electrolyte disorders (in conjunction with other therapies. II. TYPE OF SOLUTION:A. ISOTONIC1. An isotonic solution has same osmolar concentration, or tonicity, as the

plasma.2. This means that the proportion of particles to solution infused is the same as

that of the serum ; as result , fluid , dose not shift across the compartments, and the volume of fluid infused distributes equally across the intracellular and extrcellular spaces.

3. Isotonic solutions include :a. 0.9% sodium chloride ( NSS)b. Lactated Ringer’s solution.B. HYPOTONIC :1. Hypotonic solution contain a lower osmolar concentration than the serum .2. This means that the solution infused is more dilute than the plasma ,

containing more water than particles 3. When hypotonic solutions are infused, fluid shifts from the extracellular space

to intracellular space to maintain equilibrium.4. This eventually leads to swelling or “water logging” of the cells, known as

water intoxication.5. As the swelling increases, the cells eventually rupture.6. Hypotonic solutions include :a. 5 % dextrose and water (D5W).b. 0.45 % sodium chloride (half saline).c. 0.33 % sodium chloride.C. HYPERTONIC 1. Hypertonic solutions have a higher concentration of particles in solution

compared with the plasma.2. To balance the concentration of fluid and particles across fluid compartments,

fluid shifts out of the intracellular space into the extracellular space , causing cellular shrinkage or dehydration.

3. This cellular dehydration causes disturbances in the way cells function.4. In addition , the shift of fluid out of the cells causes the extracellular

compartment to expand, which, if excessive, can lead to FVE.5. Hypertonic solution include:

a. 3% sodium chloride.b. Protein solution.c. Hyperalimentation solution of 10 % , 50 %, and 70 % dextrose.D. COLLOIDS1. Colloids are fluids that contain solutes a higher molecular weight (e.g.

protein); this is in contrast to crystalloids, which are electrolyte solution (eg. D5W , lactated Ringer’s solution , 0.9% normal saline).

2. Colloids solutions have significant osmotic activity and are hypertonic.3. The presence of colloids in the vascular space pulls fluids from the interstitial

and intercellular spaces.4. This osmotic activity makes colloid solutions useful for :a. Mobilizing third – spaced fluids.b. Correcting hypotensionc. Expanding intravascular volumed. Replenishing protein depletion (such as occurs with liver and renal disease ,

starvation ,GI disease, and multisystem organ failure )5.