Types of fluids:
Crystalloids and colloids.
Crystalloids are aqueous solutions of mineral salts or other water-soluble molecules.
Colloids contain larger insoluble molecules, such as gelatin; blood.
Osmolarity and Tonicity
· The Osmolarity of a fluid is determined by the number of dissolved particles, or solutes, in 1L of water.
· The Tonicity is the Osmolarity of a solution with respect to plasma.
· Can expand the circulating intravascular fluid volume without causing major fluid shifts between compartments.
· Isotonic crystalloids are often used to treat fluid loss due to vomiting, diarrhea or surgical procedures especially when blood pressure is low.
· Because isotonic fluids can rapidly expand, circulating blood volume care must be taken not to create fluid overload.
· 0.9% sodium chloride solution, Lactated Ringer’s solution, Blood components, Albumin 5%, Plasma
· Dextrose 5 % in water (D5W) (in the bag) (this is physiologically hypotonic as dextrose get metabolized quickly only water remains so inside the body it is hypotonic)
Will cause water to move out of the plasma to the tissues and cells in the intracellular compartments; thus, these solutions are not considered efficient plasma volume expanders.
Hypotonic crystalloids are indicated for clients with hypernatremia and dehydration.
Care must be taken not to cause depletion of the intravascular compartment or too much expansion of the intracellular compartment.
· Administration of this fluid generally causes dilution of plasma solute concentration and forces water movement into cells to reestablish intracellular and extracellular equilibrium; cells will then expand or swell.
· 0.45% sodium chloride solution (half-normal saline)
· 0.33% sodium chloride solution (one-third normal saline)
· Infusion of hypertonic crystalloids expands plasma volume by drawing water from the cells and tissues.
· These agents may be used to relieve cellular edema, especially cerebral edema.
· Over treatment with hypertonic crystalloids can lead to excessive expansion of the intravascular compartment and hypertension.
· Dextrose Normal Saline,
· D5W in half-normal saline,
· Dextrose 10% in water,
· 3% or 5% sodium chloride solution.
· Hydroxyethyl starch
· Dextran 40 in NS or 5% D5W
Monitoring for complications of fluid restoration:
· Use of monitors to measure fluid volume- CVP
· Urine output, body weight
· Serum sodium, potassium, BUN, osmolality monitoring.