IV FLUIDS

Presented By
WAFAA ABDELSALAM
ASS LECTURER OF ANEATHESIA AND ICU
KAFR ELSHEIKH UNIVERSITY

INTRAVENOUS THERAPY OR IV
THERAPY

Intravenous therapy also referred as IV therapy

constitutes the administration of liquid
substances directly into a vein and the
general circulation through venepuncture
(Mosby 1998)

REASONS FOR INFUSION:

A/c to Brooker(2007) and Martin (2003) Intravenous fluid
therapy may be used to:
Replace fluids and replace imbalances.
Maintain fluid, electrolyte and acid-base balance.
Administer blood and blood products
Administer medication
Provide parenteral nutrition
Monitor cardiac function
Immediate results
To provide avenue for diagnostic testing
Predictable therapeutic effects
There are more than 200 types of commercially prepared IV

fluids.

BODY
COMPARTMENTS

INTRACELLULAR

EXTRACELLULA
R

EXTRACELLULAR

INTRAVASCULA
R

INTERSTITIAL

TRANSCELLULA
R

TYPES OF IV FLUIDS:
CRYSTALLOIDS

COLLOIDS

CRYSTALLOIDS:
Isotonic, Hypotonic and Hypertonic

ISOTONIC
Osmolalit
y of 250375
mOsm/L
No
shifting
of fluid
Only
serves to
increase
the ECF

HYPOTONIC
Osmolarity of
>250 mOsm/L
Shifting of fluid
from
intravascular
to both
intracellular
and interstitial
spaces
Hydrate the
cells causing
them to swell.

HYPERTONIC
Osmolarity of
375 mOsm/L
or higher
Water moves
out of the
intracellular
space
increasing
ECF( volume
expanders)
Dehydrate the
cells causing
shrinkage.

ISOTONIC

HYPOTONIC

HYPERTONIC

0.9% Nacl

0.45% Nacl

3% Nacl

Lactated
Ringer

0.33% Nacl

5% Nacl

0.2 % Nacl

3%Nacl or
5% Nacl
+D/W

Ringers
Solution
5% Dextrose
in water

2.5%
Dextrose
water

>5% D/W
example,D10
W

ISOTONIC SOLUTIONS
INDICATIONS:
Isotonic solutions contain electrolytes
such as Nacl,KCL,Cacl and sodium
lactate.
Indicated in the treatment of vascular
dehydration, replaces sodium and
chloride.
5%D/W is isotonic when infused but
becomes hypotonic when dextrose has
been metabolized.
Use cautiously in patients who are
fluid-overloaded or who would be
compromised if vasscular volume
would increase such as renal and

ISOTONIC FLUIDS AND THEIR

USES:
0.9% Nacl
Shock
Resuscitation
Fluid challenges
Blood transfusions
Metabolic alkalosis
Hyponatremia
DKA
Use with caution in
patients with heart
failure,edema,or
hypernatremia.
Can lead to fluid
overload.

Lactated
Ringers

Dehydration
Burns
GI tract fluid loss
Acute blood loss
Hypovolemia
Contains potassium,
can cause
hyperkalemia in renal
patients.
Patients with liver
disease cannot
metabolize lactate.
Lactate is converted
into bicarb by liver.

D5W
Fluid loss and
dehydration
Hypernatremia
Solution becomes
hypotonic when
dextrose is
metabolized
Do not use for
resuscitation
Use cautiously in
renal and cardiac
patients

HYPOTONIC SOLUTIONS
INDICATIONS (<250mOsm/L)
0.45% Nacl normal
saline
Treatment of hypertonic dehydration.
Gastric fluid loss
Cellular dehydration from excessive diuresis
Slow rehydration
SPECIAL CONSIDERATIONS:
Do not give to patients at risk for ICP
Not for rapid rehydration
Electrolyte disturbances can occur

HYPERTONIC
SOLUTIONS INDICATIONS
5%Dextrose in 0.9%
Nacl
( D5NS)
USES:
Heat related
disorders
Fresh water
drowning
Peritonitis
SPECIAL
CONSIDERATION
S:
Avoid in impaired
cardiac or renal
function.
Draw blood
before

5%Dextrose in
Lactated Ringers
( D5LR)

5% Dextrose in
0.45% Nacl
(D51/2NS)

USES:
Hypovolemic
shock
Hemorrhagic
shock
Certain cases of
acidosis

USES:
Heat exhaustion
Diabetic disorders
TKO solution in
patients with renal
or cardiac
dysfunction

SPECIAL
CONSIDERATIO
NS:

SPECIAL
CONSIDERATION
S:

Avoid in patients
with cardiac or
renal dysfunction.

NOT for rapid

fluid replacement

ACTIONS OF COLLOIDS: (Plasma

Expanders)
These contain large insoluble particles such as gelatin.
Used if crystalloids do not improve blood volume.

BLOOD can be categorized as a colloid. Act like

HYPERTONIC solutions causing shifting of fluid out of
the cell increasing ECF.
Long lasting effect than crystalloid hence should be
infused slowly and watch out for circulatory overload.
USES:
Emergency treatment of shock,circulatory collapse
,hypotonic dehydration.

CAUTION :

HYPOKALAEMIA

HYPERKALAEMIA

Inappropriate IV therapy is a significant cause of pt

mortality and morbidity and may result from either
PERIPHERAL
too much or too little volume.
EDEMA
TOO MUCH!
Fluid overload has no precise definition but
complications usually arise in the context of
preexisting cardiorespiratory disease and severe
HYPONATREMIA
acute illness.
TOO LITTLE!
Insufficient fluid administration is readily identified
by signs and symptoms of inadequate circulation
and decreased organ perfusion .
HYPERNATREMIA
INFUSION OF WRONG TYPE OF FLUID!!!
This results in derangement of serum sodium
concentration,which if severe,leads to changes in
cell volume and function and may result in serious
PULMONARY
neurological injury.
EDEMA
HYPOVOLAEMIA

HOW TO AVOID LETHAL

CONSEQUENCES ???
2 STRATEGIES:Fixed fluid replacement regimens:
Fixed fluid regimens should be considered guides to safe volume
replacement, with the actual amount to be given determined by
clinical response, including serial observations of heart rate blood
pressure and urine output.However,extremes of age,pre-existing
disease severity of acute illness and major surgery MUST be
taken into account.
Recent studies support the safety of more restrictive
perioperative fluid regimens in uncomplicated elective surgery
Algorithmic approaches:
Recent evidence also suggests that volume replacement
targetting a specific circulatory parameter may improve patient
outcome
These targets involve invasive monitoring of cardiac chamber
filling pressures (CVP and Pulmonary artery wedge pressure)and
cardiac output.

PROTOCOL:

TAKE HOME MESSAGE !

Measure serum sodium concentration daily in all
patients receiving maintenance fluids.
Use a staggered regimen for fluid administration
giving isotonic fluids during the period of high ADH
secretion (24-96 hrs)and introduce hypotonic fluids
only later or if Hypernatremia develops.
Completely avoid all hypotonic fluids in patients
whose serum sodium concentration is low or falling
rapidly (by>8mmol/L per day)
Acute decrease in serum sodium below 125mmol/L
with neurological symptoms should be considered a
medical emergency and should include prompt
control of serum sodium concentration.
Rapid correction of chronic or asymptomatic
hyponatremia is not indicated.

Acute increase in serum sodium above 150 mmol/L

should be assessed for a cause and corrected

Diabetes insipidus is important to recognize as it
can cause large rapid losses of free water with a
rapid rise in serum Na concentration
In either hypo or hypernatremia,the rate of
correction should be proportional to the rate of
onset of hypernatremia taking into account the
presence and severity of neurological symptoms.
Overly rapid correction may result in cerebral
oedema,seizures or death!

REFERENCES:
Andrew K Hilton and et al,MJA(Medical journal of Australia)

Avoiding common problems associated with IV therapy.

Ann Crawford PhD,RN,Helene Harris MSN,RN (Lippincot

Nursing Center)IV fluids-what nurses need to know.

Algorithims for IV fluid therapy in adults,(NICE clinical

guidelines Dec 2013)