• To add on, D5NS (Dextrose 5% in normal saline) is hypertonic, meaning it

has a higher solute concentration than tissues, so it can be used to help

draw fluids out of oedematous (fluid-swollen) tissues.
Lactated Ringer's solution, on the other hand, is isotonic, meaning it will
stay in the veins, not move into tissues, but will not draw fluid out of
tissues either. It can be used when someone needs to replenish their
blood volume really quickly, such as a person who has had a really bad
bleed or burn and is headed for shock.
Saline on its own is hypotonic (some will say it's isotonic, but actually it's
hypo), meaning it has a lower solute concentration than the fluid inside
cells. Through osmosis, water (the saline!) will move into the cells to try to
equalize the concentration inside and outside body cells... This is great if
someone is extremely dehydrated, but baaaad if they're already fluid
overloaded (as with oedema)
• Dextrose....to provide some calories, especially if
people aren't eating.

Lactated Ringer's Solution is often used for fluid

replacement after blood loss due to trauma, surgery, or
burns. It's also used to induce urine output in patients
with renal failure (kidney damage).

Lactated Ringer's Solution is used because it

counteracts acidosis, which is a chemical imbalance
that occurs with acute fluid loss or renal failure
• I'm presuming you mean IV solutions so we're talking about tonicity. Generally
speaking, IV fluids are ordered to (1) maintain fluid volume balance, (2) replace
fluid volume loss, or (3) correct imbalances.
HYPOTONIC SOLNS: Include D5W in this group because although it's labeled as
isotonic, once it's infusing it acts as a hypotonic. Hypotonic crystalloids have a
tonicity that's lower than that of plasma. They cause water to shift from
intravscular space (blood) to extravascular space and eventually into tissue cells.
These solutions are used in hemodialysis, to correct dehydration secondary to
diuretics, during DKA and hyperglycemia Hyperosmolar Nonketotic syndrome,
during surgery because the fluid shift from blood to tissue reduces blood loss.
HYPERTONIC SOLNS: Hypertonic crystalloids have a tonicity higher than body
plasma and pull water from extravascular space into the blood. This is the opposite
of the action of a hypotonic solution. These fluids are used to expand the vascular
compartment and will beef up B/P. They're used for hydration and nutrition
(TPN/PPN). P/o to shift fluid back to the blood, to reduce the r/f edema, to
stabilize B/P and to help maintain UOP.
• Reggaemoncharlie:
Interesting name. Since you are a nursing student, I'll answer and also teach a little.
5% glucose solution is isotonic, that is it has the same mOsm as your blood serum so the formed elements (RBC's, WBC's, etc - don't swell or shrink.
Here is a physiology site that explains it:
http://www.anaesthesiamcq.com/FluidBook/...
Now, we use specific solutions for specific treatments - for "maintenance fluid", we can use 0.9% NaCl, D5W, D5 in 1/2 NS, etc., then there are
specific compositions like normosol or lactated ringers, those are isotonic too. There you have hypotonics like 0.45% NaCl (not nml saline or NS, it has
half the salt), and even lower, 0.225NaCl. And we have hypertonics too - like concentrated albumin, or hetastarch.
Why the difference? Isotonic solutions do not disrupt the normal osmolarity of the serum, the cells in the body fluid, the interstitium, and the cells of
the tissues are balanced with that fluid....nothing should swell or shrink with such an infusion.
For volume expansion, the shear ml load is the important issue.
For a patient who is volume overloaded - like post surgical, with volume support during a long surgery and poor urine output - it may be worthwhile
to give hetastarch or albumin - hypertonics - to "draw" the water out of the tissues. Albumin only lasts a few hours (24-36) in the bloodstream, but it
helps "mobilize" the fluid from swollen tissues during a time when it could help balance a patients fluid losses intravascularly (bleeding, hemolysis,
and edema) with their needs of a euvolemic intravascular fluid.
Some fluids are compatible with certain IV infusions, that also dictates our choice of IV fluids.
Hope this helps!
• Although these solutions will have different solutes in
them, I use this trick. Thinks of salt and the fact that
water will go where the salt content is highest. In
a hypertonic solution the salt is higher than the
surrounding cells, therefore the water in the cells is
going to go out into the higher salt hypertonic solution.
In a hypotonic solution, the salt in the fluid in lower
than the salt in the cells, so the water is going to go
from the solution into the cells. In an isotonic solution
the content of the salt in the cells and the fluid is the
same,so there is no movement of water at all. Hope
this helps
• tonicity refers to the solute concentration of a solution outside a cell and its effect on cellular fluid volume. the osmolarity of the solution determines the direction of water flow into or
out of the cell. in normal body situations, solute concentration within and outside of the cell is usually nearly the same (isotonic).

isotonic: same osmolarity as the cells (270 – 300 mmol/l). equal solute and water—exact same number of particles in both solutions—no net movement of water. does not change cell
volume.

higher solute concentration surrounding cells pulls water out of the cells. hypertonic: higher osmolarity than cells (> 300 mmol/l). greater solute, less water—water moves out of cells. the
cell will shrink.

lower solute concentration surrounding cells causes water to move into the cells. hypotonic: lower osmolarity than cells (< 270 mmol/l). less solute, more water—water moves into cells.
the cell will swell.
isotonicity. if the concentrations of electrolytes are the same in the cell and surrounding fluid, the situation is balanced (homeostatic). the cell fluid volume remains the same.

hypertonicity: the cell will shrink (crenation) by loss of its fluid to the surrounding hypertonic environment. high osmotic pressure of surrounding fluid pulls fluid out of the cell.

hypotonicity. in a hypotonic environment, fluid will enter a cell and cause it to swell and burst. the inside of the cell has higher osmotic pressure than the surrounding fluid, so fluid is
drawn into the cell.

both hypertonicity and hypotonicity in the extracellular fluids will destroy cells.

need isotonicity for cell homeostasis, for balance.

½ ns iv is hypotonic relative to cells. fluid moves from the vascular space into the cells. when a liter of ½ ns is administered intravenously, it will go into the cells and very little will remain
in the blood vessel (since it is hypotonic).

if you put two isotonic solutions side by side, no fluid shift occurs. a liter of normal saline or ringer’s lactate is limited to the extracellular space and will expand the blood volume.

5% dextrose in ns is hypertonic compared to cells; pulls water into the vascular space from the cells or interstitium.
• A good way to think of it is Tonic=Salt.
Hypotonic (little salt Less than Normal saline) i.e. 1/4
Normal saline or 0.225 Saline (recently gave this to a
patient that had diabetes insipidus and was hypernatremic
(too much saline in his blood).
Hypertonic (lots salt more than Normal saline) 3% Saline
Isotonic (normal saline) 0.9% normal saline.
Now someone else may want to jump in to talk about D5
solutions and what would be isotonic with those.
• in theory, d51/2ns is a hypertonic solution also. the only commonly-used intravenous solution containing dextrose that is considered isotonic is d5
1/4 ns (~320 mosm). solutions containing dextrose are somewhat tricky, however. once infused, the dextrose is also immediately metabolized
(within 5 minutes of entering the bloodstream) and you are left with the osmolarity effect of the underlying solution. so, even though d51/2 ns is
considered hypertonic initially, it will have the effect of a hypotonic solution after a few minutes in the bloodstream (1/2 ns is left and it is
hypotonic).
d5w is an example of a hypotonic solution. it is made by placing 50 gm of dextrose per liter of distilled water. it does not provide any electrolytes. it is
hypotonic on initial administration, at 252 mosm/ l). once the dextrose is metabolized, however, (in about 5 minutes), it provides free water for renal
excretion and promptly leaves the intravascular space to expand the intracellular fluid volume. it also provides 170 calories/l (about the same as 4 gs
shortbread cookies) for metabolism.
it is never safe to infuse pure sterile water (will kill a patient by lysing the blood cells and putting the patient into renal failure). d5w is generally a very
safe way to dilute serum osmolarity. of course, with all dextrose solutions, you want to consider the effect of the dextrose on the client's serum
glucose (especially if the client is diabetic). each gram of dextrose supplies 3.4 calories. as earlier stated, 1000 ml of d5 solution furnishes 170
calories.
hypotonic solutions are used to provide free water and treat cellular dehydration. maintenance fluids are usually hypotonic solutions, because
normal daily losses are hypotonic. provides greater amount of water than electrolytes: decreased osmotic pressure. increases intracellular fluid. the
fluid leaves the intravascular space and rehydrates the cells. out of one liter of fluid, only about 85 ml stay in the intravascular space. these solutions
also promote waste elimination by the kidneys.

hypotonic solutions should not be administered to patients with increased intracranial pressure because it can increase cerebral edema. also, not for
clients with third-space fluid shift.hypotonic solutions should be given at a slower rate than isotonic solutions. one of the best guides to a safe rate of
flow is the reaction of the patient . therefore, the nurse must observe signs and symptoms carefully (such as shortness of breath, dyspnea, coughing,
cyanosis, increased respiratory rate—all symptoms of pulmonary edema). monitor blood pressure, pulse rate and respiratory rate frequently.
• Crytalloid solutions are the most common parenteral solutions used for maintenance and replacement of fluid requirements in hospitalized patients. There are many crystalloid products
available including sodium chloride, dextrose, and Lactated Ringer’s. Normal saline (0.9%) contains 308 mOsm/L, which effectively mimics the osmolarity of body fluids (280-300
mOsm/L); therefore it is considered an isotonic solution. In contrast, 0.45% and 0.225% sodium chloride contain 154 and 77 mOsm/L, respectively and are considered hypotonic
compared to body fluids. Hypotonic solutions are used in patients with high serum osmolarity such as those with hypernatremia or hyperglycemic nonketotic coma. These fluids lower
serum osmolarity by causing body water to shift out of the blood and into cells and interstitial spaces. In critically ill adult patients, hypotonic solutions are recommended to correct free
water deficits in patients with hyperosmolar states after extracellular fluid los ses have been corrected. In pediatric patients, 0.225% NS with 20mEq K+ has been recommended for
maintenance fluid requirements. The osmolarity of various intravenous (IV) solutions are presented in table 1.
•
• Table 1. Osmolarity of various IV solutions.
• IV solution
• Osmolarity (mOsm/L)
• Sodium chloride 0.225%
• 77
• Sodium chloride 0.45%
• 154
• Dextrose 5% in water
• 252
• Lactated Ringer’s
• 273
• Sodium chloride 0.9%
• 308
• Dextrose 5%/0.225% sodium chloride
• 321
• Dextrose 5%/0.45% sodium chloride
• 406
• Body water makes up about 60% of total body weight in adults, which amounts to approximately 40 to 50 L. Despite this seemingly large reserve, even small fluid losses can necessitate
large volumes for replacement. For each liter of free water given intravenously, 2/3 will distribute to the intracellular compartment and 1/3 to the extracellular compartment. Fluid in the
extracellular compartment will further distribute, 3/4 to the interstitial compartment and 1/4 to the intravascular space. Therefore, only 1/12 of the volume of replacement fluids infused
will be available to the intravascular space. This can greatly increase fluid requirements compared to losses, and explains why crystalloid solutions are considered an abundant and
inexpensive option for fluid replacement.
• Although hypotonic solutions have the benefit of delivering the same fluid volume with less sodium than 0.9% normal saline, there are documented risks. Hemolysis of red blood cells has
occurred with rapid infusion of hypotonic solutions. In the presence of hypotonic solutions, water will enter red blood cells across a diffusion gradient and cause the cells to swell and
burst. The risk of hemolysis is greatest with 0.225% sodium chloride, the most hypotonic solution available on the market.
•
• Children are at particular risk for neurologic complications when hypotonic solutions are used. Notably, for children with hyperosmolar states, rapid administration of fluid is desirable to
quickly decrease the blood’s osmolarity. However, if hypotonic fluids are given too rapidly, fluid can shift into the brain and cause cerebral edema. In addition, if a hyponatremic child is
given hypotonic solutions this can lead to exacerbation of hyponatremia, encephalopathy, and permanent neurologic damage.
• It has been suggested that hypotonic solutions can be used safely if certain precautions are taken. Mixing hypotonic solutions with dextrose increases their tonicity and makes the overall
solution approach isotonicity. For example, 0.225% sodium chloride/dextrose 5% has an osmolarity of 321 mOsm/L. However, this method cannot be used for patients with
hyperglycemic diabetic coma who should not be given additional dextrose. Infusion of hypotonic solutions at a slower rate can also decrease the risk of hemolysis. Unfortunately, this is
not possible for patients with hyperosmolar states (for whom rapid fluid replacement is required).
• Hypotonic fluids should be used with caution in both adults and children based on the well-documented risks; the more hypotonic the solution, the greater the risks. Since 0.225% sodium
chloride is the most hypotonic solution available, and therefore poses the greatest risk of adverse events, this concentration should generally be avoided unless mixed with dextrose to
increase the solution’s overall tonicity. A better choice for first line hypotonic fluid therapy in most patients is 0.45% sodium chloride.
•