Types of therapy

1. Maintenance therapy
o Provides water, electrolytes, glucose, vitamins, and in some instances protein to
meet daily requirements.
2. Restoration of deficits
o In addition to maintenance therapy, fluid and electrolytes are added to replace
previous losses.
3. Replacement therapy
o Infusions to replace current losses in fluid and electrolytes.

Types of intravenous fluids

1. Isotonic solutions

a. Fluids that approximate the osmolarity (280-300 mOsm/L) of normal blood plasma.

• Sodium Chloride (0.9%) - Normal Saline

Indications:

• Extracellular fluid replacement when Cl- loss is equal to or greater the Na

loss.
• Treatment of matebolic alkalosis.
• Na depletion
• Initiating and terminating blood transfusions.

Possible side effects:

• Hypernatremia
• Acidosis
• Hypokalemia
• Circulatory overload.

b. Five percent dextrose in water (D5W).

• Provides calories for energy, sparring body protein and preventing ketosis
resulting from fat breakdown.

Indications:

• Dehydration
• Hypernatremia
• Drug administration

Possible side effects:

 • Hypokalemia
• Osmotic diuresis – dehydration
• Transient hyperinsulinism
• Water intoxication.

c. Five percent dextrose in normal saline (D5NS).

• Prevents ketone formation and loss of potassium and intracellular water.

Indications:

• Hypovolemic shock – temporary measure.

• Burns
• Acute adrenocortical insufiency.

Possible side effects:

• Hypernatremia
• Acidosis
• Hypokalemia
• Circulatory overload

d. Isotonic multiple-electrolyte fluids.

• Used for replacement therapy; ionic composition approximates blood

plasma.

Types:

• a. Plasmanate
• b. Polysol
• c. Lactated Ringers

Indications:

• Vomiting
• Diarrhea
• Excessive diuresis
• Burns

Possible side effects:

• Circulatory overload.
• Lactated Ringers is contraindicated in severe metabolic acidosis and/or
alkalosis and liver disease.
• Hypernatremia
 • Acidosis
• Hypokalemia

2. Hypertonic solutions

• Fluids with an osmolarity much higher than 310 mOsm (+ 50 mOsm); increase osmotic
pressure of blood plasma, thereby drawing fluid from cells.

a. Ten percent dextrose in normal saline

• Administered in large vein to dilute and prevent venous trauma.

Indications:

• Nutrition
• Replenish Na and Cl.

Possible side effects:

• Hypernatremia (excess Na)

• Acidosis (excess Cl)
• Circulatory overload.

b. Sodium Chloride solutions, 3% and 5%

Indications:

• Slow administration essential to prevent overload (100 mL/hr)

• Water intoxication
• Severe sodium depletion

3. Hypotonic solutions

• Fluids whose osmolarity is significantly less than that of blood plasma (-50 mOsm); these
fluids lower plasma osmotic pressure, causing fluid to enter cells.

a. 0.45% sodium chloride

• Used for replacement when requirement for Na use is questionable.

b. 2.5% dextrose in 0.45% saline, also 5% in 0.2 % NaCl

• Common rehydrating solution.

Indications:
 • Fluid replacement when some Na replacement is also necessary.
• Encourage diuresis in clients who are dehydrated.
• Evaluate kidney status before instituting electrolyte infusions.

Possible side effects:

• Hypernatremia
• Circulatory overload
• Used with caution in clients who are edematous, appropriate electrolytes
should be given to avoid hypokalemia.
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