Normal Saline (NS) Cheat Sheet

IV Solution Cheat Sheet A quick reference guide on the different intravenous solutions. Type Normal Saline (NS)    0.9% NaCl in Water Crystalloid Solution Isotonic (308 mOsm) 1/2 Normal Saline (1/2 NS)    Use            0.45% NaCl in Water Crystalloid Solution Hypotonic (154 mOsm)   Lactated Ringer’s (LR)      Normal saline with electrolytes and buffer Isotonic (275 mOsm)     Increases circulating plasma volume when red cells are adequate Shock Fluid replacement in patients with diabetic ketoacidosis Hyponatremia Blood transfusions Resuscitation Metabolic Alkalosis Hypercalcemia Water replacement Raises total fluid volume DKA after initial normal saline solution and before dextrose infusion Hypertonic dehydration Sodium and chloride depletion Gastric fluid loss from nasogastric suctioning or vomiting. Replaces fluid and buffers pH Hypovolemia due to thirdspace shifting. Dehydration Burns Lower GI tract fluid loss Acute blood loss Special Considerations              Do not use in patients with heart failure, edema, or hypernatremia, because NSS replaces extracellular fluid and can lead to fluid overload. Replaces losses without altering fluid concentrations. Helpful for Na+ replacement Use cautiously; may cause cardiovascular collapse or increase in intracranial pressure. Don’t use in patients with liver disease, trauma, or burns. Useful for daily maintenance of body fluid, but is of less value for replacement of NaCl deficit. Helpful for establishing renal function. Fluid replacement for clients who don’t need extra glucose (diabetics) Has similar electrolyte content with serum but doesn’t contain magnesium. Has potassium therefore don’t use to patients with renal failure as it can cause hyperkalemia Don’t use in liver disease because the patient can’t metabolize lactate; a functional liver converts it to bicarbonate; don’t give if patient’s pH > 75. Normal saline with K+, Ca++, and lactate (buffer) Often seen with surgery D5 W    Dextrose 5% in water Crystalloid solution Isotonic (in the bag) *Physiologically hypotonic (260 mOsm)     Raises total fluid volume. Helpful in rehydrating and excretory purposes. Fluid loss and dehydration Hypernatremia       D5NS   Dextrose 5% in 0.9% saline Hypertonic (560 mOsm)     D5 1/2 NS   Dextrose 5% in 0.45% saline Hypertonic (406 mOsm) D5LR       Dextrose 5% in Lactated Ringer’s Hypertonic (575 mOsm)   Normosol-R  Normosol Isotonic (295 mOsm)   Hypotonic dehydration Replaces fluid sodium, chloride, and calories. Temporary treatment of circulatory insufficiency and shock if plasma expanders aren’t available SIADH (or use 3% sodium chloride). Addisonian crisis DKA after initial treatment with normal saline solution and half-normal saline solution – prevents hypoglycemia and cerebral edema (occurs when serum osmolality is reduced rapidly). Same as LR plus provides about 180 calories per 1000cc’s. Indicated as a source of water, electrolytes and calories or as an alkalinizing agent Replaces fluid and buffers pH Indicated for replacement of acute extracellular fluid volume losses in surgery, trauma, burns or shock. Used as an adjunct to restore a decrease in circulatory volume in patients with moderate blood loss         Solution is isotonic initially and becomes hypotonic when dextrose is metabolized. Not to be used for resuscitation; can cause hyperglycemia Use in caution to patients with renal or cardiac disease, can cause fluid overload Doesn’t provide enough daily calories for prolonged use; may cause eventual breakdown of protein. Provides 170-200 calories/1,000cc for energy. Physiologically hypotonic -the dextrose is metabolized quickly so that only water remains - a hypotonic fluid Do not use in patients with cardiac or renal failure because of danger of heart failure and pulmonary edema. Watch for fluid volume overload In DKA, use only when glucose falls < 250 mg/dl Most common postoperative fluid Useful for daily maintenance of body fluids and nutrition, and for rehydration. Contraindicated in newborns (≤ 28 days of age), even if separate infusion lines are used (risk of fatal ceftriaxone-calcium salt precipitation in the neonate’s bloodstream). Contraindicated in patients with a known hypersensitivity to sodium lactate. Not intended to supplant transfusion of whole blood or packed red cells in the presence of uncontrolled hemorrhage or severe reductions of red cell volume