IV Solutions Cheat Sheet
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Hypertonic Solutions
Hypertonic Sodium Chloride Solutions
3% NaCl Uses
Sodium (513 mEq/L) Used in the acute treatment of severe hyponatremia and should only be used in critical
Chloride (513 mEq/L) situations to treat hyponatremia.
1030 mOsm/L Used in patients with cerebral edema.
5% Nacl Some patients may need diuretic therapy to assist in fluid excretion.
Sodium (855 mEq/L) Caution
Chloride (855 mEq/L) Should be infused at a very low rate to avoid risk of pulmonary edema.
1710 mOsm/L I fadministered in large quantities and rapidly, they may cause ECF excess and circulatory
Overload.
Dextrose 10% (D10W)
Other names Uses
Dextrose 10% in Used in the treatment of ketosis of starvation and provides calories and free water.
Water Caution
Osmolality Should be administered using a central lineif possible.
505 mOsm/L Do NOT infuse using the same line as blood products as it can cause RBC hemolysis.
Contains
Water
Glucose (100g/L)
380 kcal/L
Dextrose 20% (D20W)
Other names Uses
Dextrose 20% in Used as an osmotic diuretic that causes fluid shifts between various fluid compartments
Water to promote diuresis.
Osmolality
660 mOsm/L
Contains
Water
Glucose (200g/L)
Dextrose 50% (D5OW)
Other names Uses
Dextrose 50% in Used to treat severe hypoglycemia.
Water Administered rapidly via IV bolus.
Osmolality
2523 mOsm/L
Contains
Water
Glucose (500g/L)
Nursing Considerations for Hypertonic Solutions
Document baseline data. Before infusion, assess the patient's vital signs, edema status, lung sounds, and heart
sounds, glucose levels. Continue monitoring during and after the infusion.
Watch for signs of hypervolemia. Since hypertonic solutions move fluid from the ICF to the ECF, they increase the
extracellular fluid volume and increase the risk for hypervolemia. Look for signs of swelling in arms, legs, face, shortness
of breath, high blood pressure, and discomfort in the body (e.g., headache, cramping).
Monitor and observe the patient during administration. Hypertonic solutions should be administered only in high
acuity areas with constant nursing surveillance for potential complications.
Verify order. Prescriptions for hypertonic solutions should state the specific hypertonic fluid to be infused, the total
volume to be infused, the infusion rate and the length of time to continue the infusion.
Assess health history. Patients with kidney or heart disease and those who are dehydrated should not receive
hypertonic IV fluids. These solutions can affect renal filtration mechanisms and can easily cause hypervolemia to
patients with renal or heart problems.
Prevent fluid overload. Ensure that administration of hypertonic fluids does not precipitate fluid volume excess or
overload.
Do not administer peripherally. Hypertonic solutions can cause irritation and damage to the blood vessel and should
be administered through a central vascular access device inserted into a central vein.
Monitor blood glucose closely. Rapid infusion of hypertonic dextrose solutions can cause hyperglycemia. Use with
caution for patients with diabetes mellitus.
Check integrity of IV Solution. Solution should be clear with the container and seals intact. IV solutions are covered in
overwrap, do not remove until ready for use. Check for minute leaks by squeezing the container firmly, if leaks are
found, discard solution as sterility may be compromised.
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IV Solutions Cheat Sheet
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Isotonic Solutions
Normal Saline Solution (NSS) (0.9& NaC)
Osmolality
308 mOsm/L
Uses
Isotonic solution of choice for expanding ECF volume.
Containss Infused to correct extracellular fluid volume deficit.
Water Used alongside administration of blood products.
Sodium (154 mEq/L) Used to replace large sodium losses such as burn injuries and trauma.
Chloride (154 mEq/L) Caution
Should not be used for patients with heartfailure, pulmonary edema, and renal
impairment
Dextrose 5% in Water (D5W)
Osmolality Uses
252 mOsm/L Initially isotonic and provides free water when dextrose is metabolized (making it
Containss hypotonic).
Water Expands the ECF and ICF, helpful in rehydrating and excretory purposes.
Glucose (50g/L) Used to treat hypernatremia.
Caution
Should NOT be used for fluid resuscitation because hyperglycemia can result. Should be
avoided in clients at risk for increased intracranial pressure.
Lactated Ringer's Solution in 5% Dextrose
Other Names Uses
DSLRS Used to correct dehydration, sodium depletion, and replace Gl tract fluid losses.
LR Also used in fluid losses caused by burns, fistula drainage, and trauma.
Ringer's Lactate Often administered for patients with metabolic acidosis because it is an alkalizing
Hartmann Solution solution.
Osmolality Caution
273 mOsm/L Should not be given to patients who cannot metabolize lactate (e.g., liver disease, lactic
Contains acidosis). Used in caution for patients with heart failure and renal failure
Water
Sodium (130 mEq/L)
Potassium (4 mEq/L)
Calcium (3 mEq/L)
Chloride (109 mEq/L)
Lactate (28 meq/L)
Ringer's Solution
Osmolality Uses
273 mOsm/L
Contains
Similar indications for Lactated Ringer's solution but without the contraindications
related to lactate.
Similar composition
with Lactated Ringer's
but without the
lactate
Nursing Considerations for Isotonic Solutions
Document baseline data. Before infusion, assess the patient'svital signs, edema status, lung sounds, and heart
sounds. Continue monitoring during and after the infusion.
Observe for signs of fluid overload. Look for signs of hypervolemia such as hypertension, bounding pulse, pulmonary
crackles, dyspnea, shortness of breath, peripheral edema, jugular venous distention, and extra heart sounds.
Monitor manifestations of continued hypovolemia. Look for signs that indicate continued hypovolemia such as,
decreased urine output, poor skin turgor, tachycardia, weak pulse, and hypotension.
Prevent hypervolemia. Patients being treated for hypovolemia can quickly develop fluid overload following rapid or
over infusion of isotonic V fluids.
Elevate the head of the bed at 35 to 45 degrees. Unless contraindicated, position the client in semi-Fowler's position.
Elevate the patient's legs. If edema is present, elevate the legs of the patient to promote venous return.
Educate patients and families. Teach patients and families to recognize signs and symptoms of fluid volume overload.
Instruct patients to notify their nurse if they have trouble breathing or notice any swelling.
Close monitoring for patients with heart failure. Because isotonic fluids expand the intravascular space, patients
with hypertension and heart failure should be carefully monitored for signs of fluid overload.
Check integrity of IV Solution. Solution should be clear with the container and seals intact. IV solutions are covered in
overwrap, do not remove until ready for use. Check for minute leaks by squeezing the container firmly, if leaks are
found, discard solution as sterility may be compromised.
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Hypotonic Solutions
0.45% Sodium Chloride Solution (0.45% NaC)
Other names Uses
Half-strength normal Used for replacing water in patients who have hypovolemia with hypernatremia.
saline Caution
1/2 NS Excessive use may lead to hyponatremia due to the dilution of sodium.
Osmolality
154 mOsm/L
Contains
Water
Sodium (77 mEq/L)
.Chloride (77 mEq/L)
0.33% Sodium Chloride Solution (0.33% NaCl)
Other names Uses
5 % Dextrose in 0.33 Used to allow kidneys to retain needed amounts ofwater. Free water helps kidneys
Sodium Chloride eliminate solutes.
One-third strength Typicaly administered with dextrose to increase tonicity.
normal saline Caution
Osmolality Used in caution for patients with heart failure and renal insufficiency.
365 mOsm/L
(hypotonic once
dextrose is
metabolized)
Contains
Water
Sodium (56 mEq/L)
Chloride (6 mEq/L)
Glu Icos se
170 kcal/L
0.225% Sodium Chloride Solution (0.255% NaCl)
Other names Uses
5 % Dextrose in 0.255 Used as maintenance fluid for pediatric patients as it is the most hypotonic fluid
Sodium Chloride available.
Osmolality .Typically administered with dextrose to increase tonicity.
77 mOsm/L
Contains
Water
Sodium (38 mEq/L)
Chloride (38 mEq/L)
Glucose (50g/L)
2.59% Dextrose in Water (D2.5W)
Osmolality Uses
126 mOsm/L Used to treat dehydration and decrease the levels of sodium and potassium.
Contains Caution
Water NOT be administered with blood products as it can cause hemolysis of red blood
Glucose (25g/L)
.Should
cells.
Nursing Considerations for Hypotonic Solutions
Document baseline data. Before infusion, assess the patient's vital signs, edema status, lung sounds, and heart
sounds. Continue monitoring during and after the infusion.
Do not administer in contraindicated conditions. Hypotonic solutions may exacerbate existing hypovolemia and
hypotension causing cardiovascular collapse. Avoid use in patients with liver disease, trauma, or burns.
Risk for increased intracranial pressure (1ICP). Should not be given to patients with risk for lICP as the fluid shift may
cause cerebral edema (remember: hypotonic solutions make cells swell).
Monitor for manifestations of fluid volume deficit. Signs and symptoms include confusion in older adults. Instruct
patients to inform the nurse if they feel dizzy.
Warning on excessive infusion. Excessive infusion of hypotonic V fluids can lead to intravascular fluid depletion,
decreased blood pressure, cellular edema, and cell damage.
Do not administer along with blood products. Most hypotonic solutions can cause hemolysis of red blood cells
especially during rapid infusion of the solution.
Check integrity of IV Solution. Solution should be clear with the container and seals intact. IV solutions are covered in
Overwrap, do not remove until ready for use. Check for minute leaks by squeezing the container firmly, if leaks are
found, discard solution as sterility may be compromised.
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Colloid Solutions
Human Albumin
5% Albumin Uses
309 mOsm/L
25% Albumin
Commonly utilized colloid solution.
Used to increase the circulating volume and restore protein levels in conditions such as
312 mOsm/L burns, pancreatitis, and plasma loss through trauma.
25% Albumin is used together with sodium and water restriction to reduce excessive
edema.
They are considered blood transfusion products and uses the same protocols and
nursing precautions.
Caution
Contraindicated in patients with the following conditions: severe anemia, heart failure, or
known sensitivity to albumin.
Angiotensin-converting enzyme inhibitors (ACE Inhibitors) are withheld for at least 24
hours before administering albumin.
Low-Molecular-Weight Dextran (LMWD)
Other names Uses
Dextran 40 Used to improve microcirculation in patients with poor peripheral circulation.
Used to treat shock related to vascular volume loss (e.g., burns, hemorrhage, trauma,
surgery).
Used to prevent venous thromboembolism on certain surgical procedures.
Caution
Contraindicated in patientswith thrombocytopenia, hypofibrinogenemia, and
hypersensitivity to dextran.
High-Molecular-Weight Dextran (HMWD)
Other names Uses
Dextran 70 Used for patients with hypovolemia and hypertension.
Dextran 75 Caution
Contraindicated in patients with hemorrhagic shock.
Etherified Starch
Other names Uses
EloHAES These are solutions derived from starch.
HyperHAES Used to increase intravascular fluid but can interfere with normal coagulation.
Voluven
Gelatin
Uses
Gelatins have lower molecular weight than dextrans and therefore remain in the
circulation for a shorter period of time.
Plasma Protein Fraction (PPF)
Uses
This solution is also prepared from plasma, and like albumin, is heated before infusion. It
is recommended to infuse slowly to increase circulating volume.
Nursing Considerations for Colloid Solutions
Assess allergy history. Most colloids can cause allergic reactions, although rare, so take a careful allergy history, asking
specifically if theyve ever had a reaction to an IV infusion before.
.Use a large-bore needle (18-gauge). A larger needle is needed when administering colloid solutions.
Document baseline data. Before infusion, assess the patient's vital signs, edema status, lung sounds, and heart
sounds. Continue monitoring during and after the infusion.
Monitor the patient's response. Monitor intake and output closely for signs of hypervolemia, hypertension, dyspnea,
crackles in the lungs, and edema.
Monitor coagulation indexes. Colloid solutions can interfere with platelet function and increase bleeding times, so
monitor the patient's coagulation indexes.
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