Oral Fluid Replacement

Used to correct mild fluid and electrolyte deficits
- Water
- Glucose
- Potassium
- Sodium

IV Fluids

Purposes
- Maintenance
  - When oral intake is not adequate
- Replacement
  - When losses have occurred
Types of fluids categorized by tonicity
- Hypotonic
  - More water than electrolytes
  - Pure water lyses RBCs
  - Water moves from ECF to ICF by osmosis
  - Usually maintenance fluids
  - Monitor for changes in mentation
- Isotonic
  - Expands only ECF
  - No net loss or gain from ICF
  - Ideal to replace ECF volume deficit
    - D₅W
      - 5% Dextrose (sugar) in Water
      - Free water without electrolytes
      - Provides 170 cal/L
      - Used to replace water losses, treat hypernatremia, prevent ketosis
    - Normal Saline (NS or NSS)
      - More NaCl than ECF
      - No free water, calories or electrolytes
      - Expands IV volume
        
        Preferred fluid for immediate response
      - Compatible with most medications
      - Only solution used with blood
    - Lactated Ringer’s Solution
      - Similar in composition to plasma except contains no magnesium
      - Expands ECF—treat burns and GI losses
      - Contraindicated with hyperkalemia and lactic acidosis
      - No free water or calories
- Hypertonic
  - Initially expands and raises the osmolality of ECF
  - Require frequent monitoring of
    - Blood pressure
    - Lung sounds
    - Serum sodium levels

- - - D₅ NS
      - 5% Dextrose and 0.45% Sodium Chloride Injection
      - Common maintenance fluid
      - Replaces fluid loss
      - KCl added for maintenance or replacement
    - D₁₀W
      - Dextrose 10 % in Water
      - Provides 340 kcal/L
      - Provides free water but no electrolytes
      - Limit of dextrose concentration may be infused peripherally
- Colloids
  - Stay in vascular space and increase osmotic pressure
  - Include:
    - Human plasma products (albumin, fresh frozen plasma, blood)
    - Semisynthetics (dextran and starches, [Hespan])

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