APPENDIX GUIDELINES FOR IV INITIATION Intravenous access
Dextrose 5% in Water (D5W) - A hypotonic dextrose containing solution that is primarily ''free water" with some glucose. Its primary purpose is to keep a
IV Fluids
2 sept. 2021 (D5W). 253 mOsm/L. 5 g dextrose/100mL. 50 g dextrose/L. 170 calories/L. • Both isotonic and hypotonic. Initially dilutes osmolality of.
5% Dextrose and 0.45% Sodium Chloride Injection USP
When administered intravenously these solutions provide a source of water
9/4/2013 1 Overview Question1 (Fluid Resuscitation) To answer
4 sept. 2013 D5W IV 100ml/hr. Question 8 (Hypotonic Fluid and Hypernatremia). What is the most likely cause of her elevated serum sodium?
2013 AAHA/AAFP Fluid Therapy Guidelines for Dogs and Cats
such as lactated Ringer's solution [LRS]); a hypotonic solution (e.g. a crystalloid such as 5% dextrose in water [D5W]); and a synthetic.
9/6/2012 1 Overview Question1 (Fluid Resuscitation) To answer
6 sept. 2012 D5W. ? Dextrose is metabolized to H2O and CO2 ... Calculate the osmolarity of D5W ... 0.2% NaCl is hypotonic with an osmolarity of.
Stanford Ether
One of the first animal studies on the cerebral effects of fluid administration showed that hypotonic solutions expanded the brain [23]. The osmotic gradient.
Intravenous Fluids in the Hospitalized Child
11 juil. 2018 therapy with hypotonic fluids. ... Normal Saline (0.9% NaCl) ... chloride to every 100 ml of D5W to obtain maintenance fluid.
Medication Management Clinical Practice Guidelines
1 janv. 2014 with the administration of hypotonic IV fluids in children especially in ... Dextrose 3.3% + 0.3% NaCl (“D 2/3 & 1/3”) or D5W + 0.2% NaCl.
5% DEXTROSE Injection USP Trade Name® Container Rx only
The osmolarity is 252 mOsmol/L (calc.) which is slightly hypotonic. The solution pH is 4.3 (3.2 to 6.5). This solution contains no bacteriostat
IV Fluids and Solutions Guide & Cheat Sheet - Nurseslabs
12 fév 2023 · Isotonic IV Fluids 0 9 NaCl (Normal Saline Solution NSS); Dextrose 5 in Water (D5W) ; Hypotonic IV Fluids 0 45 Sodium Chloride (0 45 NaCl)
[PDF] IV Solutions - Picmonic
D5W is unique in that it may be classified as both an isotonic and hypotonic solution The dextrose in the solution makes its initial tonicity similar to
[PDF] 5% DEXTROSE Injection USP Trade Name® Container Rx only
5 Dextrose Injection USP solution is sterile and nonpyrogenic It is a parenteral solution containing dextrose in water for injection intended for intravenous
[PDF] 5% Dextrose and 045% Sodium Chloride Injection USP
DESCRIPTION 5 Dextrose and 0 45 Sodium Chloride Injection USP solution is sterile and nonpyrogenic It is a large volume parenteral solution
[PDF] Intravenous Fluid Therapy
It is considered an isotonic solution but when the dextrose is metabolized the solution actually becomes hypotonic and causes fluid to shift into
153 Intravenous Solutions – Nursing Fundamentals
Hypertonic Solutions ; Isotonic 5 Dextrose in Water (D5W) *starts as isotonic and then changes to hypotonic when dextrose is metabolized Provides free water
[PDF] Intravenous Fluids in the Hospitalized Child
11 juil 2018 · therapy with hypotonic fluids Give dextrose to decrease protein chloride to every 100 ml of D5W to obtain maintenance fluid
[PDF] Intravenous (IV) Fluids - Nursing Center
2 déc 2022 · extracellular fluid (hypotonic); once cell has used dextrose remaining saline and electrolytes act isotonic expanding the
[PDF] Fluid and Electroly te Series - CEConnection
tions discuss isotonic hypotonic dextrose in water (D5W) and Ringer's solution “normal saline solution” because the
Is D5W a hypotonic solution?
D5W (dextrose 5% in water) is a crystalloid isotonic IV fluid with a serum osmolality of 252 mOsm/L. D5W is initially an isotonic solution and provides free water when dextrose is metabolized (making it a hypotonic solution), expanding the ECF and the ICF.12 fév. 2023Is 5 dextrose in water hypertonic or hypotonic?
The actual solution in the bad is isotonic, but once you give D5W to patients the body metabolizes the glucose molecules that were once causing the solution to be isotonic. The solution is now missing solute, causing it to become a hypotonic solution.Why does D5W become hypotonic?
Each 100 mL of 5% Dextrose and 0.45% Sodium Chloride Injection, USP contains dextrose, hydrous 5 g and sodium chloride 0.45 g in water for injection. Electrolytes per 1000 mL: sodium (Na+), 77 mEq; chloride (Cl–) 77 mEq. The osmolarity is 406 mOsmol/L (calc.), which is hypertonic.
9/4/2013
1Last Chance Pharmacotherapy
Webinar - Fluids and Electrolytes
September 3, 2013
Judith L. Kristeller, PharmD, BCPS
Conflicts of Interest
I have no conflicts to disclose.
Overview
Total Body Fluid
Intravascular Volume Depletion
Fluid resuscitation vs. Maintenance IV Fluid
Osmolarity of IV Fluids
Hypertonic SalineHypertonic Saline
Hyponatremia
Hypotonic Fluid
Hypernatremia
Hypokalemia and Hyperkalemia
Other Electrolytes (Mg, PO
4 , Ca) and shortagesQuestion1 (Fluid Resuscitation) A 74yo female presents with a 3-day history of cough, fever to 102, and lethargy. Vitals/Labs: BP 72/40, HR115, CXR: LUL infiltrate, WBC 18,000, Hgb 12.5,
BUN/Cr 28/1.7 (baseline Cr 1.2), BG 82, UO 10ml/hr, wt72kg. PMH: CAD. After 500ml NS IV bolus, BP is
80/46. Which one of the followin
g is the most g appropriate treatment?A.Furosemide 40mg IV
B.0.9% NaCl 300ml/hr + Norepinephrine for SBP > 90C.1000ml fluid bolus with D5 / 0.9% NaCl
D.500ml fluid bolus with 0.9% NaCl
E.500ml fluid bolus with 5% Albumin
To answer Question 1,
think about...How do we recognize intravascular volume
depletion? H d IV fl id di t ib t i t t l b d fl id?How do IV fluids distribute in total body fluid? What IV fluids can be used to optimize intravascular volume?Total Body Fluid60%
Intracellular
(IC)40% Extracellular (EC)75% Interstitial
25% Intravascular
9/4/2013
2Intravascular Space
Not exactly "extracellular" because there are
cells in this space (RBC's)The extracellular fluid in the intravascular
space is known as plasma and is about~3Lspace is known as plasma, and is about 3 L There's an additional ~ 2L of fluid in RBC's, making the total blood volume about 5L Intravascular fluid is analogous to the fluid in your car's gas tankIntravascular Volume
Depletion
Intravascular volume depletion due to:
Hemorrhagic shock (blood loss)
Septic shock (fluid redistribution)Septic shock (fluid redistribution)Cardiogenic shock (usually fluid overload)
Intravascular volume depletion causes
reduced myocardial function and subsequent organ hypoperfusionThe Starling Curve
COMeasures of Intravascular Volume
(e.g., CVP, LVEDP, MAP)Intravascular Volume
Depletion
S/S: SBP < 80, HR > 100, BUN:Cr > 10:1, Ļ
UO, dizziness, altered mental status
Perhaps the best sign of intravascular fluid depletion ih i ' flidblis the patient's response to a fluid bolusS/S usually occur when 15% (~750ml) lost
Need promptintravascularfluid replacement
through central line to maintain organ perfusionCrystalloids
Colloids
Question 2 (Fluid Resuscitation)
Which of the following IV fluids provides the
most intravascular volume replacement?A.NS 1000ml
B.D5W 1000ml
C.25% Albumin 200ml
D.5% Albumin 500ml
Distribution of IV Crystalloid
0.9% NaCl or LR
Sodium and chloride do not freely enter cells
Distributed evenly in extracellular space
75% Interstitial and 25% Intravascular = 250ml per L infused
D5WDextrose is metabolized to H2O and CO2
Water crosses any membrane, will distribute evenly in TBW60% intracellular, 40% extracellular...then 25% of EC
intravascular = 100ml per L infusedNS or LR recommended for fluid resuscitation
9/4/2013
3NS vs. LR
LR is an isotonic solution consisting mostly of Na and Cl, but also lactate, K , and CaLR and NS are equivalent with respect to fluid
resuscitationLactate is metabolized to bicarbonate and can
be useful for metabolic acidosis, however lactate metabolism is impaired during shock, thus it's an ineffective source of bicarbonate LR is historically preferred in trauma patients, but no evidence suggest superiority over NS for fluid resuscitationDistribution of IV Colloid
Colloids are too large to cross capillary membrane, so all volume infused remains in intravascular spacePRBC fills intravascular space andcarries O
2Pooled human plasma
e.g., 5% albumin, plasma protein fraction or plasmanateSemi-synthetic glucose polymer (Dextran)
Semi-synthetic hydroxyethyl starch (hetastarch)
For products above, 500ml infused = 500ml
intravascular volume replacementDistribution of IV Colloid
Unlike 5% albumin, 25% albumin causes fluid
redistribution100ml IV = 500ml intravascular volume replacement
Theoretical risk of cellular dehydration (so monitor for organ dysfunction) Possibly useful in patients with ascites or pleural effusions where fluid redistribution is goalCrystalloids vs. Colloids
Crystalloids (NS, LR) are recommended
Colloids "seem" better than crystalloids based on distribution propertiesNo evidence to demonstrate improved outcomes
Higher cost
Limited evidence, but colloids
used in certain situations...Consider albuminafter fluid resuscitation with
crystalloid (usually 4-6 L) has failed to achieve hemodynamic goals or when li i ll i ifi dli i f hclinically significant edema limits further administration of crystalloid e.g., pulmonary edema causing hypoxia Avoid hetastarch due to risk of kidney injury and coagulopathyConsider albuminin patients who have
required large volume of resuscitation fluidAND albumin < 2.5 g/dL
Limited evidence, but colloids
used in certain situations...Consider albumin (preferably 25%) + loop
diuretic if clinically significant edema AND albumin < 2.5 g/dL AND diuretics alone ineffective e.g., pulmonary edema or effusion causing respiratory failure9/4/2013
4How much fluid?
For fluid resuscitation, administer 500-1000ml
through a large-bore central catheter as fast as possible, then re-evaluate.Continue as long as S/S of volume depletion
improve (BP HR CVP UO etc)improve (BP, HR, CVP, UO, etc)For daily fluid maintenance, many use 1500
ml for first 20kg, then 20ml/kg thereafter (~ 2500ml/day) OR 20-40 ml/kg/dayAdjust based on I/O's, weight, estimated
insensible loss (e.g., skin when febrile)Maintenance IV Fluid
Goal is prevent dehydration and maintain
normal fluid and electrolyte balanceNot for intravascular volume depletion
Typical maintenance IV fluid is D5 0.45% NaCl + KCl 20 - 40me q/LqOmit KCl if elevated K or kidney failure
0.9% NaCl, LR, or colloids are NOT appropriate maintenance IV fluids
Evaluate IV fluids daily and d/c if taking sufficient fluid orally or through feeding tubeQuestion1: Answer
A 74yo female presents with a 3-day history of cough, fever to 102, and lethargy. Vitals/Labs: BP 72/40, HR115, CXR: LUL infiltrate, WBC 18,000, Hgb 12.5,
BUN/Cr 28/1.7 (baseline Cr 1.2), BG 82, UO 10ml/hr, wt72kg. PMH: CAD. After 500ml NS IV bolus, BP is
80/46. Which one of the followin
g is the most g appropriate treatment?A.Furosemide 40mg IV
B.0.9% NaCl 300ml/hr + Norepinephrine for SBP > 90C.1000ml fluid bolus with D5 / 0.9% NaCl
D.500ml fluid bolus with 0.9% NaCl
E.500ml fluid bolus with 5% Albumin
Which of the following IV fluids provides the
most intravascular volume replacement?Question 2: Answer
A.NS 1000ml~ 250ml
B.D5W 1000ml~ 100ml
C.25% Albumin 200ml~ 1000ml
D.5% Albumin 500ml~ 500ml
Question 3 (Osmolarity)
Calculate the osmolarity of D5W
MW = 180 gm/mol
74 /LA.74 mosm/L
B.154 mosm/L
C.278 mosm/L
D.550 mosm/L
Plasma Osmolarity
Plasma osmolarity (Posm) 275-290 mOsm/kg
Primary determinant of Posm is sodium salts
(hence 2 x 140 = 280 ~ Posm)Major changes in serum Na can result in
hiPchanges in Posm Changes in Posm cause fluid shifts across cell membranesIncreased Posm causes cellular dehydration
Decreased Posm causes cellular overhydration
(cell swelling)9/4/2013
5Changes in Posm
Posm maintained in normal range by thirst
and secretion of ADH from posterior pituitaryRapidchange in Posmor in serum Nacan cause
permanent neurologic damage in CNS cells Chronic / slow changes in serum Na orPosmareChronic / slow changes in serum Na or Posmare usually well tolerated and asymptomatic In chronic hyponatremia, cerebral swelling is avoided by osmotic adaptation (i.e., solutes move out of cerebral cells to lower the cellular osmolarity...this prevents the osmotic shift of water into the cerebral cells)quotesdbs_dbs6.pdfusesText_11[PDF] is dextrose bad for you
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