FEN: Hypotonic Intravenous Fluids Flashcards
What is the risk of administering hypotonic fluids?
Hyptonic fluids administered intravenously can cause cell hemolysis and patient death
What is the minimum osmolarity that should be used as a cut off for administering intravenous fluids?
150 mOsm/L
Describe the intravenous administering of sterile water
- Sterile water is hypotonic with an osmolarity of zero mOsm/L
- It should never be administered intravenously alone due to hemolysis and patient death.
- Extemporaneously compounding by diluting products with sterile water should be used with caution to be sure the final product is not too hypotonic.
Describe the problem with diluting albumin 25% to make albumin 5%
- Albumin 5% is often on shortage, so albumin 25% is used to extemporaneously compound.
- Diluting albumin 25% with sterile water to make albumin 5% has an osmolarity of about 60 mOsm/L which can cause hemolysis.
- Instead, dilution should be done with NS or D5W.
Describe the problem with quarter normal saline or 0.225% sodium chloride
- 1/4 NS has osmolarity of 77 mOsm/L and can cause hemolysis
- In general it is almost always made by adding 39 mEq of NaCl to D5W.
What is the best case alternative for 0.225% sodium chloride in setting of hypernatremia?
- Enteral water, by mouth or feeding tube
If intravenous access is required, what is the best alternative for 0.225% NaCl in hypernatremia?
- D5W
What are two other strategies for using quarter normal saline in setting of
- Combination of D5W and 1/4 NS. If hyperglycemia is a concern (~50 g dextrose/L), recommend 2.5% dextrose and 0.225% NaCl. (osmolarity of 2.5% dextrose is 126.25 mOsm/L)
- Potassium chloride can be added to increase osmolarity
If a provider insists on using 0.225% sodium chloride alone, what is a recommendation you can make to improve safety?
- Central venous line
