Crystalloid | Action / Use | Nursing Considerations |
Hypotonic: <250 mOsm/L 0.25% normal saline (NS) 0.33% NS 0.45% NS 5% dextrose in water (D5W)-hypotonic once administered |
· Shifts fluid out of vessels into cells · Hydrates cells · D5W spares protein, provides calories and free water, treats hyperkalemia, is a diluent for IV drugs |
· May worsen hypotension · Can increase edema · May cause hyponatremia · D5W may also irritate veins · Do not give to those at risk for increased intracranial pressure: stroke, head trauma or neurosurgery |
Isotonic: >250 mOsm/L 0.9% NS Lactated Ringer’s (LR) Ringer’s Normosol Plasma-Lyte |
· No fluid shift · Vascular expansion · Electrolyte replacement |
· May cause fluid overload, especially with hypertension and heart failure · Generalized edema, · Dilutes hemoglobin · May cause electrolyte imbalance |
Hypertonic: >375 mOsm/L D50.45% NS D50.9% NS D5LR Hypertonic saline (HS) 3% or 5% |
· Shifts fluid back into circulation · Vascular expansion · Replaces electrolytes |
· Irritating to veins · May cause fluid overload · May cause hypernatremia · May cause hyperchloremia · HS slows inflammation and increases capillary permeability |
Colloids | Action / Use | Nursing Considerations |
Albumin (plasma protein) 5% or 25% |
· Keeps fluid in vessels · Maintains volume · Used to replace protein and treat shock and erythroblastosis fetalis |
· May cause anaphylaxis (watch for hives, fever, chills, headache). · May cause fluid overload and pulmonary edema |
Hetastarch (HES) (synthetic starch) 6% or 10% |
· Shifts fluid into vessels · Vascular expansion · Prolongs hemodynamic response when given with hypertonic saline |
· May cause fluid overload and hypersensitivity · Increased risk of bleeding contraindicated in bleeding disorders, CHF, and renal failure |
Dextran (polysaccharide) 40 kDa or 70 kDa |
· Shifts fluids into vessels · Vascular expansion · Prolongs hemodynamic response when given with hypertonic saline |
· May cause fluid overload and hypersensitivity · Contraindicated in bleeding disorders, CHF, and renal failure |