Get to know the different types of intravenous solutions or IV fluids in this guide and

cheat sheet. Differentiate isotonic, hypertonic, and hypotonic IV solutions and

the nursing interventions and management for each.

What are IV Fluids?

Intravenous fluids (IV Fluids), also known as intravenous solutions, are
supplemental fluids used in intravenous therapy to restore or maintain normal fluid
volume and electrolyte balance when the oral route is not possible. IV fluid therapy is an
efficient and effective way of supplying fluids directly into the intravascular fluid
compartment, in replacing electrolyte losses, and in administering medications
and blood products.

Types of IV Fluids
There are different types of IV fluids and different ways on how to classify them.
The most common way to categorize IV fluids is based on their tonicity:
Isotonic. Isotonic IV solutions that have the same concentration of solutes as
blood plasma.
Hypotonic. Hypotonic solutions have lesser concentration of solutes than plasma.
Hypertonic. Hypertonic solutions have greater concentration of solutes than plasma.
IV solutions can also be classified based on their purpose:
Nutrient solutions. May contain dextrose, glucose, and levulose to make up the
carbohydrate component – and water. Water is supplied for fluid requirements and
carbohydrate for calories and energy. Nutrient solutions are useful in
preventing dehydration and ketosis. Examples of nutrient solutions include D5W, D5NSS.
Electrolyte solutions. Contains varying amounts of cations and anions that are used
to replace fluid and electrolytes for clients with continuing losses. Examples of
electrolyte solutions include 0.9 NaCl, Ringer’s Solution, and LRS.
Alkalinizing solutions. Are administered to treat metabolic acidosis. Examples: LRS.
Acidifying solutions. Are used to counteract metabolic alkalosis. D51/2NS, 0.9 NaCl.
Volume expanders. Are solutions used to increase the blood volume after a
severe blood loss, or loss of plasma. Examples of volume expanders are dextran, human
albumin, and plasma.
Crystalloids
Crystalloid IV solutions contain small molecules that flow easily across semipermeable
membranes. They are categorized according to their relative tonicity in relation to
plasma. There are three types: isotonic, hypotonic, and hypertonic.
Isotonic IV Fluids
Most IV fluids are isotonic, meaning, they have the same concentration of solutes as
blood plasma. When infused, isotonic solutions expand both the intracellular
fluid and extracellular fluid spaces, equally. Such fluids do not alter the osmolality of the
vascular compartment. Technically, electrolyte solutions are considered isotonic if the
total electrolyte content is approximately 310 mEq/L. Isotonic IV fluids have a total
osmolality close to that of the ECF and do not cause red blood cells to shrink or swell.
 Cheat sheet for
Isotonic IV Fluids.

0.9% NaCl (Normal Saline Solution, NSS)

Normal saline solution (0.9% NaCl) or NSS, is a crystalloid isotonic IV fluid that
contains water, sodium (154 mEq/L), and chloride (154 mEq/L). It has an osmolality of
308 mOsm/L and gives no calories. It is called normal saline solution because the
percentage of sodium chloride dissolved in the solution is similar to the usual
concentration of sodium and chloride in the intravascular space. Normal saline is the
isotonic solution of choice for expanding the extracellular fluid (ECF) volume because it
does not enter the intracellular fluid (ICF). It is administered to correct extracellular fluid
volume deficit because it remains within the ECF.
Normal saline is the IV fluid used alongside the administration of blood products. It is
also used to replace large sodium losses such as in burn injuries and trauma. It should
not be used for heart failure, pulmonary edema, and renal impairment, or conditions
that cause sodium retention as it may risk fluid volume overload.
Dextrose 5% in Water (D5W)

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. It is
administered to supply water and to correct an increase in serum osmolality. A liter of
D5W provides fewer than 200 kcal and contains 50g of glucose. It should not be used
for fluid resuscitation because hyperglycemia can result. It should also be avoided to be
used in clients at risk for increased intracranial pressure as it can cause cerebral edema.
Lactated Ringer’s 5% Dextrose in Water (D5LRS)

Lactated Ringer’s Solution (also known as Ringer’s Lactate or Hartmann solution) is

a crystalloid isotonic IV fluid designed to be the near-physiological solution of
balanced electrolytes. It contains 130 mEq/L of sodium, 4 mEq/L of potassium, 3 mEq/L
of calcium, and 109 mEq/L of chloride. It also contains bicarbonate precursors to prevent
acidosis. It does not provide calories or magnesium and has
limited potassium replacement. It is the most physiologically adaptable fluid because its
electrolyte content is most closely related to the composition of the body’s blood serum
and plasma.
Lactated Ringer’s is used to correct dehydration, sodium depletion, and replace GI tract
fluid losses. It can also be used in fluid losses due to burns, fistula drainage, and trauma.
It is the choice for first-line fluid resuscitation for certain patients. It is often
administered to patients with metabolic acidosis.
Lactated Ringer’s solution is metabolized in the liver, which converts the lactate to
bicarbonate, therefore, it should not be given to patients who cannot metabolize lactate
(e.g., liver disease, lactic acidosis). It should be used in caution for patients with heart
failure and renal failure.
Ringer’s Solution

Ringer’s solution is another isotonic IV solution that has content similar to Lactated
Ringer’s Solution but does not contain lactate. Indications are the same for Lactated
Ringer’s but without the contraindications related to lactate.
Nursing Considerations for Isotonic IV Solutions

The following are the general nursing interventions and considerations when
administering isotonic 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.
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 IV 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.
Hypotonic IV Fluids
Hypotonic IV solutions have a lower osmolality and contain fewer solutes than plasma.
They cause fluid shifts from the ECF into the ICF to achieve homeostasis, therefore,
causing cells to swell and may even rupture. IV solutions are considered hypotonic if the
total electrolyte content is less than 250 mEq/L. Hypotonic IV fluids are usually used to
provide free water for excretion of body wastes, treat cellular dehydration, and replace
the cellular fluid.
0.45% Sodium Chloride (0.45% NaCl)

Sodium chloride 0.45% (1/2 NS), also known as half-strength normal saline, is a
hypotonic IV solution used for replacing water in patients who
have hypovolemia with hypernatremia. Excess use may lead to hyponatremia due to the
dilution of sodium, especially in patients who are prone to water retention. It has an
osmolality of 154 mOsm/L and contains 77 mEq/L sodium and chloride.
Hypotonic sodium solutions are used to treat hypernatremia and other hyperosmolar
conditions.
0.33% Sodium Chloride (0.33% NaCl)

Cheat sheet for

Hypotonic IV Fluids.

0.33% Sodium Chloride Solution is used to allow kidneys to retain the needed
amounts of water and is typically administered with dextrose to increase tonicity. It
should be used in caution for patients with heart failure and renal insufficiency.
0.225% Sodium Chloride (0.225% NaCl)

0.225% Sodium Chloride Solution is often used as a maintenance fluid for pediatric
patients as it is the most hypotonic IV fluid available at 77 mOsm/L. Used together with
dextrose.
2.5% Dextrose in Water (D2.5W)

Another hypotonic IV solution commonly used is 2.5% dextrose in water (D2.5W). This
solution is used to treat dehydration and decreased the levels of sodium and potassium.
It should not be administered with blood products as it can cause hemolysis of red
blood cells.
Nursing Considerations for Hypotonic IV Solutions

The following are the general nursing interventions and considerations when
administering hypotonic IV 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 (IICP). Should not be given to patients with
risk for IICP 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 IV 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.
Hypertonic IV Fluids
Hypertonic IV solutions have a greater concentration of solutes (375 mEq/L and
greater) than plasma and cause fluids to move out of the cells and into the ECF in order
to normalize the concentration of particles between two compartments. This effect
causes cells to shrink and may disrupt their function. They are also known as volume
expanders as they draw water out of the intracellular space, increasing extracellular
fluid volume.

Cheat sheet for

Hypertonic IV Fluids.

Hypertonic Sodium Chloride IV Fluids

Hypertonic sodium chloride solutions contain a higher concentration of sodium and

chloride than normally contained in plasma. Infusion of hypertonic sodium chloride
solution shifts fluids from the intracellular space into the intravascular and interstitial
spaces. Hypertonic sodium chloride IV solutions are available in the following
forms and strengths:
3% sodium chloride (3% NaCl) containing 513 mEq/L of sodium and chloride with an
osmolality of 1030 mOsm/L.
5% sodium chloride (5% NaCl) containing 855 mEq/L of sodium and chloride with an
osmolality of 1710 mOsm/L.
Hypertonic sodium chloride solutions are used in the acute treatment
of sodium deficiency (severe hyponatremia) and should be used only in critical situations
to treat hyponatremia. They need to be infused at a very low rate to avoid the risk of
overload and pulmonary edema. If administered in large quantities and rapidly, they
may cause an extracellular volume excess and precipitate circulatory overload and
dehydration. Therefore, they should be administered cautiously and usually only when
the serum osmolality has decreased to critically low levels. Some patients may
need diuretic therapy to assist in fluid excretion. It is also used in patients with cerebral
edema.
Hypertonic Dextrose Solutions

Isotonic solutions that contain 5% dextrose (e.g., D5NSS, D5LRS) are slightly hypertonic
since they exceed the total osmolality of the ECF. However, dextrose is quickly
metabolized and only the isotonic solution remains. Therefore, any effect on the ICF is
temporary. Hypertonic dextrose solutions are used to provide kilocalories for the patient
in the short term. Higher concentrations of dextrose (i.e., D50W) are strong hypertonic
solutions and must be administered into central veins so that they can be diluted by
rapid blood flow.
Dextrose 10% in Water (D10W)

Dextrose 10% in Water (D10W) is an hypertonic IV solution used in the treatment of

ketosis of starvation and provides calories (380 kcal/L), free water, and no electrolytes. It
should be administered using a central line if possible and should not be infused using
the same line as blood products as it can cause RBC hemolysis.
Dextrose 20% in Water (D20W)

Dextrose 20% in Water (D20W) is hypertonic IV solution an osmotic diuretic that

causes fluid shifts between various compartments to promote diuresis.
Dextrose 50% in Water (D50W)

Another hypertonic IV solution used commonly is Dextrose 50% in Water

(D50W) which is used to treat severe hypoglycemia and is administered rapidly
via IV bolus.
Nursing Considerations for Hypertonic IV Fluids

The following are the general nursing interventions and considerations when
administering hypertonic IV 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.
Watch for signs of hypervolemia. Since hypertonic solutions move fluid from the ICF
to the ECF, they increase the extracellular fluid volume and increases 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. Prescription 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.
Colloids
Colloids contain large molecules that do not pass through semipermeable
membranes. Colloids are IV fluids that contain solutes of high molecular weight,
technically, they are hypertonic solutions, which when infused, exert an osmotic pull
of fluids from interstitial and extracellular spaces. They are useful for expanding the
intravascular volume and raising blood pressure. Colloids are indicated for patients in
malnourished states and patients who cannot tolerate large infusions of fluid.

Colloid IV Fluids and

Solutions Cheat Sheet
Human Albumin
Human albumin is a solution derived from plasma. It has two strengths: 5% albumin and
25% albumin. 5% Albumin is a solution derived from plasma and is a commonly utilized
colloid solution. It is used to increase the circulating volume and restore protein levels in
conditions such as 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 when administering albumin.
The use of albumin is contraindicated in patients with the following conditions:
severe anemia, heart failure, or known sensitivity to albumin. Additionally, angiotensin-
converting enzyme inhibitors should be withheld for at least 24 hours before
administering albumin because of the risk of atypical reactions, such as hypotension and
flushing.
Dextrans
Dextrans are polysaccharides that act as colloids. They are available in two types: low-
molecular-weight dextrans (LMWD) and high-molecular-weight dextrans (HMWD). They
are available in either saline or glucose solutions. Dextran interferes with blood
crossmatching, so draw the patient’s blood before administering dextran, if
crossmatching is anticipated.
Low-molecular-weight Dextrans (LMWD)

LMWD contains polysaccharide molecules that behave like colloids with an average
molecular weight of 40,000 (Dextran 40). LMWD is used to improve the microcirculation
in patients with poor peripheral circulation. They contain no electrolytes and are used to
treat shock related to vascular volume loss (e.g., burns, hemorrhage, trauma, or surgery).
On certain surgical procedures, LMWDs are used to prevent venous thromboembolism.
They are contraindicated in patients with thrombocytopenia, hypofibrinogenemia, and
hypersensitivity to dextran.
High-molecular-weight Dextrans (HMWD)

HMWD contains polysaccharide molecules with an average molecular weight of 70,000

(Dextran 70) or 75,000 (Dextran 75). HMWD used for patients with hypovolemia and
hypotension. They are contraindicated in patients with hemorrhagic shock.
Etherified Starch
These solutions are derived from starch and are used to increase intravascular fluid but
can interfere with normal coagulation. Examples include EloHAES, HyperHAES, and
Voluven.
Gelatin
Gelatins have lower molecular weight than dextrans and therefore remain in the
circulation for a shorter period of time.
Plasma Protein Fraction (PPF)
Plasma Protein Fraction is a solution that 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 IV Solutions
The following are the general nursing interventions and considerations when
administering colloid IV solutions:
Assess allergy history. Most colloids can cause allergic reactions, although rare, so
take a careful allergy history, asking specifically if they’ve 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.