In this review, let’s cover hypertonic IV (intravenous) solutions.
Hypertonic IV solutions have a higher osmolarity than blood, meaning they have a greater concentration of solutes within the fluid being administered than the blood.
Due to this, osmosis triggers water to exit the intracellular space, potentially causing cell shrinkage, which aids in expanding the extracellular space. This effect is particularly beneficial for patients with:
Cases of severely low sodium levels (hyponatremia): by adding a hypertonic saline solution to the plasma this will increase sodium blood levels
Brain swelling (cerebral edema): hypertonic solutions will pull water from the brain cells and decrease swelling.
Some solutions classified as hypertonic include 3% saline, dextrose 10% in water, dextrose 5% in normal saline, and dextrose 5% in half-normal saline.
When administering these fluids, it’s crucial to exercise caution due to the risk of overloading the extracellular space, as fluid moves from inside the cells to the extracellular area. This shift could potentially lead to pulmonary edema.
Additionally, hypertonic solutions are highly concentrated, such as saline, which could cause hypernatremia. Therefore, monitoring sodium levels in the blood is essential.
Before administering these solutions, always consult your facility’s protocol to ensure proper administration. Some protocols might require all hypertonic solutions to be delivered through a central line rather than a peripheral IV, while others might specify this only for concentrations of 10% or higher. The reason behind this precaution is that if hypertonic solutions infiltrate the surrounding tissue, they can cause significant damage to cells and tissue, necessitating vigilance for extravasation.
You may be interested in IV Fluid Types and IV Fluid Quiz.
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References:
Dengue Clinical Case Management E-learning. (2023). Crystalloid IV Solutions: Intravenous Fluids. Retrieved from https://www.cdc.gov/dengue/training/cme/ccm/page70749.html.
Merriam-Webster. (n.d.). Osmolarity. In Merriam-Webster.com dictionary. Retrieved March 08, 2023, from https://www.merriam-webster.com/dictionary/osmolarity
NCI Dictionary: Osmotic. National Cancer Institute. (n.d.). Retrieved March 8, 2023, from https://www.cancer.gov/publications/dictionaries/cancer-terms/def/osmotic