IV Solution Cheat Sheet

A quick reference guide on the different intravenous solutions.

Type Use Special Considerations

Normal Saline (NS)  Increases circulating plasma  Do not use in patients with heart failure,
volume when red cells are edema, or hypernatremia, because NSS
 0.9% NaCl in adequate replaces extracellular fluid and can lead to
Water  Shock fluid overload.
 Crystalloid  Fluid replacement in patients  Replaces losses without altering fluid
Solution with diabetic ketoacidosis concentrations.
 Isotonic (308  Hyponatremia  Helpful for Na+ replacement
mOsm)  Blood transfusions
 Resuscitation
 Metabolic Alkalosis
 Hypercalcemia
1/2 Normal Saline  Water replacement  Use cautiously; may cause cardiovascular
(1/2 NS)  Raises total fluid volume collapse or increase in intracranial
 DKA after initial normal pressure.
 0.45% NaCl in saline solution and before  Don’t use in patients with liver disease,
Water dextrose infusion trauma, or burns.
 Crystalloid  Hypertonic dehydration  Useful for daily maintenance of body fluid,
Solution  Sodium and chloride but is of less value for replacement of
 Hypotonic (154 depletion NaCl deficit.
mOsm)  Gastric fluid loss from  Helpful for establishing renal function.
nasogastric suctioning or  Fluid replacement for clients who don’t
vomiting. need extra glucose (diabetics)
Lactated Ringer’s  Replaces fluid and buffers  Has similar electrolyte content with serum
(LR) pH but doesn’t contain magnesium.
 Hypovolemia due to third-  Has potassium therefore don’t use to
 Normal saline space shifting. patients with renal failure as it can cause
with electrolytes  Dehydration hyperkalemia
and buffer  Burns  Don’t use in liver disease because the
 Isotonic (275  Lower GI tract fluid loss patient can’t metabolize lactate; a
mOsm)  Acute blood loss functional liver converts it to bicarbonate;
don’t give if patient’s pH > 75.
 Normal saline with K+, Ca++, and lactate
(buffer)
 Often seen with surgery
 D5 W  Raises total fluid volume.  Solution is isotonic initially and becomes
 Helpful in rehydrating and hypotonic when dextrose is metabolized.
 Dextrose 5% in excretory purposes.  Not to be used for resuscitation; can
water Crystalloid  Fluid loss and dehydration cause hyperglycemia
solution  Hypernatremia  Use in caution to patients with renal or
 Isotonic (in the cardiac disease, can cause fluid overload
bag)  Doesn’t provide enough daily calories for
 *Physiologically prolonged use; may cause eventual
hypotonic (260 breakdown of protein.
mOsm)  Provides 170-200 calories/1,000cc for
energy.
 Physiologically hypotonic -the dextrose is
metabolized quickly so that only water
remains - a hypotonic fluid
D5NS  Hypotonic dehydration  Do not use in patients with cardiac or
 Replaces fluid sodium, renal failure because of danger of heart
 Dextrose 5% in chloride, and calories. failure and pulmonary edema.
0.9% saline  Temporary treatment of  Watch for fluid volume overload
 Hypertonic (560 circulatory insufficiency and
mOsm) shock if plasma expanders
aren’t available
 SIADH (or use 3% sodium
chloride).
 Addisonian crisis
D5 1/2 NS  DKA after initial treatment  In DKA, use only when glucose falls < 250
with normal saline solution mg/dl
 Dextrose 5% in and half-normal saline  Most common postoperative fluid
0.45% saline solution – prevents  Useful for daily maintenance of body
 Hypertonic (406 hypoglycemia and cerebral fluids and nutrition, and for rehydration.
mOsm) edema (occurs when serum
osmolality is reduced
rapidly).
D5LR  Same as LR plus provides  Contraindicated in newborns (≤ 28 days of
about 180 calories per age), even if separate infusion lines are
 Dextrose 5% in 1000cc’s. used (risk of fatal ceftriaxone-calcium salt
Lactated Ringer’s  Indicated as a source of precipitation in the neonate’s
 Hypertonic (575 water, electrolytes and bloodstream).
mOsm) calories or as an alkalinizing  Contraindicated in patients with a known
agent hypersensitivity to sodium lactate.
Normosol-R  Replaces fluid and buffers  Not intended to supplant transfusion of
pH whole blood or packed red cells in the
 Normosol  Indicated for replacement of presence of uncontrolled hemorrhage or
 Isotonic (295 acute extracellular fluid severe reductions of red cell volume
mOsm) volume losses in surgery,
trauma, burns or shock.
 Used as an adjunct to restore
a decrease in circulatory
volume in patients with
moderate blood loss