so isotonic osmolarity Falls within or
close to the normal range of your serum
normal was 270 to 300 and if we give it
an appropriate
amount yeah that was intentional silence
there because I want you to really hear
that if we give isotonic in appropriate
amounts for that patient if I have a
little tiny 95y old grandma she can't
handle as much someone my age and my
size okay so inappropriate amounts for
that patient's age and body and ability
of their heart to pump and function
should not cause fluid volume to shift
the volume we put in should stay in the
intravascular space and should be about
equal to what stays in the
cells isotonic Solutions we use to
expand the intravascular compartment
that just means because the fluid stays
in the intravascular department we use
it to fill that tank back up watch the
patient for fluid volume overload once
you give too much isotonic fluids for
that patient you can throw them into at
least elevated blood pressure or even
congestive heart failure depending on
how fragile they are so look back at our
picture there we've got 40% fluid is
extracellular it's outside of the cells
it's either in the interstitial or the
intravascular with an isotonic solution
we're putting the solution directly into
the intravascular space
and it's likely going to stay there not
cause too much problems as long as we
don't overload the patient if we
overload the patient and hang way too
much isotonic solution it's going to
start functioning like another one of
our Solutions and we're going to be in
big
trouble here's a listing again each
Solution on this slide is an isotonic
solution that if hung in an appropriate
amount should not cause fluid
shifting normal saline is what you're
going to see most often in your practice
0.9% normal saline sometimes you'll see
it just written as NS we use it if the
patient needs extra volume they're a
little low they're a little dehydrated
but keep in mind these are crystalloids
crystalloids mean they don't have the
ability to carry oxygen they don't have
any protein they're just a crystalloid
CR y s t a l l o i d now colloids are
proteins
that's spelled c l l o i DS these are
crystalloids so we give this for people
who are in Shock who are in diabetic
keto acidosis we give normal salum with
blood transfusions if they have a little
bit of low sodium that's what
hyponatremia is we give it for metabolic
alkalosis or for elevated calcium hyper
calcemia okay so this is a pretty
generic solution no solution is harmless
but this is the one that's least risky
as long as we give it in the appropriate
amount watch them for fluid volume
overload watch them to see if their po
if their sodium is going so high it's
causing their potassium to be lower and
if they have renal disease or they're on
the right kind of
glucocorticoid make sure that you watch
their sodium levels because normal
saline will be adding additional sodium
to your
patient lactated ringers is our next
solution now lactated ringers is a
little bit different because the liver
takes that lactate and converts it to
bicarbonate so the name of this solution
is lactated ringers and the liver once
it takes in that lactate it will change
it to bicarbonate which is a base so
patients with liver disease this is a
problem lactated ringers and liver
disease they can't metabolize that
lactate well so it's not good for them
and it's really not good if someone's
already in osis their pH is already too
basic and so they're already too basic
and we turn this into moic carbonate
we're going to have an even bigger pH
problem so we give this as a fluid and
electrolyte replenisher you just want to
be careful with people who have liver
problems or who are in alkalosis that's
a pH that's greater than
7.45 now D5W this one has got like a
double life it's isotonic in the bag but
once that dextrose is metabolized it
becomes
hypotonic so in the bag it's an isotonic
solution but once you put it in the body
and the body eats through that dextrose
it's metabolized happens pretty quick
then it becomes
hypotonic so remember hypotonic
Solutions cause fluid to go into the
cells right because you hang a hypotonic
solution I'm more concentrated in my
cell so you walk into the cell so it's
not good for people with ele at ICP I
don't want swellen Souls there it's not
good for people with CHF or who are
early postop surgical stress might cause
this increase in their ADH so this isn't
a great choice for them now we can use
it for fluid loss and dehydration or
hyponatremia because it'll help dilute
that extra sodium in their extra
cellular fluid so D5W is a little
different isotonic in the bag hypotonic
after the body metabolizes that how to
start a normasol you may or may not see
they're a little bit unusual but it
depends on what type of unit you're on
but they function just like an isotonic
solution
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