II. Preparations: Hypotonic Solutions
- Dextrose in Water (D5W)
- Half Normal Saline (0.45 NaCl or 1/2NS)
- Osmolality: 154 mOsm/L
- Sodium: 77 mEq/L (with equivalent chloride)
- Equivalent of administering half free water and half Isotonic Saline
- Consider in Hypernatremia with volume depletion
- Risk of Hyponatremia
III. Preparations: Isotonic Solutions
- See Crystalloid Isotonic Solution
-
General
- NS or LR is the typical replacement in most volume depleted cases
- LR may be preferred as more physiologic (pH neutral) compared with the acidic NS
- Hypovolemia due to Hemorrhage should be replaced with blood (as indicated)
-
Normal Saline (0.9% NaCl or NS)
- Osmolality: 308 mOsm/L
- Sodium: 154 mEq/L (with equivalent chloride)
- pH: 5-6
- Lactated Ringers (LR)
IV. Preparations: Hypertonic Solutions
- Hypertonic Saline (3% NaCl)
- Osmolality: 1026 mOsm/L
- Sodium: 513 mEq/L (with equivalent chloride)
- pH: 5
- Exercise caution and dose very carefully (risk of Central Pontine Myelinolysis)
- Five fold greater effect of expanding extracellular space than Isotonic Solutions given the same fluid volume
- However, no survival benefit over Isotonic Solutions (with the added risk)
- Indications
- Severe symptomatic Hyponatremia
- Severe cerebral edema with risk of Herniation (Traumatic Brain Injury)
V. References
- Loflin (2015) Crit Dec Emerg Med 29(9): 11-18
- Marino (2014) The ICU Book, Wolters Kluwer, Philadelphia, p. 217-37
- Preston (2011) Acid-Base, Fluids and Electrolytes, Medmaster, Miami, p. 30-4
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| Definition (NCI_NCI-GLOSS) | A solution of salt and water. |
| Definition (NCI) | A solution of salt and water. Saline usually refers to normal or physiological saline, which is an aqueous solution containing 0.9% sodium chloride. |
| Definition (CSP) | any aqueous salt solution; usually means normal or physiological saline, which is 0.9% sodium chloride, and is used as a base for culture media and buffers, and as an injection vehicle or control. |
| Concepts | Substance (T167) |
| MSH | D012965 |
| SnomedCT | 373757009, 256557003, 32841004 |
| LNC | LP31577-7 |
| English | NaCl - Sodium chloride solutn, Sodium Chloride 0.9%, Saline, SALINE SOLUTION, saline solution, saline solutions, sodium chloride solution, chloride sodium solution, Saline Solution, Sodium Chloride Solution, saline, NaCl - Sodium chloride solution, Sodium chloride solution, Sodium chloride solution (product), Sodium chloride solution (substance) |
| Spanish | solución salina, solución de NaCl, solución de cloruro de sodio (producto), solución de cloruro de sodio (sustancia), solución de cloruro de sodio |
| French | Solution saline |
| German | Salz |
| Italian | Soluzione salina |
| Norwegian | Saltoppløsning |
| Czech | solný roztok |
Ontology: Saline Solution, Hypertonic (C0036085)
| Definition (NCI) | Any solution of sodium chloride (NaCl) in water with a concentration of NaCl higher than that found in physiological saline (0.9% w/v). When administered in vivo, hypertonic saline (HTS) exhibits several physiological effects beneficial to cerebral injury including: 1) osmotic and vasoregulatory - by promoting the flow of excess water from cerebral tissue to the blood via osmosis and decreasing edema in the vascular endothelium of injured tissues, thus lowering vascular resistance and allowing more blood flow; 2) hemodynamic - by effectively expanding plasma volume; 3) immunomodulatory - by preventing leukocytes from becoming activated and adhering to injured neurons and; 4) neurochemical - by counteracting detrimental excitatory amino acids through the normalization of neuronal cell membranes and by restoration of normal electrolyte and neurotransmitter levels in brain cells, and normal cell volumes. |
| Definition (MSH) | Hypertonic sodium chloride solution. A solution having an osmotic pressure greater than that of physiologic salt solution (0.9 g NaCl in 100 ml purified water). |
| Definition (PDQ) | Any solution of sodium chloride (NaCl) in water with a concentration of NaCl higher than physiologic (0.9% w/v). When administered in vivo, hypertonic saline (HTS) exhbits several physiological effects beneficial to cerebral injury including: 1) osmotic and vasoregulatory - by promoting the flow of excess water from cerebral tissue to the blood via osmosis and decreasing edema in the vascular endothelium of injured tissues, thus lowering vascular resistance and allowing more blood flow; 2) hemodymanic - by effectively expanding plasma volume; 3) immunomodulatory - by preventing leukocytes from becoming activated and adhering to injured neurons and; 4) neurochemical - by counteracting detrimental excitatory amino acids through the normalization of neuronal cell membranes and by restoration of normal electrolyte and neurotransmitter levels in brain cells, and normal cell volumes. Check for "http://www.cancer.gov/Search/ClinicalTrialsLink.aspx?id=467928&idtype=1" active clinical trials or "http://www.cancer.gov/Search/ClinicalTrialsLink.aspx?id=467928&idtype=1&closed=1" closed clinical trials using this agent. ("http://nciterms.nci.nih.gov:80/NCIBrowser/ConceptReport.jsp?dictionary=NCI_Thesaurus&code=C60814" NCI Thesaurus) |
| Concepts | Pharmacologic Substance (T121) , Inorganic Chemical (T197) |
| MSH | D012462 |
| SnomedCT | 51103004, 373766008 |
| English | Hypertonic Saline Solution, Hypertonic Saline Solutions, Hypertonic Solution, Saline, Hypertonic Solutions, Saline, Saline Hypertonic Solution, Saline Hypertonic Solutions, Saline Solutions, Hypertonic, Sodium Chloride Solution, Hypertonic, Sodium Chloride Solutions, Hypertonic, Solution, Hypertonic Saline, Solution, Saline Hypertonic, Solutions, Hypertonic Saline, Solutions, Saline Hypertonic, HTS, hypertonic saline, Saline Solution, Hypertonic, SALINE SOL HYPERTONIC, SODIUM CHLORIDE SOL HYPERTONIC, HYPERTONIC SOL SALINE, HYPERTONIC SALINE SOL, Hypertonic Saline, Sodium Chloride Hypertonic, Sodium Chloride, Hypertonic, hypertonic sodium chloride, hypertonic saline solution, sodium chloride, hypertonic, Hypertonic sodium chloride, Hypertonic saline, Hypertonic saline (product), Hypertonic saline (substance) |
| Swedish | Saltlösning, hyperton |
| Czech | sůl - hypertonický roztok |
| Finnish | Hypertoniset suolaliuokset |
| Russian | SOLEVOI RASTVOR GIPERTONICHESKII, GIPERTONICHESKII SOLEVOI RASTVOR, NATRIIA KHLORISTOGO RASTVOR GIPERTONICHESKII, GIPERTONICHESKII RASTVOR SOLEVOI, ГИПЕРТОНИЧЕСКИЙ РАСТВОР СОЛЕВОЙ, ГИПЕРТОНИЧЕСКИЙ СОЛЕВОЙ РАСТВОР, НАТРИЯ ХЛОРИСТОГО РАСТВОР ГИПЕРТОНИЧЕСКИЙ, СОЛЕВОЙ РАСТВОР ГИПЕРТОНИЧЕСКИЙ |
| Italian | Soluzione ipertonica di cloruro di sodio, Soluzione salina ipertonica, Soluzioni ipertoniche di cloruro di sodio, Soluzioni saline ipertoniche |
| Polish | Roztwór soli hipertoniczny, Roztwór chlorku sodu hipertoniczny |
| Japanese | 高張塩化ナトリウム溶液, 高張食塩水, 食塩高張溶液, 高張食塩液, 高張食塩溶液, 食塩水-高張 |
| Norwegian | Saltvannsoppløsning, hyperton, Hypertonisk natriumkloridoppløsning, Hyperton saltvannsoppløsning, Hypertonisk saltvannsoppløsning, Natriumkloridoppløsning, hyperton, Hyperton natriumkloridoppløsning, Natriumkloridoppløsning, hypertonisk, Saltvannsoppløsning, hypertonisk |
| Spanish | cloruro de sodio hipertónico, solución salina hipertónica (producto), solución salina hipertónica (sustancia), solución salina hipertónica, Solución Hipertónica de Cloruro de Sodio, Solución Salina Hipertónica |
| French | Solution saline hypertonique |
| German | Hypertone Lösung, Salz-, Hypertone Salzlösung, Kochsalzlösung, hypertone, Natriumchloridlösung, hypertone, Salzlösung, hypertone |
| Portuguese | Solução Hipertônica de Cloreto de Sódio, Solução Salina Hipertônica |
Ontology: Fluid replacement (C0521302)
| Concepts | Therapeutic or Preventive Procedure (T061) |
| SnomedCT | 78534001 |
| Italian | Reintegrazione di liquidi, Reintegrazione di liquidi NAS, Reintegrazione volumetrica |
| Dutch | vochtsubstitutie NAO, volumesubstitutie, vochtsubstitutie |
| French | Réhydratation SAI, Remplacement du volume circulant, Réhydratation |
| German | Fluessigkeitssubstitution NNB, Volumensubstitution, Fluessigkeitssubstitution |
| Portuguese | Reidratação NE, Reposição de volume, Reidratação |
| Spanish | Reposición de líquidos NEOM, Reposición de volumen, reposición de líquidos corporales (procedimiento), reposición de líquidos corporales, reposición de líquidos, Reposición de líquidos |
| Japanese | 補液, 補液ＮＯＳ, ﾎｴｷNOS, ﾎｴｷ, 循環血液量補充, ｼﾞｭﾝｶﾝｹﾂｴｷﾘｮｳﾎｼﾞｭｳ |
| Czech | Náhrada tekutin, Náhrada tekutin NOS, Náhrada objemu tekutin |
| English | Fluid replacement NOS, fluid replacement, fluids replacement, body fluid replacement, Volume replacement, Body fluid replacement, Body fluid replacement (procedure), Fluid replacement |
| Hungarian | Folyadékpótlás k.m.n., Folyadékpótlás, Volumen pótlás |
Ontology: Intravenous fluid replacement (C0559692)
| Concepts | Therapeutic or Preventive Procedure (T061) |
| SnomedCT | 281800008 |
| English | IV - IV fluid replacement, Intravenous fluids replacement, fluid intravenous replacement, intravenous fluid replacement, IV - Intravenous fluid replacement, Intravenous fluid replacement, Intravenous fluid replacement (procedure) |
| Spanish | Reposición de líquidos por vía intravenosa, reemplazo intravenoso de líquidos (procedimiento), reemplazo intravenoso de líquidos |
| Dutch | vervanging van intraveneuze vloeistoffen |
| German | intravenoeser Fluessigkeitsersatz |
| Japanese | 静脈内補液, ｼﾞｮｳﾐｬｸﾅｲﾎｴｷ |
| Czech | Výměna intravenózní kapaliny |
| Portuguese | Substituição dos líquidos intravenosos |
| Italian | Reintegrazione di liquidi per via endovenosa |
| French | Remplacement des liquides intraveineux |
| Hungarian | Intravénás folyadékok cseréje |
Ontology: Intravenous fluid (C1289919)
| Definition (NCI) | A sterile liquid preparation infused into a vein. IV fluid is prescribed as a replacement of fluid, electrolytes, calories, vitamins, and other nutritional substances. In addition, IV fluids are used to administer blood products and medications such as chemotherapy. Examples of IV fluids include Normal Saline, Ringers Solution, and Lactated Ringers Solution. (NCI) |
| Concepts | Substance (T167) |
| SnomedCT | 118431008 |
| Spanish | líquido para administración intravenosa, Fluidoterapia intravenosa, líquido IV, líquido endovenoso, líquido intravenoso, líquido para administración intravenosa (sustancia) |
| English | Fluid for intravenous administration, Intravenous fluids, intravenous (IV) fluid, intravenous fluid, Fluid for intravenous administration (substance), IV fluid, Intravenous fluid, Intravenous Fluid, IV Fluid |
| Italian | Liquidi intravenosi |
| French | Liquides intraveineux |
| Dutch | intraveneuze vloeistoffen |
| German | intravenoese Fluessigkeitsgabe |
| Portuguese | Fluidos intravenosos |
| Japanese | ｼﾞｮｳﾐｬｸﾅｲﾎｴｷ, 静脈内補液 |
| Czech | Intravenózní tekutiny |
| Hungarian | Intravénás folyadékok |
