Pharm 101: Intravenous Fluids

Classes

• Colloid:
  • Albumin
  • Dextran
  • Gelatin
• Crystalloid:
  • Isotonic: normal saline, Hartmann’s, plasmalyte
  • Hypertonic saline: 3% or 7.5% NaCl
  • Hypotonic: 0.45% NaCl, dextrose (5%, 10%)
• Blood and blood products

Normal Saline

• Na 154 mmol/L
• Cl 154 mmol/L
• Osmolality 300 mOsm/kg
• pH 5.0

Compound Sodium Lactate

• Differs from normal saline with addition of sodium lactate, KCl, CaCl (and pH adjustment)
• Constituents:
  • Na 130 mmol/L
  • Cl 112 mmol/L
  • K 5.4 mmol/L
  • Ca 1.8 mmol/L
  • Lactate 27 mmol/L
• Osmolality 278 mOsm/kg
• pH 6.0
• Potential advantages:
  • Closer to physiologic – K, Cl
  • Less hyperchloraemia
  • Effective bicarbonate – some (slow) good effect on acidosis

Complications of crystalloid fluid therapy

• APO
• Hypothermia
• Dilutional coagulopathy
• Acidosis
• Tissue edema; limb and abdominal compartment syndromes
• Electrolyte abnormalities
• Extravasation
• Air embolism
• Infection

References

• Katzung BG. Basic and Clinical Pharmacology. 14e. 2018