COMMON IV SOLUTION CONCENTRATIONS

Mildly hypertonic solution (can be bolused)

0.9g of NaCl/100 cc

9g Nacl/1L

Used as a maintenance solution in SAH only (salt is good for brains)

Otherwise it is not an ideal maintenance fluid due to it's NaCl content and lack of dextrose (no calories)

Used as a TKVO solution and dilution fluid for medications

Can cause a hyperchloremic metabolic acidosis when used as a resuscitation solution

Hypotonic Solution (cannot be bolused)

0.45g of NaCl/100 cc

4.5g NaCL/1L

Rarely indicated in the ICU

Hypertonic Solution (can be bolused)

3g of NaCl/100 cc

30g NaCl/1L

Used for hyperosmolar therapy in cerebral edema (see section on Traumatic Brain Injury)

Balanced Solution (can be bolused)

Used as a resuscitation fluid because it is more balanced in relation to serum

Can be combined with 25% albumin in equal parts to form ~12.5% Albumin with less salt content (Example 200cc of 25% albumin with 250cc Ringers Lactate)

Used as a replacement for GI loses and for post operative General Surgery and Vascular Surgery patients to maintain circulating volume for the first 24 hours

Hypotonic Solution  (cannot be bolused)

Can be used for DKA although in the ICU we tend to use either D10 or D50 as they rarely require the volume after our reuscitations

Can be used for hypernatremia although in the ICU we tend to correct hypernatremia by providing free water by gut

Not to be used to correct hypernatremia associated with brain pathology

170 calories/L from Dextrose

Hypotonic solution (cannot be bolused)

Not infrequently used for DKA as the titration glucose to maintain insulin infusions running at 0.1 Unit/Kg (See DKA Section)

340 calories/L

Hypertonic Solution (can be bolused)

10-50 ccs at a time used for hypglycemia

Several Amps can be mixed in a mini bag for infusions in DKA (See DKA section)

1700 calories/L

Hypotonic Solution (cannot be bolused)

Often used as a maintenance solution 

Started after 24 hours of Ringers Lactate in all open AAAs (see AAA section)

Hypotonicity precludes use in brain pathology in the ICU

132 Calories/L

Can be bolused

Artificial Colloid (Starch)

Hydroxyethyl Starch (Hetastarch)

Large Molecule (130 kDa) and less likely to leak through endothelial gap junctions

Contains 6g Starch/100cc

Volume expander that lasts up to 4-6 hours in the intravascular space

Can be bolused

Concentrated colloid solution

Increases oncotic pressure within the intravascular space

Moderate sized (66 kDa and so stays in the intravascular space longer)

High salt content

May be given at the same time as RL to decrease the salt concentration relative to 5% albumin

Can be bolused

Dilute albumin solution

High salt content

Can be bolused

3 amp HCO3 (150cc) in 1L D5W

Moderate dextrose content (50g/L= 132 calories/L which is enough to effect glucose in patients with diabetes

Used for all cause acidosis and to replace HCO3 in patients with renal failure

Gets buffered via carbonic anhydrase to for H2O and CO2

Causes a transient fall in intracellular pH that is then corrected as CO2 is lost through respiration