Intravenous (IV)

Hypernatremia (see Hypernatremia)

• xxxxx

Hypoglycemia (see Hypoglycemia)

• xxxx

Definitions

• Crystalloids: sodium-based electrolyte solutions

History of Crystalloids

• 1831 (Europe): first clinical use of crystalloids during the India Blue Cholera pandemic
• 1896 (Holland): Hartog Hamburger (Dutch physiologist) invented “normal saline”: he intended to use this fluid in the in vitro study of erythrocyte lysis
• 1880 (England): Sydney Ringer invented “Ringer’s solution”: he used this fluid to sustain contractility in isolated frog hearts
  • The fluid was inadvertently made with tap water (instead of distilled water) and the inadvertent presence of calcium likely led to the experiment being successful
  • Ringer analyzed the fluid and found that it contained calcium, sodium, potassium, chloride, and magnesium
• 1930’s (USA): pediatrician Alexis Hartmann added lactate to a solution very similar to Ringer’s solution, creating a forerunner of “Lactated Ringer’s” (see Lactated Ringers): lactate was added by Hartmann to “buffer” the solution (creating a “balanced” solution)

Balanced vs Unbalanced Crystalloids

• Balanced Crystalloids: mildly hypotonic lactate or acetate buffered solutions (with signficantly lower chloride concentrations than saline)
  • Lactated Ringer’s (LR) (see Lactated Ringers)
  • Acetate Ringer’s
  • Hartmann Solution
  • Plasma-Lyte (from Baxter Healthcare)
• Unbalanced Crystalloids : contain no buffer (note: additionally, normal saline has higher chloride concentration than the above)
  • Normal Saline (NS) (see Normal Saline): 0.9% NaCl
  • Half Normal Saline (see Half Normal Saline): 0.45% NaCl
  • Quarter Normal Saline (see Quarter Normal Saline): 0.22% NaCl
  • Dextrose 5% in Water (D5W): Dextrose 5%
  • D5 Normal Saline (D5NS): Dextrose 5% + 0.9% NaCl
  • D5 Half Normal Saline (D5 1/2NS): Dextrose 5% + 0.45% NaCl
  • D5 Quarter Normal Saline (D5 1/4NS): Dextrose 5% + 0.22% NaCl

Composition of Various Intravenous Fluids

Cardiovascular Adverse Effects

• Congestive Heart Failure/Fluid Overload (see Congestive Heart Failure)

Endocrinologic Adverse Effects

• Hyperglycemia (see Hyperglycemia)

Renal Adverse Effects

• Hyponatremia (see Hyponatremia)

Other Adverse Effects

• Exacerbation of Cirrhotic Ascites (see Ascites)