Commonly used Fluids: (RL, NS, Dextrose, Half Normal Saline)

 

Ms. Sarika U. Bais

Lecturer, Vspmmdine, Nagpur, Maharashtra.

 

ABSTRACT:

Electrolytes become imbalanced when body loss the fluid for any reason, body systems are stressed, and cognitive function in the brain is impaired. As a result, urine output is decreased. When blood is “thicker,” the heart has to work harder, causing the pulse to increase in order to maintain blood pressure. Replacement of fluids intravenously resolves the imbalance and restores normal body functions.

 

 

 

 

INTRODUCTION:

In this article I would like to share basic things commonly known about the four most frequently used I.V. fluids and also share some recent knowledge surrounding them.¹

 

Nearly 50-60% of the human body is made up of water. There are many disease conditions where there is water loss from the body: e.g. vomoting, diarrhea, trauma burns. Among all the I.V. fluids available, NS (normal saline) and RL (Ringer’s lactate) Dextrose 5% in Water, 0.45% Normal Saline (Half Normal Saline, 0.45 Na Cl, 45NS) are the most commonly used.¹

 

NS: 0.9% Normal Saline (NS, 0.9NaCl, or NSS)

Normal saline is the chemical name for salt. The generic name is sodium chloride. Each 100ml of NS contains 0.9% of NaCL.It is very useful to replenish water and salt lost in diarrhoea, vomiting, excessive diuresis or excessive sweating. Normal saline can be used as a flush -- to clean out an intravenous (IV) catheter.

 

It helps to prevent blockage and removes medicine leftover in the catheter area after the patient has received an IV infusion. Dosage is dependent upon the age, weight and clinical conditions of the patient as well as laboratory determination. Normal saline solution can be administered only via intravenous (IV) access. It is mainly distributed in the extracellular compartment and hence it increases the intravascular volume significantly. It finds its usefulness in the treatment of hypovolemic shock. It is preferred to RL during metabolic alkalosis.²

 

Fig. No. 1

 

 

RL: Lactated Ringers (LR, Ringers Lactate, or RL)

 

Fig. No. 2

 

The composition of each 100ml of RL: sodium lactate 320mg, sodium chloride 600mg, potassium chloride 40 mg, calcium chloride 27mg. Comparable to NS, RL tends to stay in the extracellular compartment. Hense it can be used to treat hypovolemia. It is more physiological than NS due to the concentrations of electrolytes similar to plasma. Additionally, the lactate in RL is converting to bicarbonate in the liver. This property is very useful in correcting metabolic acidosis. Caution is needed in patients with liver disease. It must be borne in mind that in vomiting, the loss of fluid and electrolyte is associated with metabolic alkalosis. The use of RL here can worse the acid-base balance.²

 

Dextrose 5% in Water

 

Fig. No. 3

 

Crystalloids are isotonic and hypotonic, administered for hypernatremia and to provide free water for the kidneys. Initially hypotonic, D5 dilutes the osmolarity of the extracellular fluid. D5 should not be used as the sole treatment of fluid volume deficit, because it dilutes plasma electrolyte concentrations. Contraindications are resuscitation, early post-op recovery, cardiac and renal conditions, and in any case of suspected increased intracranial pressure. Because the solution contains calories, due to dextrose as the solute, it does provide very limited nutrition.³

 

 

0.45% Normal Saline (Half Normal Saline, 0.45NaCl,)

 

Fig. No. 4

 

This solution of sodium chloride dissolved in sterile water, administered to treat hypernatremia or diabetic ketoacidosis. Contraindications are patients with burns, trauma, or liver disease due to depletion of intravascular fluid volumes. 0.45 normal saline may result in fluid overload and subsequent decreased electrolyte concentrations or pulmonary edema. Infusing too quickly can cause hemolysis of red blood cells.³

 

Points to note:

1. It is commonly belived that RL must not be administered in patient with hyperkalemia. However, it this just a myth. In facts, comparing NS with RL, it is NS that is found to increase potassium serum levels. NS cause hyperchloremic non-anion gap metabolic acidosis which leads to extracellular shift of potassium and hereby worsening of the hyperkalemia.²

 

2. In patients with hypovolemic shock, large amount of NS lead to high chloride levels which can be sensed by the maculadensa of the kidney and eventually leads to vasoconstriction to the kidney leading to acute kidney injury.³

 

REFERENCES:

1.     Practical guideline on fluid Therapy, 2ndedition, Dr. Sanjay Pandya

2.     Myth-busting lactated Ringer is safe in hyperkalemia and is superior to NS. September 29, 20I4 by josh farkas, https://emcrit, org /pulmcrit /myth-busting–lactated-ringers-is-safe-in-hyperkalemia –and –is –superior –to –ns/

3.     I43 Neph Madness: fluid wars MARCH I5, 20I9 By JUSTIN Berk https:// The curbsiders.com /podcast /I43-nephmadness –fluid-wars

 

 

Received on 27.07.2020          Modified on 30.09.2020

Accepted on 04.11.2020       ©A&V Publications All right reserved