What is the effect of a 0.9% NaCl solution to a human cell what type of solution is a 0.9% NaCl?

All nursing programs include fluid balance and intravenous (IV) therapy as part of the curriculum. The information about the types of IV solutions and when to use them can be confusing for a nursing student. Nurse.Plus is happy to offer this simple reference guide to the four basic types.

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When water is lost, IV solutions restore fluid balance

The human body is made up of about 60% water, with two-thirds of it stored intracellularly. The rest is found in blood vessels and between the cells. Water makes up 73% of the brain and heart; 83% of the lungs; 79% of the muscles and kidneys; and 64% of the skin.

Water is essential to every living cell. Some of its functions:

• Necessary for cellular metabolism and building materials
• Regulation of internal body temperature, through respiration and sweating
• Transport of protein and carbohydrates
• Elimination of waste through urine and feces
• Shock absorber for the brain and spinal cord
• Joint lubrication

When fluid is lost for any reason, electrolytes become imbalanced, body systems are stressed, and cognitive function in the brain is impaired. Blood becomes concentrated, signaling the kidneys to retain water. 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. All of these compensatory actions by the body put an already-compromised patient at risk.

Replacement of fluids intravenously resolves the imbalance and restores normal body functions. Which IV solution to administer is related to the reason for the fluid loss.

Crystalloid Solutions: Most Commonly Used

Crystalloid solutions contain small particles that that pass easily from the bloodstream to cells and tissues. There are three types of crystalloids, given according to their tonicity, the ability to make water move into or out of a cell by osmosis.

Tonicity is related to the concentration of all the solute particles in a solution, called the osmolarity. A solution with few particles has a low osmolarity, while a solution with a high number of particles has a high osmolarity. Water moves through the semipermeable membranes of the body from low-to-high osmolarity, to create a balance of water and solutes.

The three types of crystalloids are:

1. Hypotonic: When the extracellular fluid has fewer solutes (osmolarity) than the fluid in the cells. Water will move from extracellular space into the cells.
2. Hypertonic: When the extracellular fluid has more solutes (osmolarity) than within the cells, water flows out of the cells.
3. Isotonic: Both the extracellular and intracellular fluids have the same osmolarity, so there is no movement of water between them.

Which crystalloid solution to administer? It depends…

Although crystalloids are administered routinely, which solution is ordered depends on the patient’s condition. Four solutions are the most commonly administered. Here is a brief description of each:

1. 1

   
   
   Less commonly, this solution is referred to as physiological saline or isotonic saline

   Normal saline is the chemical name for salt. The generic name is sodium chloride. It is a sterile, nonpyrogenic crystalloid fluid administered via an intravenous solution. Normal saline infusion is used for extracellular fluid replacement (e.g., dehydration, hypovolemia, hemorrhage, sepsis), treatment of metabolic alkalosis in the presence of fluid loss, and for mild sodium depletion. Normal saline can aslo be used as a flush -- to clean out an intravenous (IV) catheter. This helps prevent blockage and removes any medicine left in the catheter area after the patient has received an IV infusion. Dosage is dependent upon the age, weight and clinical condition of the patient as well as laboratory determinations. Normal saline solution can be administered only via intravenous (IV) access.

   0.9% Normal Saline (NS, 0.9NaCl, or NSS) is one of the most common IV fluids, it is administered for most hydration needs: hemorrhage, vomiting, diarrhea, hemorrhage, drainage from GI suction, metabolic acidosis, or shock. It is an isotonic crystalloid that contains 0.9% sodium chloride (salt) that is dissolved in sterile water. It’s the fluid of choice for resuscitation efforts as well. It is sometimes used with caution or even avoided in patients with cardiac or renal compromise because of the sodium causing fluid retention or volume overload. IMPORTANT: NS is also the only fluid used in conjunction with blood product administration.

2. 2

   The IV solution most similar to blood plasma concentration, it is the fluid of choice for burn and trauma patients. It used for acute blood loss; hypovolemia from third-space fluid shifts; electrolyte imbalance; and metabolic acidosis. LR is an isotonic crystalloid containing sodium chloride, potassium chloride, calcium chloride, and sodium lactate in sterile water. It is contraindicated in patients with a pH > 7.5, patients with liver disease who are unable to metabolize lactate, or for any patient with lactic acidosis. Use with extreme caution in cases of renal failure.

   Watch the following video if you want to learn more about administering Lactated Ringers.

3. 3

   A crystalloid that is both isotonic and hypotonic, administered for hypernatremia and to provide free water for the kidneys. Initially hypotonic, D5 dilutes the osmolarity of the extracellular fluid. Once the cells have absorbed the dextrose, the remaining water and electrolytes become an isotonic solution. D5 should not be used as the sole treatment of fluid volume deficit, because it dilutes plasma electrolyte concentrations. It is contraindicated in 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 (a form of glucose) as the solute, it does provide very limited nutrition.

   Here is a short animation that explains consequences of fluid overload for tissues.

4. 4

   A hypotonic crystalloid solution of sodium chloride dissolved in sterile water, administered to treat hypernatremia or diabetic ketoacidosis.. It is contraindicated in patients with burns, trauma, or liver disease due to depletion of intravascular fluid volumes. Half 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.

Colloids: Less frequent, but important!

Colloids have large molecules that are unable to pass through semipermeable membranes. They remain in the blood vessels. They’re also called volume or plasma expanders, because they draw fluid from the interstitial space back into the blood vessels with oncotic pressure. Because colloids require less volume than crystalloid solutions, they are used for patients who are unable to tolerate large fluid volumes, or are malnourished.

Some of the uses for colloids are shock, external burns, pancreatitis, peritonitis, and post-op albumin loss. Common colloids are Albumin and Hespan.

As a nurse, learn the types of IV solutions, and the reasons they are administered. Be aware of contraindications, and notify the prescribing provider if you know any reasons the patient should not receive fluid replacement with the solution.

Uses

This solution is used to supply water and salt (sodium chloride) to the body. Sodium chloride solution may also be mixed with other medications given by injection into a vein.

This solution is usually given by injection into a vein as directed by your doctor. It may be given in the hospital, in a clinic, or at home.

If you are using this product at home, learn all preparation and usage instructions from your health care professional. Before using, check this product visually for particles or discoloration. If either is present, do not use the liquid. If you are mixing this solution with another medication, ask your doctor or pharmacist if it is proper to mix it with the medication. Learn how to store and discard medical supplies safely.

The dosage is based on your age, weight, medical condition, and response to treatment.

Side Effects

Redness, pain, or swelling at the injection site may occur. If any of these effects persist or worsen, tell your doctor or pharmacist promptly.

Remember that this medication has been prescribed because your doctor has judged that the benefit to you is greater than the risk of side effects. Many people using this medication do not have serious side effects.

Tell your doctor right away if you have any serious side effects, including: swelling hands/ankles/feet, muscle cramps, unusual weakness, headache, nausea, extreme drowsiness, mental/mood changes (such as confusion), seizures.

A very serious allergic reaction to this drug is rare. However, get medical help right away if you notice any symptoms of a serious allergic reaction, including: rash, itching/swelling (especially of the face/tongue/throat), severe dizziness, trouble breathing.

This is not a complete list of possible side effects. If you notice other effects not listed above, contact your doctor or pharmacist.

In the US - Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088 or at www.fda.gov/medwatch.

In Canada - Call your doctor for medical advice about side effects. You may report side effects to Health Canada at 1-866-234-2345.

Precautions

Before using this product, tell your doctor or pharmacist if you have any allergies. This product may contain inactive ingredients, which can cause allergic reactions or other problems. Talk to your pharmacist for more details.

Before using this product, tell your doctor or pharmacist your medical history, especially of: kidney problems, heart problems (such as heart failure), body water/salt imbalance.

Before having surgery, tell your doctor or dentist about all the products you use (including prescription drugs, nonprescription drugs, and herbal products).

This solution is safe to use during pregnancy or while breastfeeding when used as directed.

Interactions

Drug interactions may change how your medications work or increase your risk for serious side effects. This document does not contain all possible drug interactions. Keep a list of all the products you use (including prescription/nonprescription drugs and herbal products) and share it with your doctor and pharmacist. Do not start, stop, or change the dosage of any medicines without your doctor's approval.

Overdose

If someone has overdosed and has serious symptoms such as passing out or trouble breathing, call 911. Otherwise, call a poison control center right away. US residents can call their local poison control center at 1-800-222-1222. Canada residents can call a provincial poison control center.

Notes

Do not share this product with others.

Laboratory and/or medical tests (such as blood tests, kidney function) may be performed periodically to monitor your progress or check for side effects. Consult your doctor for more details.

Missed Dose

It is important to get each dose of this medication as scheduled. If you miss a dose or if your dose is interrupted or stopped, ask your doctor right away for a new dosing schedule.

Storage

Store at room temperature away from light and moisture. Do not store in the bathroom. Keep all medications away from children and pets.

Do not flush medications down the toilet or pour them into a drain unless instructed to do so. Properly discard this product when it is expired or no longer needed. Consult your pharmacist or local waste disposal company.

Selected from data included with permission and copyrighted by First Databank, Inc. This copyrighted material has been downloaded from a licensed data provider and is not for distribution, except as may be authorized by the applicable terms of use.

CONDITIONS OF USE: The information in this database is intended to supplement, not substitute for, the expertise and judgment of healthcare professionals. The information is not intended to cover all possible uses, directions, precautions, drug interactions or adverse effects, nor should it be construed to indicate that use of a particular drug is safe, appropriate or effective for you or anyone else. A healthcare professional should be consulted before taking any drug, changing any diet or commencing or discontinuing any course of treatment.