1. Plasma volume expander
2. Also expands interstitial fluid volume
3. Plasma volume effect is only temporary as most of the saline moves out of the blood vessels quite quickly

Glucose replacement
Immediately taken up into ISF and Intracellular spaces

IV. BA 100%

IV. BA 100%

~15mins:
ISF 750mls
Plasma volume 250mls.
Not distributed to ICF

ICF 670mls
ECF 330mls (with ISF 250mls and plasma 80mls).

Unmetabolized

Dextrose is taken into cells and potentially metabolized by multiple pathways, depending on:
- Nutritional state
- Catabolic or anabolic state
- Insulin resistance/DM

Excreted by kidney
Slower than balanced solutions

Water is excreted via kidney

1. Fluid overload
2. hyperchloremic metabolic acidosis
3. increased risk of renal failure compared to balanced solutions
4. Injury to endothelial glycocalyx

Fluid overload (less than dextrose)
Cerebral edema
Hyperglycaemia
Electrolyte imbalances (hypokalemia,Mg,P)
Extravasation/ Vein irritation / tissue necrosis
Severe dehydration if given in diabetics without insulin

Crystalloid

Crystalloid

1. Initial replacement fluid, in volume depleted or dehydrated patients. Volume depletion may be due to loss of blood, plasma or fluid and electrolytes.
2. Maintenance of hydration during prolonged patient contact time.
3. To keep vein open, as IV route for drugs.

1. Maintenance fluid and caloric supply in cases of hypoglycaemia or starvation
2. Fluid replacement along with Insulin in DKA/HHS states
3. Fluid replacement in hypernatremic/ hyperosmolar states

intravenous fluid with 9g NaCl in litre of sterile water.
Isotonic crystalloid solution

intravenous fluid with 50g glucose in litre of sterile water.

Hypotonic solution

Level 1

Level 1

500 or 1000mls of 0.9% Sodium Chloride solution in a collapsible plastic flask or bag.

500 or 1000mls of 5% glucose in a collapsible plastic flask or bag

pH 5.0
Osm 308
Tonicity 286

Na 154
Cl 154

pH 3.5-6.5
Osm 278

Dextrose penetrates the cells so easily, it cannot contribute to tonicity