Now let's look at Hypotonic Solutions. Look at that cell is swelling. I hang a hypotonic solution
into my blood stream. I'm more concentrated in the cell. So fluid is going to shift into the cell
from the vessels into the cell. So, look at those arrows. You see the fluid shifting into the cell.
So it's going from extracellular to intracellular. People at risk: Elevated intracranial pressure,
people with head traumas, people with strokes and people who had neurosurgery. People who
are already bad 3rd spacers, someone who has had a burn, because they have had such severe trauma
to their body, fluid shifting all over the place. So we're not going to want to hang a hypotonic
solution. That's going to further cause that fluid shifting. Also if someone has low serum protein.
Protein is this really big molecule. It's charged in a way that attracts water. Because it's charged
to attract sodium and where sodium goes water follows. So protein in your blood stream is kind
of what helps keep fluid where it's supposed to be. Somebody already has low serum protein,
they're having a difficult time keeping fluid in the right space. So hypotonic solutions are not
the best choice for them. Here we have another great list for you. The hypotonic solutions all
on one slide. Again, thank the artist they did a really good job with that. So 1/2 normal saline,
it replaces water but remember it's a hypotonic solution. We can use it for DKA after saline and
before dextrose. Now, that is just kind of a good to know thing. That's not necessarily a need
to know. The treatment of DKA is very complex and individualized. So that's just kind of a rough
practice idea just for you to have an idea but that one will be individualized by each patient
status. Now someone has significant gastric fluid loss because we've had them on NG tube. That's a
tube that goes in your nose, goes down into your stomach and suctions things out all the time
or they've had intractable vomiting we might consider using a 1/2 normal saline solution. The
cool thing is if you're hypertonic dehydration, that means your water loss is greater than your
salt loss. So now you're pretty salty, we can hang a 1/2 normal saline. I know it's 0.45% but
we usually just call that 1/2 normal saline. Because this patient has hypertonic dehydration,
they've got an elevated sodium level so hanging 1/2 normal saline would actually be of benefit.
So people end up like that because sometimes they have a water deficit because they've had
not enough to drink, for some reason they have been cut up from their fluids or they just have
a severe water loss. So, 1/2 normal saline can be useful in DKA but remember that's really
individualized. If the patient has lost a lot of water and they have a high sodium, 1/2 normal
saline is helpful. Plus anyone who has had intractable vomiting or they've had an NG tube in
which has the same effect on the body as long-term vomiting and these would be appropriate times to
use 1/2 normal saline. Again, do not use it with patients who have had burns, who have liver
disease or trauma.