Infusion solutions and Electrolytes

Use of infusion solutions
Dextran
Dextrose - Glucose
Half Strength Darrow's solution
Polygeline
Potassium chloride
Ringer lactate (Hartmann)
Sodium bicarbonate
Sodium chloride

Use of infusion solutions

Choice of infusion solutions according to the indications

There is no justification for using more than 3 kinds of infusion solution:
- one kind for IV rehydration (ringer lactate is the most suitable);
- one kind for dilution of IV injectable drugs (isotonic dextrose solution is the most suitable);
- one kind for fluid replacement (best choice is polygeline)..

Precautions for the use of infusion solutions
- Read the labels on the infusion bottle (or bag) well to avoid mistakes.
- Indicate on the label any drugs added to the infusion..
- If drugs are added in a vial, think of the risks of:
· physical or chemical incompatibility,
· contamination: strict asepsis.

- Inspect each bottle against the light to check its clarity: discard any bottles that show particles in suspension.

DEXTRAN (Macrodex(R), Rheomacrodex(R) )
solution for INFUSION

District hospital

Preparation
- Bottle of 500 ml

Composition
- Dextran 40,000 or 70,000 (composition and concentration varies with manufacturer) in a sorbitol, glucose, NaCI or ringer lactate solution

Indications
- Restoring macromolecules and maintaining the blood pressure and volume. Fluid replacement in case of hypovolemic shocks: trauma, surgery and sepsis.

Contra-indications, side-effects, precautions, remarks
- Risk of inducing renal failure: do not exceed 1000 ml for an adult and/or 500 ml/d if the treatment has to be prolonged.
- Risk of haemostatic disorder.
- Risk of allergy.
- In case of dehydration, correct electrolyte imbalance.
- Draw blood for type and cross-match before infusing.
- Do not mix other drugs in the infusion solution.
- Storage: keep below 30°C, but over 4°C.
The solution must be clear.

DEXTROSE 5 % = GLUCOSE 5 %
isotonic solution in INFUSION

District hospital

Preparation
- Bottle/bag of 500 ml of 5 %
- Bottle/bag of 1 litre of 5 %

Composition
- Isotonic solution: dextrose 5 g per 100 ml

Indications
- Infusion medium
- Intra-cellular dehydration (rare): fevers, sunstroke

Contra-indications, side-effects, precautions, remarks
- This solution contains no electrolytes or lactate. Therefore it is not recommended for the treatment of dehydration. Preferably use ringer lactate. If this is not available, take a solution of dextrose 5 % and add KCI (2 g/l) + NaCI (4 g/l).
- The solutions of dextrose 5 % 1/2, 1/3 or 1/4 salted have the same indications and inconveniences as the isotonic NaCI solution.
- Do not confuse with the 10 %, 15 %, 30 % and 50 % hypertonic solutions.
- Storage: keep below 30°C

DEXTROSE 30 or 50 % = GLUCOSE 30 or 50 %
hypertonic solution in AMPOULE

District hospital

Preparation
- Ampoule of 10 ml of 30 % or 50 %
There are also ampoules of 20 ml and bottles of 50 ml, 500 ml

Composition
- Hypertonic solution: dextrose 30 % = 3 g/10 ml dextrose 50 % = 5 g/10 ml

Indications
- Energy supplementation (1 g dextrose provides 4 calories)
- Hypoglycaemia

Contra-indications, side-effects, precautions, remarks
- Do not administer hypertonic solution IM or SC. The injections must be given in slowly direct IV injection or in IV infusion.
- Storage: keep below 30°C

Half Strenght DARROW'S SOLUTION
solution for INFUSION

District hospital

Preparation
- Bottle/bag of 500 ml
- Bottle/bag of 1 litre

Composition
- Varies with manufacturer. Example (ionic composition per litre):
Sodium (Na+) : 61 mmol = 61 mEq
Potassium (K+) : 18 mmol = 18 mEq
Chloride(Cl-) : 51 mmol = 51 mEq
Bicarbonate : 27 mmol = 27 mEq

Indications
- Severe dehydration

Contra-indications, side-effects, precautions, remarks
- Isotonic solution without providing calories.
- This solution has the disadvantage of not providing enough NaCl, but the advantage of providing suitable quantities KCI. For prolonged use, double the amount or add 10 % or 20 %, NaCl by ampoule in order to obtain sufficient concentrations (1 ampoule per litre = 1 to 2 g NaCl).
- Preferably use ringer lactate when available.
- There are also hypertonic solutions.
- Storage: keep below 30°C

POLYGELINE (Hæmacel(R)..)
solution for INFUSION

District hospital

Preparation
- Bottle of 500 ml

Composition
- Varies with manufacturer. Example (ionic composition per litre):

Indications
- Fluid replacement in cases of hypovolemic shock: trauma, surgery and sepsis.

Contra-indications, side-effects, precautions, remarks
-This solution combines replacement of electrolytes and macromolecules. It has almost no effect on haemostasis.
-Administer 1 or 2 bottles on average. Adapt dosage according to the needs of the patient.
-In case of haemorrhagic shock, infuse one after the other. If polygelines are not availabe, use ringer lactate, giving three times the lost volume.
-For other forms of shock, infuse quickly until a good pulse reappears.
-Risk of allergy.
-Draw blood for type and cross-match before infusing.
-Do not dilute other drugs into this type of infusion.
Storage: stable between 18°C and +50°C.
Usable after freezing.

POTASSIUM Chloride 10 %
hypertonic solution in AMPOULE

District hospital

Preparation
- Ampoule of 10 ml of 10 % = 1 g KCI per ampoule
- Ampoule of 20 ml of 10 % = 2 g KCl per ampoule
There are also ampoules of 10 ml and 20 ml of 7.5 %, 15 % and 20 %. Adapt dosage accordingly.

Composition
Potassium chloride: 10 g per 100 ml
- Hypertonic solution
- Ionic composition:

Indications
- Treatment and prevention of hypokalemia

Contra-indications, side-effects, precautions, remarks
- Do not administer hypertonic solution IM or SC. Administer slowly as direct IV injection or infusion (in dextrose 5 %).
- Risk of ventricular rhythm problems if injected too quickly : do not exceed 2 to 3 g KCl/hour.
- If ringer lactate is not available, take a 5 % solution of dextrose and add KCl (2 g/l) + NaCl (4 g/l)
- Storage: no special precautions

RINGER LACTATE = COMPOUND SODIUM LACTATE SOLUTION = Hartmann's solution
isotonic solution for INFUSION

District hospital

Preparation
- Bottle/bag 500ml
- Bottle/bag 1 litre

Composition
- Varies with manufacturer
- Most usual ionic composition per litre:
Sodium (Na+) : 130.50 mmol = 130.50 mEq
Potassium (K+) : 4.02 mmol = 4.02 mEq
Calcium (Ca++) : 0.67 mmol = 1.35 mEq
Chloride (Cl-) : 109.60 mmol = 109.60 mEq
Lactate : 28.00 mmol = 28.00 mEq

Indications
-Severe dehydration

Contra-indications, side-effects, precautions, remarks
-Isotonic solution without providing calories.
-Ringer lactate provides appropriate quantities of electrolytes. It contains lactate which transforms into bicarbonate in the body and corrects metabolic acidosis if it exists (if haemodynamic and liver function are normal). WARNING, SOME COMMERCIALLY AVAILABLE SOLUTIONS DO NOT CONTAIN LACTATE.
-It does not contain much KCl (5 mEq/litre), but sufficient for short term use. For prolonged use (after 2 to 3 days), a supplement of potassium is necessary. Add 1 or 2 g KCl per litre = 1 to 2 ampoules of 10 ml KCl 10 %/litre.
-For moderate and mild dehydration, administer ORS (Oral Rehydration Salts).
-This solution can be used for haemorrhagic shock. In that case, 3 times the lost volume has to be infused.
Storage: keep below 30°C

SODIUM Bicarbonate 1.4 %
isotonic solution for INFUSION

District hospital

Preparation
- Bottle/bag 500 ml

Composition
Sodium bicarbonate :1.4 g per 100 ml
- Isotonic solution
- Ionic composition per litre:
Sodium (Na+): 167 mmol = 167 mEq
Bicarbonate 167 mmol = 167 mEq

Indications PRESCRIPTIONS AND FOLLOW-UP OF TREATMENT MUST BE UNDER MEDICAL SUPERVISION
- Severe metabolic acidosis

Contra-indications, side-effects, precautions, remarks
- Do not use in case of metabolic alkalosis or respiratory acidosis.
- Contains a high concentration of bicarbonate and sodium ions. This is seldom justified in the case of metabolic acidosis caused by dehydration. Poor monitoring of use may induce hypernatremia and hypokalemia.
- Do not mix in the same infusion: penicillin, chloramphenicol, aspirin, atropine, calcium, insulin, vitamins...
- Storage: keep below 30°C

SODIUM Bicarbonate 8.4 %
hipertonic solution in AMPOULE

District hospital

Preparation
- Ampoule of 10 ml or 20 ml

Composition
Sodium bicarbonate: 8.4 g per 100 ml
- Hypertonic solution
- Ionic composition:
Sodium (Na+): 10 mmol = 10 mEq per ampoule of 10 ml
Bicarbonate : 10 mmol = 10 mEq per ampoule of 10 ml

Indications PRESCRIPTIONS AND FOLLOW-UP OF TREATMENT MUST BE UNDER MEDICAL SUPERVISION
- Severe metabolic acidosis

Contra-indications, side-effects, precautions, remarks
- Do not administer hypertonic solutions IM or SC. Administer under strict medical supervision, slowly direct IV injection or infusion (in dextrose 5 %).
- Do not use in case of alkalosis or respiratory acidosis.
- Contains a high concentration of bicarbonate and sodium ions. This is seldom justified in the case of metabolic acidosis caused by dehydration. Poor monitoring of use may induce hypernatremia and hypokalemia.
- Do not mix in the same infusion: penicillin, chloramphenicol, aspirin, atropine, calcium, insulin, vitamins...
- Storage: keep below 30°C

SODIUM Chloride 0.9 % = NaCl physiological salt = normal saline
isotonic solution for INFUSION

District hospital

Preparation
- Bottle/bag of 500 ml or 1 litre of 0.9 %
There are also ampoules of different volumes.

Composition
Sodium chloride :0.9 g per 100 ml
- Isotonic solution
- Ionic composition: Sodium (Na+) : 154 mmol per litre (154 mEq)
Chloride (Cl-) : 154 mmol per litre (154 mEq)
Indications
- Infusion medium (administration of drugs, instant venous access)

Contra-indications, side-effects, precautions, remarks
- Do not use in case of water-salt retention, heart failure, oedema and ascites due to cirrhosis.
- This solution contains neither lactate nor potassium. Its use is therefore not recommended for the treatment of severe dehydration. Preferably use ringer lactate.
- If ringer lactate is not available, take a 5 %, solution of dextrose and add KCI (2 g/l) + NaCl (4 g/l).
- Storage: keep below 30°C

SODIUM Chloride = NaCl
hypertonic solution in AMPOULE

District hospital

Preparation
- Ampoules of 10 ml or 20 ml of 10 % and 20 %

Composition
Sodium bicarbonate: 10 g per 100 ml and 20 g per 100 ml
- Hypertonic solution
- Ionic composition:
Sodium (Na+) : 1.7 mmol per litre (1.7 mEq), solution 10 %
3.4 mmol per litre (3.4 mEq), solution 20 %
Chloride (Cl-): 1.7 mmol per litre (1.7 mEq), solution 10 %
3.4 mmol per litre (3.4 mEq), solution 20 %

Indications
- Hyponatremia

Contra-indications, side-effects, precautions, remarks
- Do not administer hypertonic solutions IM or SC. Administer slowly direct IV injection or IV infusion.
- Do not use in case of water-salt retention, heart failure, oedema and ascites due to cirrhosis.
- Storage: keep below 30°C