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why is 0.9% sodium chloride used as a fluid replacement in the human body?

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Working part time for a local fire department i need to do a class for the crew next week about iv's and iv preperation and I want to get all my bases covered. Im talking about what the iv bag/tubing is made out of, what the ports are for, color coding of needle gauges ect ect to give a comprehensive class. Something that I have had a hard time finding information on is why EXACTLY is 0.9% sodium chloride (normal saline/lactated ringers) used for as a fluid replacement? what does it actually do for the body and why not just like a sterile water, why is the salt needed? im taking shots in the dark because i have found numerous answers in my research ranging that it is soluable with normal blood to having a similar ph balance to whatever else to the point i just couldnt get one distinct, solid answer for what it does and why its used (even from the medics I work with).

Any help is greatly appreciated thanks

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Posted · Report post

For starters, normal saline and lactated ringer's are two different fluids. They are not the same.

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As someone who is new to the forum, be forewarned, you won't find anyone to do your homework for you here. You will find plenty of people who will be more than happy to lead you to the answer. Try looking up osmolarity.

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I think part of the problem is that the answer to that question isn't as simple as you are hoping. Frankly, we learned that in two separate classes over a single semester. ERDoc is right, we won't give you the answer, but we will direct you in the right direction and then help you if you are still having issues. While looking up osmolarity, look up hypertonic/hypotonic/isotonic solutions. As paramedicmike stated, normal saline and lactated ringers are different beasts. As a matter of fact, these are only two of the intravenous fluids out there. Go and look up colloids/crystalloids.

Hopefully, this will give you a good start...and we are here if you have specific questions on what you've read.

Toni

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Well, to be fair, sterile water is used in certain situations, but lab values are required to decide to go that route.

If you really want to blow your mind, look up how the body controls total body water and how the body controls osmolaity.

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Posted · Report post

Might want to look up PH and then look on the IV bags themselves.

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You know Brother, it may seem that folks are just bagging on you, but they're not.

You want to run IV fluids, right? The problem that arises as you begin your new medical career is that you see people run them all the time on TV, and you see medics starts lines and run fluid all the time on scene, so it appears that anyone can run fluids. I get that, but it's really a false view of what's going on.

You did well by coming here for advice, but then you stopped participating after you didn't get the easy answer. But you know what? There isn't an easy answer. There is a short answer...

The saline is added to try and match the electrolytes in the fluids to the electrolytes in the body in an attempt to approximate a homeostatic relationship to try and prevent radical fluid shifts into or out of the vascular/interstitial systems.

Do you think that I tried to make up big words and make that as complicated as possible? Truthfully, that is the simplest explanation that I can think of. And I'm easily one of the dumbest people here.

If that is all that you know about running fluids, or why there is salt in the water we push into people's veins, then you have to stop pretending that you want to do medicine and admit that you're simply an ignorant whacker that wants to look like a hero in front of the chicks and his buddies.

Be better than that. Show that you actually have the balls to participate in EMS instead of simply pretend to participate. Come back and explain the paragraph above to the best of your ability after doing a bit of Googling. Not cut and paste, but in your own words....we'll walk you down the path, help you all that you need and more...but you've gotta pay to play man...

We're not jerking you around because it's fun, but because it's good for you. If you really want to be an EMS provider prove it by doing the real work on this subject as it is vital.

Of course, you've probably already gone to one of the other sites where they gave you the answer and told you what a hero you are for wanting to help people...If so, I'm sorry for that. They lied to you, and cheated you out of an opportunity to be better today than you were yesterday. If being better is not your goal then get out now my friend because you'll always be ashamed of yourself when you work around people that are truly dedicated. Because those people have been trying to be better today than yesterday for weeks, months, years, some here, even decades. That is what makes them really good medical providers.

You want to knock the socks off of your teacher? Show the class that you came to play and that they'd better amp up their game if they want to keep up? Then understand this presentation when you give it instead of just parroting a bunch of crap you found online like everyone else is going to do.

I look forward to your thoughts and I hope that you stay to participate. There is nothing at all foolish or stupid about your question. Many here can learn from this discussion. Show that you have a true EMS spirit...don't cheat them out of it...

Dwayne

Edited for poor grammar and typos. No significant context changes made.

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Posted · Report post

I think part of the problem is that the answer to that question isn't as simple as you are hoping. Frankly, we learned that in two separate classes over a single semester. ERDoc is right, we won't give you the answer, but we will direct you in the right direction and then help you if you are still having issues. While looking up osmolarity, look up hypertonic/hypotonic/isotonic solutions. As paramedicmike stated, normal saline and lactated ringers are different beasts. As a matter of fact, these are only two of the intravenous fluids out there. Go and look up colloids/crystalloids.

Hopefully, this will give you a good start...and we are here if you have specific questions on what you've read.

Toni

Hey Mrs. Toni, Is Hartmans no longer available in the US?

Hopefully I will get to hang around in your chatroom again soon.

Well, to be fair, sterile water is used in certain situations, but lab values are required to decide to go that route.

If you really want to blow your mind, look up how the body controls total body water and how the body controls osmolaity.

This is a real question not a chain pull. When would you use sterile water IV. Wouldn't there be a pretty high risk of hemolysis?

In what cases would hemolysis not occur with a sterile water infusion?

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Fluid replacement following severe dehydration when you don't want to increase the total body salt load. Hypernatremia is more often due to low fluid levels than excess sodium.

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As far as I know, there is NO reason to administer sterile water IV, and several states have issued safety alerts concerning the danger. There was a case where a diabetic patient with a primary diagnosis of congestive heart failure also had hypernatremia. The doc ordered iv sterile water. The patient died after a bolus of just over 500ml. The bulk sterile water in pharmacies is for dilution of drugs, mixes, etc. The availability of it in an infusable form has been identified as a serious safety risk in hospitals.

Edited for spelling

Edited by CrapMagnet
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Looking through my class notes a second time, it discusses D5W for IV for euvolemic hypernatremia and 0.45 saline for hypovolemic hypernatremia. I could have sworn, though, that I've heard sterile water being administered for hypernatremia, however it's definitely not something to be done without lab values.

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Fluid replacement following severe dehydration when you don't want to increase the total body salt load. Hypernatremia is more often due to low fluid levels than excess sodium.

I am not busting your chops but have you ever actually seen sterile water infused IV with positive results?

I would be really afraid it cause horrible things to my patient.

I was typing at the same time as you so you can disregard this comment and question.

Edited by DFIB
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I could have sworn, though, that I've heard sterile water being administered for hypernatremia, however it's definitely not something to be done without lab values.

The safety alerts regarding this also recommend education and intense training early in medical school to teach doctors to NEVER do this.

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I have heard of D5W being infused in dehydration with hypernatremia under the theory that the body will use up/store the dextrose, leaving free water.

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I have heard of D5W being infused in dehydration with hypernatremia under the theory that the body will use up/store the dextrose, leaving free water.

Absolutely correct. In this particular patient death, the patient was diabetic with extremely high BGL. The doc decided against the D5W for this reason. The correct thing to do would have been to use the D5W and correct the BGL with insulin.

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Look up osmolarity, tonicity, haemodilution and clotting

The last two are quite important when it comes to IV fluids in trauma resuscitation

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JP, sterile water is for injection once you have used it to dilute something to get the right osmolarity. If you have someone who is hypernatremic you give D5W or a sodium chloride solution, which will dilute the Na. Giving a water infusion will cause hemolysis. Are you thinking of hypertonic saline for hyponatremia?

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No, more of mis recalled something as stated. Probably a bit to do with discussing free water deficit, 0.45%NaCL, D5w, and enteral water replacement in a short amount of space.

Edited by JPINFV
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I hear you. All of that chemistry crap starts to blend into one. Nephrology sucks, lol.

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