Make it Simple
Remember to use your medical terminology skills to understand the prefixes “hyper-” and “hypo-” (as described in Chapter 8), with “hyper-” meaning excessive or above normal and “hypo-” meaning below or less than normal.
CautionIV potassium can cause severe and potentially fatal cardiac rhythm disturbances. Thus patients should be carefully monitored, and when possible, oral potassium in liquid, tablet, or capsule form is preferable.
Sodium controls distribution of water in the body and maintains fluid and electrolyte balance. Sodium is the principal cation of ECF and vital to neuromuscular function. Normal sodium levels are 135 to 145 mEq/L. If there is too much sodium in the body, the condition is called hypernatremia. This condition frequently results from a relative water loss, and the cells become dehydrated. If there is too little, it is called hyponatremia. This results from excessive water ingestion or retention or inadequate sodium intake.
Intravenous Fluids
Appropriate fluid and electrolyte management is an integral component of surgical patient care, both for maintaining homeostasis and for positive surgical outcomes. Nearly every surgical patient will receive IV fluids. An IV drip is “started” on the patient for two purposes: to establish a direct access to the circulatory system for medication administration and to administer parenteral fluids. IV fluids may be used at a slow rate (e.g., 30 mL/hr on an adult) to keep the vein open (KVO or TKO). Parenteral fluid therapy has three objectives: to maintain daily fluid requirements, restore previous losses, and replace current losses. To accomplish these objectives, several fluids are available and used for specific purposes. The IV fluids most commonly used in the surgical setting are called crystalloids. These are solutions composed mainly of water with dissolved electrolytes, dextrose solutions, and multiple electrolyte solutions. The names of IV solutions are abbreviated on their bags and containers. The abbreviation letters indicate the components of the solution, and the numbers indicate the strength or concentration of the components in the solution. Numbers are often written as subscripts to the letters. For example, an IV solution of D5W indicates dextrose (D) is 5% of the concentration in water (W) (Table 11-2).
Quick QuestionUsing the information in the previous paragraph, what is the IV solution described as D10W?
Common Intravenous Fluids Administered in Surgery
Sodium chloride (NaCl) in a 0.9% solution (isotonic) is the agent of choice for fluid replacement or simple hydration and one of the most common IV fluids used in surgery. It is considered isotonic, which means its concentration of dissolved particles is similar to plasma and causes no shift in cell fluids. Sodium chloride is packaged in 1000-, 500-, 250-, and 100-mL bags for IV administration. It comes in a variety of concentrations (the amount of sodium chloride in solution), which includes 3%, 5%, 0.9%, 0.45%, 0.33%, and 0.225% (Fig. 11-1). Sodium chloride is used when chloride loss is greater than or equal to sodium loss, for treatment of metabolic acidosis (excess acid in body fluids) in the presence of fluid loss, and to replenish lost sodium. Sodium chloride is the IV fluid used when transfusing blood products because it does not hemolyze (fill with fluid and rupture) blood cells.
TABLE 11-2
Common Intravenous Fluid Components
| Component | Abbreviation |
| Dextrose | D |
| Lactated Ringer’s (or Ringer’s lactate) | LR (or RL) |
| Normal saline (0.9%) | NaCl, NS |
| Saline | S |
| Sodium chloride | NaCl |
| Water | W |
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