CLINICAL QUERIES: Managing hypernatremia
Judith Sweeney MSN, RN

September 2010 
Volume 40  Number 9
Pages 63 - 63
  PDF Version Available!

My patient's serum sodium level was 153 mEq/L (normal, 135 to 145 mEq/L) and the healthcare provider prescribed an infusion of 5% dextrose in 0.45% sodium chloride solution. Why was a hypertonic, instead of a hypotonic, I.V. solution used to treat this patient's hypernatremia?—E.E., OKLA.Judith Sweeney, MSN, RN, replies:Osmolality, which reflects the concentration of solutes such as sodium and glucose in water, is indicated on the I.V. solution container. Tonicity refers to the effect that a solution's osmolality has on cell size because of water movement across the cell membrane.1 Because 0.9% sodium chloride solution is considered physiologically equal to the osmolality of plasma, it's an isotonic solution.Solutions with a higher concentration of solutes (such as sodium or glucose) than isotonic solutions are hypertonic. They increase the osmotic pressure in plasma, pulling fluid from the intracellular and interstitial spaces into the vascular compartment

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