Medical Surgical Fluids and Hormones #4

Question

Which client would hypotonic fluids be contraindicated?

Answers

  1. A client with diabetes insipidus.
    • Rationale:

      This answer is not correct because diabetes insipidus causes large amounts of urine loss which results in hypernatremia. A hypotonic solution would shift the fluid into the cells and correct the imbalance, therefore a hypotonic solution would be indicated in a client with diabetes insipidus.

  2. A client with diarrhea from a stomach virus.
    • Rationale:

      This answer is not correct because a client with diarrhea will be secreting fluid and can become dehydrated. A hypotonic solution would shift water back into the cells creating cellular hydration.

  3. A client having peritoneal dialysis.
    • Rationale:

      This answer is not correct because peritoneal dialysis causes water loss and increased sodium. However, a modified solute concentration in dialysate can treat the hypernatremia successfully. If this client required IV fluids, hypotonic solution would be best indicated.

  4. A client diagnosed with second-degree burns.
    • Rationale:

      This answer is correct because a burn victim is at risk for third-space fluid shifts. A hypotonic solution pushes fluid into the cells and interstitial cells as well. A more appropriate solution would be a solution that does not shift fluid, such as Lactated Ringer’s, which is an isotonic solution.

Overview

Hypotonic solution shifts fluid from intravascular spaces to intracellular and interstitial spaces to hydrate the cells and cause them to swell. Anything that causes dehydration or hypernatremia would require a hypotonic solution. A hypotonic solution has less salt and more water than other solutions.

Explanation

Learning Outcomes

Hypotonic solution shifts fluid from intravascular spaces to intracellular and interstitial spaces to hydrate the cells and cause them to swell. Anything that causes dehydration or hypernatremia would require a hypotonic solution. A hypotonic solution has less salt and more water than other solutions. Burn victims are at risk for third-space fluid shifts. The inflammatory response that is experienced in burn victims causes low blood pressure due to the fluid loss. Since hypotonic solutions push fluid into the cells and interstitial cells, it is not used for these clients. This can cause edema, reduced cardiac output, or additional low blood pressure.

Test Taking Tip

Notice the correlation with hypotonic solution and hypernatremia. The first three answers result in hypernatremia.

Video Rationale