All of the following are selective indications for the use of Hypotonic solutions, except:
Using hypotonic solutions on patients with burns may be hazardous, beacause these patients are at risk for developing third spacing, an abnormal fluid shift into the serous linings of the body. Hypotonic Solutions: A hypotonic fluid has an osmolarity less than that of serum (It has less sodium ion concentration than serum) When this fluid is placed in the vascular compament, it begins diluting the serum and soon the serum osmolarity of the vascular compament becomes less than that of the interstitial fluid. Water is pulled from the vascular compament into the interstitial fluid comparment and eventually the same process is repeated, pulling water from the interstitial compament into the cells. Hypotonic solutions thus hydrate the cells while depleting the vascular compament Indications for the use of Hypotonic solutions: (These solutions may be needed for) A patient on dialysis when diuretic therapy dehydrates the cells. For hyperglycaemic conditions in which high serum glucose levels draw fluid out of the cells and into the vascular and interstitial compaments. Like diabetic ketoacidosis Like hyperosmolar hyperglycaemic non-ketotic syndrome. Hypotonic solutions can be dangerous to use because they can cause a sudden fluid shift from the intravascular space to the cells, causing cardiovascular collapse and increased intracranial pressure (ICP) from shifting fluid into the brain cells. This makes hypotonic solutions dangerous to use with patients experiencing a stroke or any head trauma. Using hypotonic solutions on patients with burns, trauma, malnutrition, or liver disease is also hazardous beacause these patients are at risk for developing third spacing, an abnormal fluid shift into the serous linings of the body. Ref: Harrisons 19th edition
Dehydration secondary to diuretic therapy
Diabetic ketoacidosis
Hyperosmolar, Hyperglycaemic Non-ketotic syndrome
Burns
Fluid and electrolytes