Dextrose containing fluids
|
Feature |
D25 (25% Dextrose) |
½ DNS (D5 + 0.45% NaCl) |
DNS (D5 + 0.9% NaCl) |
|
Composition |
25 g dextrose/100 mL |
5% dextrose + 0.45% saline |
5% dextrose + 0.9% saline |
|
Dextrose |
250 g/L |
50 g/L |
50 g/L |
|
Sodium |
0 |
77 mEq/L |
154 mEq/L |
|
Chloride |
0 |
77 mEq/L |
154 mEq/L |
|
Osmolarity |
~1260–1400 mOsm/L |
~406 mOsm/L |
~560 mOsm/L |
|
Initial tonicity |
Hypertonic |
Hypertonic |
Hypertonic |
|
Physiologic effect after glucose metabolism |
Free water only |
Hypotonic maintenance fluid |
Isotonic saline remains |
|
Provides calories |
1000 kcal/L |
170 kcal/L |
170 kcal/L |
D5W
Indications
- Free water replacement (especially hypernatremia)
- Maintenance glucose to prevent starvation ketosis
- Mild hypoglycemia (D10W preferred for most patients)
- Vehicle for IV medications
Advantages
- Excellent source of free water
- Lower risk of hyperglycemia than D10W or D50W
- Useful for gradual correction of hypernatremia
D10W
Indications
- Preferred IV dextrose solution for hypoglycemia
- Continuous glucose infusion
- Glucose supplementation during insulin therapy (DKA, hyperkalemia)
- Prevention of starvation ketosis
Advantages
- Highest dextrose concentration suitable for continuous peripheral infusion
- Less free water than D5W → lower risk of hyponatremia
- Lower risk of phlebitis than D50W
D50W
Indications
- Severe symptomatic hypoglycemia requiring rapid correction
- High-dose insulin therapy (e.g., β-blocker or calcium channel blocker overdose) when large glucose loads are required
Contraindications / Avoid
- Routine peripheral administration (relative; high risk of phlebitis/extravasation)
Contraindications / Avoid Dextrose Solutions
- Uncontrolled hyperglycemia
- Hyponatremia
- Raised ICP/cerebral edema (unless treating hypoglycemia)
- Initial fluid resuscitation
Adverse Effects
- Hyperglycemia
- Hyponatremia
- Refeeding syndrome
- Wernicke encephalopathy in thiamine-deficient patients
- Fluid overload (large volumes)
- Hypokalemia (D5W or D10W infusions; not D50W)
ICU Pearls
- D5W is primarily a free water solution.
- D10W is the preferred IV dextrose solution for most hypoglycemic patients.
- D50W should be reserved for emergencies requiring rapid glucose delivery.
- In malnourished or alcohol-dependent patients, administer IV thiamine before or with dextrose whenever feasible.
- During prolonged dextrose therapy, monitor blood glucose, sodium, potassium, phosphate, and magnesium.