What about administering D5W (5% Dextrose in Water) to the previous patient?

From the Guidelines

I would recommend giving D5W to the previous patient if they have a condition such as congenital nephrogenic diabetes insipidus, as it is recommended for intravenous rehydration in these cases, according to the international expert consensus statement 1. D5W (5% dextrose in water) is an intravenous solution used for fluid replacement, providing free water and a small amount of calories. Before administering D5W, it's essential to know the patient's current fluid status, electrolyte levels, blood glucose, and underlying medical conditions. Some key points to consider when deciding on IV fluid therapy include:

• The patient's fluid status and whether they are hypovolemic or euvolemic
• The presence of any underlying medical conditions, such as hyperglycemia or cerebral edema
• The specific therapeutic goal, such as rehydration or volume resuscitation
• The potential risks and benefits of using D5W, including the risk of worsening hyperglycemia or exacerbating cerebral edema According to the evidence, D5W can be used for intravenous rehydration in patients with congenital nephrogenic diabetes insipidus, as recommended by the international expert consensus statement 1. However, it's crucial to consider the individual patient's needs and circumstances before making a decision. In general, a proper clinical assessment including vital signs, laboratory values, and the specific therapeutic goal is necessary before deciding on the appropriate IV fluid therapy for any patient. It's also important to note that other evidence suggests avoiding D5W in certain cases, such as acute ischemic stroke patients, due to the potential detrimental effects of glucose on brain injury 1. But in the context of congenital nephrogenic diabetes insipidus, the recommendation is to use water with dextrose, such as 5% dextrose, for intravenous rehydration 1.

From the Research

Administration of D5W

• The administration of D5W (5% dextrose in water) to patients can have various effects, depending on the context and patient condition 2.
• In patients undergoing elective surgery, the use of D5W as an initial intravenous replacement fluid can lead to significant hyperglycemia, even in non-diabetic patients 3.
• However, in certain situations, such as rehydration of elderly patients, subcutaneous infusion of D5W can be an effective and safe method, with similar rates of adverse effects to intravenous infusion 4.

Considerations for Administration

• When administering D5W, it is essential to consider the patient's fluid status, glucose levels, and overall medical condition 5.
• Nurses play a crucial role in assessing patients' fluid status and administering and monitoring IV fluid therapy, including D5W 5.
• The preparation and administration of IV medicines, including D5W, require careful attention to detail, calculation skills, and knowledge of compatibility, stability, and storage requirements 6.

Potential Risks and Complications

• The administration of D5W can worsen brain edema in patients with closed head trauma, particularly when given as a hypoosmolar solution 2.
• Hyperglycemia caused by D5W can have adverse effects on patient outcomes, highlighting the need for careful monitoring and management of glucose levels 3.
• As with any IV fluid therapy, there is a risk of complications, such as anaphylaxis, which requires prompt recognition and management 6.