When is D5 (5% dextrose) with 0.25 normal saline used?

From the Guidelines

D5 with 0.25% normal saline is not recommended for use in patients with congenital nephrogenic diabetes insipidus (NDI) due to its potential to exacerbate hypernatraemia, instead, water with dextrose (such as 5% dextrose) is preferred for intravenous rehydration. The use of D5 with 0.25% normal saline is generally considered for maintenance fluid therapy in patients who require both glucose supplementation and mild sodium replacement 1. This solution contains 5% dextrose and 0.25% sodium chloride, providing approximately 170 calories per liter and helping to maintain serum sodium levels. However, in the context of NDI, the primary concern is hypernatraemic dehydration, and the use of salt-containing solutions like D5 with 0.25% normal saline can worsen this condition by increasing the renal osmotic load 1.

Key Considerations

• The tonicity of salt-containing solutions exceeds the typical urine osmolality in NDI, risking serious hypernatraemia 1
• Water with dextrose (such as 5% dextrose) is recommended for intravenous rehydration in NDI patients to avoid exacerbating hypernatraemia 1
• The initial rate of fluid administration should be calculated based on physiological demand, using a routine maintenance rate as a starting point 1
• Patients with NDI require close monitoring and follow-up to prevent complications such as chronic kidney disease (CKD) and to manage associated conditions 1

Clinical Applications

• D5 with 0.25% normal saline may be used in other clinical contexts, such as maintenance fluid therapy in pediatric or elderly patients, or in patients with conditions like diabetic ketoacidosis (after initial resuscitation) or moderate hyponatremia
• However, its use should be cautious in patients with heart failure, renal failure, or severe electrolyte abnormalities, as the glucose may contribute to hyperglycemia and the sodium content may be insufficient for patients with significant sodium depletion 1

From the Research

Use of D5 with 0.25 Normal Saline

• The provided studies do not directly address the use of D5 with 0.25 normal saline 2, 3, 4, 5, 6.
• However, the studies discuss the use of D5W (5% dextrose in water) and normal saline in various medical contexts, including the treatment of hyponatremia and hypernatremia 2, 3, 4, 5.
• One study suggests that using D5W as a diluent for drugs can help prevent hypernatremia in intensive care unit patients 5.
• Another study found that administering hypoosmolar intravenous fluids, such as 0.45% saline and 5% dextrose in water, can worsen brain edema after closed head trauma in rats 6.
• There is no direct evidence in the provided studies to support the use of D5 with 0.25 normal saline for a specific medical condition or treatment.

Relevant Findings

• The use of D5W and normal saline can have different effects on electrolyte balances and fluid status in patients 3, 4, 5.
• The choice of intravenous fluid can impact patient outcomes, including the development of hypernatremia and hyperchloremia 3, 5.
• Further research is needed to determine the optimal use of D5 with 0.25 normal saline in various medical contexts.

Medical Context

• The provided studies discuss the use of D5W and normal saline in intensive care unit patients, patients with hyponatremia and hypernatremia, and patients with closed head trauma 2, 3, 4, 5, 6.
• The findings of these studies may be relevant to the use of D5 with 0.25 normal saline in similar medical contexts, but more research is needed to confirm this.