From the Guidelines
The recommended infusion rate for correcting a 1.4L free water deficit with D5W (Dextrose 5% in Water) is approximately 100-125 mL/hour over 12-24 hours. This gradual correction is preferred to avoid rapid shifts in serum osmolality that could lead to neurological complications, as supported by the guidelines for managing hyperglycemic crises in patients with diabetes mellitus 1. D5W is an appropriate choice because once the dextrose is metabolized, it effectively provides free water to the body.
When administering this infusion, it's crucial to monitor serum sodium levels every 2-4 hours initially, as well as the patient's neurological status and fluid balance, to prevent complications such as cerebral edema 1. The correction should be slowed if the serum sodium decreases by more than 8-10 mEq/L in 24 hours. The physiological basis for this approach is that free water deficits typically occur in hypernatremic states, and too-rapid correction can cause cerebral edema as water shifts into brain cells.
Key considerations in the management include:
- Monitoring serum osmolality and frequent assessment of cardiac, renal, and mental status to avoid iatrogenic fluid overload 1.
- Gradual replacement of sodium and water deficits, with a maximal reduction in osmolality of 3 mOsm kg–1 H2O h–1 1.
- Addition of dextrose to the hydrating solution once blood glucose reaches 250 mg/dl to maintain a stable glucose level and prevent further complications 1.
- Regular assessments of vital signs, urine output, and electrolytes throughout the correction period to ensure safe and effective treatment.
By following these guidelines and recommendations, the risk of morbidity and mortality associated with free water deficit correction can be minimized, and the quality of life for patients can be improved.
From the Research
Infusion Rate of D5W to Correct Free Water Deficit
To correct a 1.4L free water deficit, the recommended infusion rate of D5W (Dextrose 5% in Water) is not explicitly stated in the provided studies. However, the following points can be considered:
- The treatment of hypernatremia and free water deficit often involves the administration of free water, either orally or intravenously, in addition to other therapies such as desmopressin 2, 3, 4, 5.
- The use of D5W is mentioned in the context of treating hyperglycemia and hypernatremia, but the specific infusion rate for correcting free water deficit is not provided 2, 3.
- The studies suggest that the treatment approach should be individualized and based on the patient's specific condition, including the severity of hypernatremia, the presence of other complications, and the patient's response to therapy 2, 4, 5.
- In general, the goal of treatment is to correct the free water deficit and normalize serum sodium levels, while also managing other related conditions such as hyperglycemia and dehydration 2, 4, 6.
Key Considerations
- The infusion rate of D5W should be tailored to the individual patient's needs and response to therapy.
- Close monitoring of serum sodium levels, urine output, and other clinical parameters is essential to adjust the treatment approach as needed.
- The use of desmopressin and other therapies may be necessary to manage hypernatremia and free water deficit, in addition to D5W infusion 2, 3, 4, 5.