When is D5 (5% dextrose solution) IV used in the elderly?

Indications for D5 IV Fluid Use in the Elderly

D5 (5% dextrose) IV solutions should be used in elderly patients primarily for treating hyperosmolar dehydration, preventing hypoglycemia during medication administration, and managing specific electrolyte disorders, rather than as routine maintenance fluids. 1, 2

Primary Indications

1. Treatment of Hyperosmolar Dehydration

• For elderly patients with measured serum osmolality >300 mOsm/kg (or calculated osmolarity >295 mmol/L) who appear unwell 1
• Administered subcutaneously or intravenously alongside oral fluid intake when possible
• Appropriate formulations include:
  • Half-normal saline-glucose 5% (D5 0.45% NaCl)
  • 40 g/L dextrose with 30 mmol/L NaCl
  • 5% dextrose with 4 g/L NaCl
  • Two-thirds 5% glucose with one-third normal saline 1

2. Prevention of Hypoglycemia

• During administration of medications that may cause hypoglycemia (e.g., insulin for hyperkalemia)
• When patients are NPO (nothing by mouth) and at risk for hypoglycemia
• For patients receiving certain IV medications that require glucose as a carrier solution 2

3. Management of Electrolyte Disorders

• For correction of hyponatremia during continuous renal replacement therapy 3
• As part of hyperkalemia treatment protocols (often D10W rather than D5W is preferred) 4

Administration Considerations

Route of Administration

• Intravenous: When rapid correction is needed or larger volumes required 1
• Subcutaneous: Effective alternative for mild-to-moderate dehydration in frail elderly patients 5
  • Associated with fewer complications than IV route
  • More suitable for community settings
  • Similar efficacy to IV administration with appropriate dextrose formulations 1

Monitoring Requirements

• Regular blood glucose monitoring to prevent hyperglycemia
• Serum electrolytes, especially in patients at risk for electrolyte disturbances
• Fluid status to prevent overload, which can precipitate pulmonary edema 1, 2

Cautions and Contraindications

Risk of Hyperglycemia

• Even in non-diabetic patients, 500ml of D5 can cause significant transient hyperglycemia 6
• Hyperglycemia may worsen outcomes in certain conditions and increase ischemic brain injury 2

Fluid Overload Risk

• Elderly patients are more susceptible to fluid overload
• D5 solutions can precipitate pulmonary edema or ARDS in vulnerable patients 1
• Can worsen cerebral edema in at-risk patients 1, 2

Not Recommended For

• Routine maintenance fluid in non-diabetic elderly patients 2
• Volume resuscitation in hypovolemic states (isotonic solutions preferred) 1
• Treatment of volume depletion (requires isotonic fluids with electrolytes) 1

Common Pitfalls to Avoid

1. Using D5W for volume depletion instead of isotonic solutions
2. Failing to monitor glucose levels during D5 infusion
3. Not considering subcutaneous administration when appropriate
4. Administering too rapidly in patients at risk for cerebral edema
5. Using as routine maintenance fluid rather than for specific indications

D5 solutions should be used thoughtfully in the elderly population with careful consideration of the patient's clinical condition, comorbidities, and specific fluid and electrolyte needs.