Is Normal Saline (NS) with 5% Dextrose (D5) still used for hydration?

Normal Saline with 5% Dextrose (D5NS) Is No Longer Recommended as a First-Line Hydration Fluid

Normal saline with 5% dextrose (D5NS) is no longer recommended as a first-line hydration fluid and has been largely replaced by balanced crystalloid solutions such as Ringer's lactate or isotonic saline without dextrose for most clinical scenarios. 1

Current Hydration Fluid Recommendations

Preferred Fluids for Different Clinical Scenarios:

1. General Hydration and Perioperative Care

   • First choice: Balanced crystalloids (e.g., Ringer's lactate) 1
   • Alternative: 0.9% normal saline (NS) without dextrose
   • Avoid: 0.9% saline should be used cautiously due to risk of salt and fluid overload 1

2. Acute Pancreatitis

   • Recommended: Conservative intravenous fluid resuscitation with isotonic crystalloid (Ringer's lactate or normal saline) 1
   • Avoid: Aggressive fluid administration may increase complications

3. Stroke Management

   • Recommended: Isotonic solutions (0.9% saline) 1
   • Avoid: Hypotonic solutions like 5% dextrose as they may exacerbate ischemic brain edema 1

4. Geriatric Patients

   • Recommended: Individualized hydration with isotonic fluids 1
   • For subcutaneous hydration: Half-normal saline-glucose 5% or similar combinations may be used 1

5. Pediatric Diarrhea and Dehydration

   • First choice: Oral rehydration solution (ORS) for mild to moderate dehydration 2
   • For IV hydration: Isotonic crystalloids without dextrose 2

Problems with D5NS and Dextrose-Containing Solutions

1. Hyperglycemia Risk

   • Even 500ml of dextrose-containing fluids can cause significant hyperglycemia in non-diabetic patients 3
   • 72% of patients receiving dextrose saline had plasma glucose >10 mmol/L after infusion 3

2. Electrolyte Imbalances

   • When used as drug diluents, saline causes more hypernatremia and hyperchloremia than D5W 4
   • D5NS can contribute to hyperchloremic metabolic acidosis 5, 6

3. Brain Edema Risk

   • Hypotonic solutions (including D5W after glucose metabolism) distribute into intracellular spaces and may exacerbate ischemic brain edema 1

Current Clinical Applications Where Dextrose Solutions May Still Be Used

1. Prevention of hypoglycemia: Not generally needed for elective surgery in non-diabetic patients (average fasting times of 13 hours did not cause hypoglycemia) 3

2. Drug diluent: May be appropriate in specific situations, though saline is increasingly preferred 4

3. Pediatric maintenance fluids: Some centers still use dextrose-containing solutions, but isotonic solutions are increasingly preferred to prevent hyponatremia 6

4. Subcutaneous hydration in geriatrics: Combinations like half-normal saline with 5% glucose may be used 1

Key Considerations When Choosing Hydration Fluids

• Patient condition: Underlying cardiac, renal, or neurological conditions
• Electrolyte status: Current sodium, potassium, and chloride levels
• Acid-base balance: Risk of metabolic acidosis with high chloride solutions
• Glucose control: Diabetes or stress hyperglycemia risk
• Volume status: Dehydration vs. euvolemia vs. fluid overload risk

Common Pitfalls to Avoid

1. Automatic use of D5NS by habit - This practice is outdated and not supported by current evidence
2. Ignoring hyperchloremic acidosis risk with normal saline
3. Assuming dextrose is needed to prevent hypoglycemia in routine cases
4. Using hypotonic solutions in patients at risk for cerebral edema
5. Overhydration in vulnerable populations (elderly, cardiac or renal patients)

The evidence clearly shows that D5NS is no longer considered a first-line hydration fluid in most clinical scenarios, with balanced crystalloids or isotonic saline without dextrose being preferred for most patients requiring intravenous hydration.