When should D5 (Dextrose 5%) infusion be stopped due to side effects?

When to Stop D5 (Dextrose 5%) Infusion Due to Side Effects

D5 infusion should be discontinued immediately if signs of hyperosmolar syndrome (mental confusion, loss of consciousness), hyperglycemia, fluid overload, or extravasation occur. 1

Common Side Effects Requiring Discontinuation

Metabolic Complications

• Hyperglycemia: Monitor blood and urine glucose regularly; discontinue if persistent hyperglycemia develops 1
• Electrolyte imbalances: Particularly serum potassium and phosphate deficits during prolonged use 1
• Hyperosmolar syndrome: Characterized by mental confusion and/or loss of consciousness from excessively rapid administration 1

Vascular Complications

• Venous thrombosis or phlebitis extending from injection site 1
• Extravasation: Ensure needle is well within vein lumen; stop immediately if extravasation occurs 1
• Infection at injection site 1

Volume-Related Complications

• Hypervolemia/Fluid overload: Can precipitate pulmonary edema or ARDS, especially in elderly patients 2
• Cerebral edema worsening: D5 solutions should be used cautiously in patients at risk for cerebral edema 2

Monitoring Parameters

Essential Monitoring During D5 Administration

• Blood glucose levels (to prevent hyperglycemia)
• Serum electrolytes (especially in at-risk patients)
• Fluid status (to prevent overload)
• Injection site (for signs of extravasation or phlebitis)
• Mental status (for signs of hyperosmolar syndrome)

Special Considerations

Elderly Patients

• More susceptible to fluid overload complications
• D5 should not be used as routine maintenance fluid in non-diabetic elderly patients 2
• Should not be used for volume resuscitation in hypovolemic states 2

Patients with Cerebral Issues

• Avoid in patients at risk for cerebral ischemia (acute stroke, impending cardiac arrest, severe hypotension) 3
• Hyperglycemia may increase ischemic brain injury 2, 3

Patients with Diabetes

• Use with caution in patients with known subclinical or overt diabetes mellitus 1
• More frequent glucose monitoring required

Appropriate Alternatives

When D5 Must Be Discontinued

• For hypoglycemia treatment: Consider D10 as a safer alternative to D50 4, 5
• For maintenance fluids: Use isotonic solutions with appropriate electrolytes 2
• For elderly patients with mild-to-moderate dehydration: Consider subcutaneous administration as an alternative with fewer complications 2

Common Pitfalls to Avoid

• Using D5W for volume depletion instead of isotonic solutions
• Failing to monitor glucose levels during D5 infusion
• Not considering subcutaneous administration when appropriate in elderly patients
• Administering D5 solutions subcutaneously or intramuscularly (contraindicated) 1
• Abruptly withdrawing concentrated dextrose infusion without follow-up with 5% or 10% dextrose to avoid rebound hypoglycemia 1

By monitoring patients closely for these side effects and discontinuing D5 infusion promptly when they occur, clinicians can minimize adverse outcomes while still providing necessary treatment.