What is dextrose 5% (five percent) infusion continuous?

Dextrose 5% Infusion Continuous

Dextrose 5% (D5W) is an isotonic intravenous solution containing 5% glucose (50g/L) in water that becomes hypotonic once administered, providing free water and approximately 170 calories per liter without electrolytes. It is commonly used for free water administration, as a vehicle for medication delivery, and in specific clinical scenarios requiring glucose supplementation.

Composition and Properties

• Concentration: Contains 5 grams of dextrose per 100 mL (5% w/v)
• Osmolarity: Initially isotonic at approximately 278 mOsm/L before administration
• Tonicity: Becomes hypotonic after glucose metabolism
• Caloric content: Provides 170 calories per liter (3.4 kcal/g of dextrose)
• pH: Approximately 4.0

Clinical Applications

Primary Uses

• Free water replacement in patients with hypernatremia or hyperosmolality
• Vehicle for medication delivery when electrolyte-free solutions are preferred
• Glucose supplementation in specific clinical scenarios:
  • Hypoglycemia management (though higher concentrations like D10W or D50W are typically used for acute treatment)
  • Prevention of hypoglycemia during insulin administration 1
  • Management of hyperkalemia (when combined with insulin)

Specific Clinical Scenarios

1. Beta-blocker overdose management:

   • Used in high-dose insulin-euglycemia therapy protocols
   • Administered at 0.5 g/kg/hour alongside insulin infusions
   • Titrated to maintain serum glucose between 100-250 mg/dL 1

2. Hypovolemic hypernatremia:

   • Used after initial volume restoration with isotonic solutions
   • Helps correct hypernatremia while providing free water 2
   • Various formulations include D5 0.45% NaCl (half-normal saline with 5% dextrose)

3. Nephrogenic diabetes insipidus:

   • Used as maintenance fluid when patients cannot self-regulate fluid intake
   • Provides free water without additional osmotic load 1

Administration Considerations

Monitoring Requirements

• Blood glucose: Regular monitoring (every 15-30 minutes initially) is essential during administration, especially with higher infusion rates 1
• Serum electrolytes: Monitor for development of hyponatremia, particularly in at-risk patients
• Fluid status: Assess for signs of fluid overload

Precautions and Contraindications

• Not recommended for volume resuscitation in hypovolemic states (isotonic crystalloids preferred)
• Use with caution in patients at risk for cerebral edema 2
• Avoid in patients with severe hyperglycemia or diabetic ketoacidosis
• Central venous access required for sustained infusions of concentrated dextrose solutions (>10%) 1

Physiological Effects

• Continuous D5W infusion at 100 mL/hr typically raises serum glucose by approximately 9 mg/dL above baseline
• At 200 mL/hr, serum glucose may increase by approximately 24 mg/dL above baseline 3

Potential Complications

• Hyperglycemia: Especially in stress states or with higher infusion rates
• Hyponatremia: Due to free water effect after glucose metabolism
• Fluid overload: If administered too rapidly or in excessive volumes
• Tissue damage: If extravasation occurs (less concerning than with higher dextrose concentrations)
• Electrolyte disturbances: Particularly hypokalemia when combined with insulin therapy 1

D5W should be used judiciously based on specific clinical indications, with appropriate monitoring of glucose levels, electrolytes, and fluid status to prevent complications.