What are the contraindications for dextrose normal saline (DNS)?

Contraindications for Dextrose Normal Saline (DNS)

Dextrose normal saline is contraindicated in patients with intracranial or intraspinal hemorrhage, delirium tremens with pre-existing dehydration, and should not be administered simultaneously with blood through the same infusion set due to risk of pseudoagglutination of red blood cells. 1

Absolute Contraindications

• Intracranial or intraspinal hemorrhage: DNS should not be used in patients with active bleeding in the brain or spinal cord as it may worsen outcomes 1
• Delirium tremens with dehydration: Using concentrated dextrose solutions in already dehydrated patients with delirium tremens is contraindicated 1
• Concurrent blood administration: DNS should not be administered simultaneously with blood through the same infusion set due to risk of pseudoagglutination of red blood cells 1

Relative Contraindications and Cautions

• Fluid overload risk: DNS should be used cautiously in patients with:

  • Congestive heart failure 2
  • Renal insufficiency 2
  • Conditions predisposing to fluid retention 2

• Hyperglycemia risk: DNS should be used with caution in:

  • Diabetic patients 3
  • Non-diabetic patients at risk for stress hyperglycemia 3
  • Patients with cerebral ischemia, as hyperglycemia may worsen neurological outcomes 4

• Electrolyte imbalances: Caution should be exercised when using DNS in:

  • Patients with hyponatremia, as dextrose metabolism can worsen this condition 5
  • Patients requiring precise electrolyte management 5

Special Considerations

Stroke and Cerebral Ischemia

• DNS should be avoided in patients with acute stroke or cerebral ischemia as hyperglycemia may worsen neurological outcomes 4, 2
• For stroke patients requiring hydration, normal saline without dextrose is preferred 2

Anaphylaxis Management

• While DNS can be used for volume resuscitation in anaphylaxis, normal saline is preferred as the first-line crystalloid 2
• In anaphylaxis management, crystalloids like normal saline are recommended at 5-10 mL/kg in the first 5 minutes 2

Surgical Patients

• In elective surgical patients, initiating IV fluid therapy with non-dextrose containing solutions is preferred as DNS can cause transient hyperglycemia 3
• A study showed that 72% of non-diabetic patients receiving DNS had plasma glucose exceeding 10 mmol/L after infusion 3

Pediatric Considerations

• DNS should be used cautiously in children with dehydration from gastroenteritis, as studies have not shown clear clinical benefits over normal saline 6
• For pediatric patients with hypoglycemia risk, D10W (10% dextrose in water) may be preferred over DNS for more precise glucose control 7

Alternative Solutions When DNS is Contraindicated

• Normal saline (0.9% NaCl): Preferred for volume resuscitation without glucose supplementation 2
• Lactated Ringer's solution: Alternative for fluid resuscitation when electrolyte balance is important 3
• D10W (10% dextrose in water): For treatment of hypoglycemia without significant sodium load 7
• Subcutaneous hydration: In geriatric patients, subcutaneous infusion of appropriate dextrose solutions can be considered when IV access is difficult 8, 2

Remember that while DNS has specific contraindications, it remains a valuable solution for rehydration with prevention of hypoglycemia in appropriate clinical scenarios 5.