Is dextrose 5% (five percent dextrose) effective for intravascular volume expansion?

Dextrose 5% is Not Effective for Intravascular Volume Expansion

Dextrose 5% (D5W) is not effective for intravascular volume expansion and should not be used for this purpose. 1

Why D5W is Ineffective for Volume Expansion

• D5W is a hypotonic solution that distributes primarily into intracellular spaces after the glucose is metabolized, which can exacerbate ischemic brain edema rather than expand intravascular volume 1
• Only one-quarter of crystalloid infusate remains intravascularly, while three-quarters distributes into the interstitial space, making D5W particularly inefficient for volume expansion 2
• D5W contains no sodium or electrolytes, which are necessary components for effective intravascular volume expansion 1

Recommended Solutions for Intravascular Volume Expansion

Isotonic Crystalloids (First-Line)

• Isotonic crystalloids such as 0.9% saline are recommended as first-line fluids for intravascular volume expansion 1
• Isotonic solutions distribute more evenly into extracellular spaces (interstitial and intravascular) and are better for volume expansion 1
• The KDOQI Work Group recommends using isotonic crystalloids rather than colloids for initial management of expansion of intravascular volume in patients at risk for AKI or with AKI 1

Balanced Crystalloid Solutions

• Balanced crystalloid solutions (like lactated Ringer's) may be preferable to 0.9% saline in some situations to avoid hyperchloremic metabolic acidosis 2
• Studies show that lactated Ringer's and acetated Ringer's solutions have slightly lower plasma-dilution efficiency compared to normal saline (0.88 and 0.91 respectively, with normal saline as reference = 1) 3

Colloids (Special Situations)

• Albumin is appropriate for specific clinical scenarios:
  • Patients with liver disease, especially those with spontaneous bacterial peritonitis 1
  • Patients undergoing large-volume paracentesis 1
  • Diagnostic workup for hepatorenal syndrome (1 g/kg/day up to 100 g/day) 1, 4
• Starch-containing fluids should be avoided in patients at risk of AKI or with AKI 1
• Albumin should be avoided in patients with traumatic brain injury 1

Potential Harms of D5W for Volume Expansion

• Administration of D5W can cause significant hyperglycemia, with one study showing plasma glucose exceeding 10 mmol/L in 72% of non-diabetic patients receiving just 500 mL 5
• Hypotonic solutions like D5W can exacerbate cerebral edema in patients with acute ischemic stroke 1
• The rapid metabolism of glucose in D5W effectively turns it into free water, which can worsen hyponatremia 1

Appropriate Uses for D5W

• D5W may be appropriate in specific situations:
  • Treatment of hypernatremia with adequate hemodynamic stability 6
  • As a vehicle for medication administration 1
  • When glucose is needed to prevent hypoglycemia while continuing other treatments 6

Volume Expansion Efficiency Comparison

• Relative efficiency of fluid types for plasma volume expansion (using 0.9% saline as reference = 1):
  • Lactated Ringer's: 0.88
  • Acetated Ringer's: 0.91
  • Hypertonic saline: 3.97
  • Hypertonic saline in dextran: 7.22 3

Clinical Considerations

• For patients requiring intravascular volume expansion, isotonic crystalloids should be the initial choice 1
• Euvolemia is the goal for most patients requiring fluid resuscitation 1
• The choice of fluid should consider the patient's underlying condition, electrolyte status, and acid-base balance 1
• Adequate volume expansion is critical in preventing complications like contrast-induced acute kidney injury, with studies showing that higher infused volumes (>960 mL) are associated with lower incidence of kidney injury 7

In summary, D5W should not be used for intravascular volume expansion due to its hypotonic nature and distribution primarily to intracellular spaces after glucose metabolism. Isotonic crystalloids remain the first-line choice for volume expansion in most clinical scenarios.