Is D5 (dextrose 5%) effective in correcting hypotension?

D5 (Dextrose 5%) Does NOT Correct Hypotension

D5 (5% dextrose in water) should not be used to correct hypotension, as it functions as a hypotonic solution in vivo and can actually worsen hemodynamic instability and increase intracranial pressure. 1

Why D5 Fails as a Resuscitation Fluid

Physiological Problem with D5

• D5 behaves as free water in the body because glucose is rapidly metabolized, leaving behind hypotonic fluid that shifts from the extracellular space into cells 1
• While D5 appears isotonic in vitro (approximately 252 mOsmol/L), its in vivo effect is equivalent to pure water once dextrose is metabolized 1
• This hypotonic effect can decrease plasma osmolality by 3%, producing dangerous increases in intracranial pressure of approximately 15 mmHg 1

Appropriate Fluid Choices for Hypotension

For initial resuscitation of hypotensive patients, crystalloids (normal saline or lactated Ringer's) should be used first, with colloids added within prescribed limits for each solution. 2

Crystalloid Solutions (First-Line)

• Normal saline (0.9% NaCl) is the preferred initial fluid for treating hypotension, as it maintains appropriate osmolality (286 mOsmol/kgH2O) 1
• Crystalloids should be infused rapidly to restore mean arterial pressure to 65-70 mmHg 2
• Large volumes may be required: adults can receive 1-2 L at 5-10 mL/kg in the first 5 minutes; children can receive up to 30 mL/kg in the first hour 2

When D5-Containing Solutions Are Used

• D5 normal saline (D5NS) contains both dextrose and sodium chloride and may be used as a vehicle for vasopressor administration 3
• However, the primary therapeutic effect comes from the saline component, not the dextrose 3
• The dextrose content (50 grams per liter) must be considered in patients with diabetes or glucose metabolism disorders 3

Evidence-Based Fluid Selection

Trauma and Hemorrhagic Shock

• Hypertonic saline (3% or 7.5%) has shown benefit in increasing blood pressure in trauma patients, though effects may not be sustained beyond the first hour 2
• The SAFE study showed albumin was not superior to normal saline, with a trend toward higher mortality in trauma patients receiving albumin (p = 0.06) 2

Septic Shock

• Norepinephrine is the first-line vasopressor for correcting hypotension in septic shock, not fluid alone 2
• Fluid resuscitation should be achieved within 3 hours, using crystalloids as first choice 2
• Avoid fluid overload, which can aggravate gut edema and increase intra-abdominal pressure 2

Special Populations

Pediatric Patients

• For hypotension refractory to volume replacement, dopamine can be administered at 2-20 mcg/kg/min (prepared using "rule of 6": 0.6 × body weight in kg = mg diluted to 100 mL saline) 4
• Epinephrine remains the primary intervention for anaphylaxis-related hypotension 2

Geriatric Patients

• Isotonic fluids (not D5) should be used for volume depletion via oral, subcutaneous, or intravenous routes 2
• For low-intake dehydration (osmolality >300 mOsm/kg), hypotonic fluids are appropriate, but this represents a different clinical scenario than acute hypotension 2

Critical Pitfalls to Avoid

• Never use D5W as a primary resuscitation fluid for hypotension—it provides no sustained volume expansion and can cause cellular edema 1
• Avoid confusing D5W with D5NS; the latter contains sodium and provides some volume expansion from the saline component 3
• Large volumes of hypotonic solutions can increase intracranial pressure and should be avoided in patients at risk for cerebral edema 1
• When epinephrine infusions are prepared in D5W for anaphylaxis management, the therapeutic effect comes from epinephrine, not the dextrose carrier solution 2