Can D5W (5% Dextrose in Water) be given as a bolus?

D5W Should NOT Be Given as a Bolus for Resuscitation or Volume Expansion

D5W (5% dextrose in water) is not appropriate for bolus administration in resuscitation or volume expansion scenarios, as it lacks electrolytes and can cause significant hyperglycemia, potentially worsening neurological outcomes in critically ill patients. 1

Clinical Context and Appropriate Uses

When D5W is NOT Appropriate as a Bolus

• Volume resuscitation: D5W provides no sodium or electrolytes and is rapidly distributed into total body water, making it ineffective for intravascular volume expansion 2
• Cardiac arrest or cerebral ischemia: Glucose administration before or during cerebral ischemia worsens neurologic and histologic outcomes in both animal and human studies 1
• Routine fluid replacement: Even 500 mL of D5 normal saline (which contains electrolytes unlike pure D5W) causes significant hyperglycemia, with 72% of patients exceeding 10 mmol/L glucose 2

When Dextrose Solutions ARE Appropriate

D5W serves as a diluent for specific medications, not as a bolus fluid:

• Dopamine infusions (2-20 mcg/kg/min in 500 mL D5W) for refractory hypotension 3
• Epinephrine infusions (1 mg in 250 mL D5W yielding 4 mcg/mL) 3
• Sodium bicarbonate for tricyclic antidepressant toxicity (150 mEq NaHCO3 per liter of D5W) 3
• Amiodarone continuous infusion (concentration should not exceed 2 mg/mL diluted with D5W) 4

Hypoglycemia Treatment: Use Higher Concentration Dextrose

For documented hypoglycemia requiring rapid correction, use concentrated dextrose solutions (10%, 25%, or 50%), NOT D5W:

Pediatric Hypoglycemia

• Administer 0.5 g/kg of glucose as 10% or 25% solution slowly 4
• Avoid indiscriminate glucose treatment, as hyperglycemia increases ischemic brain injury 4

Adult Hypoglycemia

• 5-gram aliquots of 10%, 25%, or 50% dextrose achieve equivalent time to recovery (median 6 minutes to GCS 15) 5
• 10% and 25% dextrose require lower total median doses (10 g vs 15 g) compared to 50% dextrose 5
• D10 infusion is as effective as D50 bolus for preventing hypoglycemia in hyperkalemic patients receiving insulin 6

Critical Pitfalls to Avoid

Empiric Glucose Administration

• Do NOT give empiric dextrose to altered mental status patients without documented hypoglycemia 1
• Perform bedside fingerstick glucose immediately before administering any dextrose 1
• Reserve dextrose for patients with confirmed hypoglycemia (≤70 mg/dL) 5

Patients at High Risk for Harm

Avoid dextrose boluses in patients with:

• Acute stroke or impending cardiac arrest 1
• Severe hypotension or those receiving CPR 1
• Cardiac or renal compromise (monitor for fluid overload regardless of diluent) 3

Monitoring Requirements

• Monitor blood glucose levels when using any dextrose-containing solution, especially in diabetic patients 3
• In DKA management, switch to D10 or D5 with saline only when glucose reaches 250 mg/dL 7
• Monitor hourly or more frequently during diabetic emergencies 7

Bottom Line Algorithm

1. Is this for medication dilution? → Yes: D5W is appropriate per specific drug protocols 4, 3
2. Is this for volume resuscitation? → No: Use isotonic crystalloids (normal saline or lactated Ringer's) 2
3. Is this for hypoglycemia treatment? → No: Use 10%, 25%, or 50% dextrose in small aliquots 4, 5
4. Is the patient at risk for cerebral ischemia? → Absolutely avoid any dextrose bolus 1