What if blood glucose levels are increasing in a patient on a D5 (5% dextrose) drip, should the D5 drip be stopped?

Managing Rising Blood Glucose on D5 Infusion

Yes, discontinue the D5 infusion if blood glucose levels are rising, as hypotonic dextrose solutions can worsen hyperglycemia and should be replaced with isotonic saline (0.9% NaCl) for fluid management. 1

Immediate Action

• Stop the D5 infusion immediately when blood glucose levels are increasing, as 5% dextrose becomes hypotonic after glucose metabolism and distributes into intracellular spaces 1
• Switch to 0.9% normal saline for ongoing fluid requirements, as isotonic solutions distribute more evenly into extracellular spaces and avoid exacerbating hyperglycemia 1
• Check blood glucose levels to determine the degree of hyperglycemia and guide further management 1

Understanding D5's Effect on Blood Glucose

• In non-diabetic patients, D5 infusion at 100 mL/hr typically raises serum glucose by approximately 9 mg/dL above fasting levels, while 200 mL/hr raises it by 24 mg/dL 2
• D5 infusions up to 3 liters per 24 hours generally keep blood glucose below 140 mg/dL in non-diabetic patients not on steroids 3
• Any glucose elevation exceeding these expected ranges suggests impaired glucose tolerance or an underlying hyperglycemic state that warrants D5 discontinuation 2

Clinical Context Matters

In Acute Stroke Patients

• Avoid hypotonic solutions like D5 entirely in acute ischemic stroke, as they may exacerbate cerebral edema 1
• Hyperglycemia during acute stroke is associated with worse clinical outcomes, larger infarct volumes, and increased risk of symptomatic intracranial hemorrhage in patients receiving thrombolytics 1
• Use isotonic saline (0.9% NaCl) for volume replacement and maintenance fluids 1

In Critically Ill Patients

• Target glucose levels between 150-200 mg/dL in most critically ill patients to balance hyperglycemia risks against hypoglycemia dangers 1, 4
• Continue insulin infusion if needed to manage hyperglycemia, but discontinue the glucose source (D5) that is driving the problem 1
• Monitor blood glucose every 2-4 hours when managing hyperglycemia in critical illness 4

In Diabetic Ketoacidosis (DKA)

• Do not stop insulin infusion even when glucose normalizes - continue insulin at 0.1 units/kg/hour until ketoacidosis resolves 4
• Add D5 to IV fluids only when glucose drops below 200 mg/dL during DKA treatment to prevent hypoglycemia while continuing insulin for ketoacidosis resolution 4
• This is the opposite scenario - here D5 is intentionally added to maintain safe glucose levels while treating the underlying metabolic derangement 4

Common Pitfalls to Avoid

• Do not continue D5 "for hydration" when hyperglycemia is present - switch to isotonic saline which provides equivalent or superior volume expansion without glucose load 1
• Do not assume mild hyperglycemia is acceptable - even modest elevations (>40% of patients with acute stroke) are associated with worse outcomes 1
• Do not use D5 in patients with impaired glucose tolerance or stress-induced hyperglycemia - these patients cannot handle the glucose load 2
• Avoid overcorrection - when transitioning off D5, ensure the patient has adequate fluid replacement with isotonic solutions 1

Monitoring After D5 Discontinuation

• Recheck blood glucose 1-2 hours after stopping D5 to confirm downward trend 1
• Continue monitoring every 2-4 hours until glucose stabilizes in target range 4
• Assess for underlying causes of hyperglycemia including sepsis, medications (steroids), or undiagnosed diabetes 1, 3