D5W Infusion Rate to Maintain Blood Glucose
For maintaining blood glucose levels in adults, D5W should be infused at approximately 100 mL/hour (7 mg/kg/min for a 70 kg adult), which provides sufficient glucose to prevent hypoglycemia while avoiding hyperglycemia. 1
Standard Maintenance Rates
The typical maintenance infusion rate for D5W-containing fluids is 100 mL/kg per 24 hours (approximately 4.2 mL/kg/hour), which translates to roughly 100 mL/hour for an average 70 kg adult. 1 This rate delivers approximately 5 grams of dextrose per hour, sufficient to maintain normoglycemia in most fasting patients.
Evidence-Based Dosing
- Research demonstrates that D5W at 100 mL/hour raises serum glucose by a mean of only 9 mg/dL above fasting levels, while 200 mL/hour increases glucose by 24 mg/dL. 2
- At 100 mL/hour, patients remain normoglycemic without risk of significant hyperglycemia (defined as >20 mg/dL above baseline at this rate). 2
- Even after prolonged fasting (average 13 hours), non-diabetic patients do not develop hypoglycemia without dextrose-containing fluids, suggesting that lower rates may be adequate for glucose maintenance alone. 3
Clinical Context Adjustments
For Hypoglycemia Treatment
- Acute hypoglycemia requires bolus dosing, not maintenance infusions: 5-25 grams of dextrose as a bolus (10-50 mL of D50W or equivalent), not continuous D5W. 1, 4
- After initial correction, continuous D5W at 100 mL/hour prevents recurrent hypoglycemia. 1
For Diabetic Ketoacidosis
- Once serum glucose reaches 200-250 mg/dL during DKA treatment, switch to D5W-containing fluids at 4-14 mL/kg/hour (approximately 100-280 mL/hour for a 70 kg adult) to maintain glucose in target range while continuing insulin therapy. 1, 5
- The American Diabetes Association specifically recommends this approach to prevent hypoglycemia while resolving ketoacidosis. 1
For Adrenal Insufficiency
- Initial fluid bolus of 20 mL/kg of D5NS (approximately 1400 mL for 70 kg adult) over the first hour, followed by maintenance rates of 100-150 mL/hour. 1, 5
Critical Monitoring Parameters
Blood glucose should be monitored every 1-2 hours when initiating D5W infusions to ensure the rate is appropriate for the individual patient. 1
- Target glucose range: 140-200 mg/dL for hospitalized patients receiving insulin therapy. 6
- Avoid glucose targets below 140 mg/dL due to increased risk of hypoglycemia without proven benefit. 6
- In diabetic patients, even 500 mL of D5W can cause transient hyperglycemia exceeding 200 mg/dL (11.1 mmol/L) in 72% of patients. 3
Common Pitfalls to Avoid
- Do not use D5W at rates exceeding 150-200 mL/hour for simple glucose maintenance, as this frequently causes iatrogenic hyperglycemia without additional benefit. 2, 3
- Do not rely on D5W alone to treat acute hypoglycemia—bolus therapy with higher dextrose concentrations (D10W, D25W, or D50W) is required for rapid correction. 1, 4
- In patients with cardiac or renal compromise, limit rates to 100 mL/hour or less and monitor closely for fluid overload. 5
- For pediatric patients, use weight-based calculations: 100 mL/kg/24h for first 10 kg, 50 mL/kg/24h for 10-20 kg, and 20 mL/kg/24h for remaining weight. 1