What is the recommended administration rate for dextrose 5% (D5W) in water?

Administration Rate for Dextrose 5% (D5W)

The maximum safe infusion rate for dextrose 5% is 0.5 g/kg/hour to avoid glycosuria, which translates to approximately 10 mL/kg/hour of D5W solution for peripheral administration. 1

Standard Infusion Rates

Peripheral Administration

• The FDA-approved maximum rate is 0.5 g/kg/hour of dextrose, with approximately 95% retention when infused at 0.8 g/kg/hour 1
• Since D5W contains 5 grams of dextrose per 100 mL (50 grams per liter), this translates to 10 mL/kg/hour maximum for a typical adult to prevent glycosuria 2, 1
• For a 70 kg adult, this equals approximately 700 mL/hour maximum rate, though clinical practice typically uses much slower rates 1

Emergency Hypoglycemia Treatment

• For acute hypoglycemia, 20-50 mL of 50% dextrose (10-25 grams) should be administered as a slow IV push, with repeated doses as needed in severe cases 1
• This is a distinct indication from maintenance fluid therapy and requires immediate administration without awaiting laboratory results 1

Special Clinical Scenarios

Hypernatremic Dehydration

• D5W is the recommended fluid for hypernatremic dehydration, as it provides free water without additional sodium 3, 4
• Calculate the initial rate to avoid decreasing serum sodium by more than 8 mmol/L per day to prevent cerebral edema 3
• The administration rate should balance ongoing losses plus replacement of fluid deficit over 48-72 hours 3, 5
• For severe hypernatremia (>170 mEq/L), the water deficit should be corrected slowly over 48-72 hours using D5W 5

Central Venous Administration

• For total parenteral nutrition, 50% dextrose must be administered via central line (preferably superior vena cava) after admixture with amino acids or dilution with sterile water 1
• The same maximum dextrose administration rate of 0.5 g/kg/hour applies to prevent glycosuria 1

Critical Monitoring Requirements

During Active Resuscitation

• Monitor serum glucose hourly during acute resuscitation, then every 2-4 hours once stable 4
• Check serum sodium and osmolality frequently to ensure correction rate does not exceed 8 mEq/day for hyponatremia or 3 mOsm/kg H₂O per hour for hyperosmolar states 4
• Assess clinical status including neurological condition, fluid balance, body weight, and serum electrolytes closely 3

High-Risk Populations

• In pediatric patients under 20 years, observe particularly closely for cerebral edema during osmolality correction 4
• In geriatric patients, monitor carefully for fluid overload and pulmonary edema 4
• In patients with cardiac or renal compromise, frequent reassessment is essential to avoid iatrogenic fluid overload 4

Common Pitfalls to Avoid

• Never administer D5W rapidly in hypernatremia - too rapid correction can cause cerebral edema and neurological deterioration 3, 5
• Do not exceed 0.5 g/kg/hour dextrose without monitoring for glycosuria, as this represents the threshold for glucose spillage 1
• Avoid using D5W alone for volume resuscitation in hypovolemic shock - it lacks electrolytes and provides inadequate intravascular volume expansion 4
• In patients with diabetes or glucose metabolism disorders, the dextrose content must be factored into overall glucose management 2
• Ensure medical staff understand the specific fluid requirements in conditions like nephrogenic diabetes insipidus, where standard fluid protocols may be inappropriate 3