What is a safe infusion rate for D5W (Dextrose 5% in Water) to maintain stable glucose levels?

Safe D5W Infusion Rate for Glucose Maintenance

For stable glucose maintenance in adults, infuse D5W at 100 mL/hour, which delivers approximately 5 grams of dextrose per hour and prevents both hypoglycemia and hyperglycemia in most patients. 1

Standard Maintenance Protocol

• The recommended rate is 100 mL/hour for an average 70 kg adult, calculated as 100 mL/kg per 24 hours 1
• This rate aligns with the FDA-approved maximum infusion rate of 0.5 g/kg/hour of dextrose to prevent glycosuria 2
• At 100 mL/hour, approximately 95% of infused dextrose is retained when the rate does not exceed 0.8 g/kg/hour 2

Critical Monitoring Requirements

• Check blood glucose every 1-2 hours when initiating D5W infusions to verify the rate is appropriate for the individual patient 1
• This frequent monitoring is essential because glucose metabolism varies significantly between patients based on insulin sensitivity, stress response, and underlying conditions 1

Rate Adjustments Based on Clinical Context

For Hypoglycemia Prevention

• After correcting acute hypoglycemia with bolus dextrose, maintain D5W at 100 mL/hour to prevent recurrence 1
• This continuous infusion provides steady glucose delivery without causing rebound hyperglycemia 1

For Diabetic Ketoacidosis

• Switch to D5W-containing fluids at 4-14 mL/kg/hour (approximately 280-980 mL/hour for 70 kg adult) once serum glucose reaches 200-250 mg/dL 1
• This higher rate maintains glucose in target range while continuing insulin therapy to resolve ketoacidosis 1
• The wide range allows titration based on ongoing insulin requirements and glucose trends 1

For Adrenal Insufficiency

• Give initial bolus of 20 mL/kg D5NS over the first hour, then reduce to maintenance of 100-150 mL/hour 1
• The higher initial rate addresses both volume depletion and glucose needs in cortisol-deficient states 3

Special Population Considerations

Cardiac or Renal Compromise

• Limit D5W to ≤100 mL/hour and monitor closely for fluid overload 1
• These patients cannot tolerate volume expansion and require careful input/output monitoring 3
• Watch for signs of pulmonary edema, peripheral edema, and worsening renal function 3

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
• This translates to approximately 4 mL/kg/hour for infants and young children 3

Common Pitfalls to Avoid

• Do not exceed 100 mL/hour in stable patients without specific indication, as this increases risk of hyperglycemia and glycosuria 2
• Avoid reflexively increasing the rate if glucose is slightly low (60-80 mg/dL); instead give a small bolus of concentrated dextrose and continue maintenance rate 4
• Do not use D5W as the sole fluid replacement in hypovolemic patients; it provides inadequate sodium and volume expansion 3
• Remember that D5W becomes hypotonic once dextrose is metabolized, making it inappropriate for resuscitation 3

When to Escalate Beyond Standard Rate

If blood glucose drops below 70 mg/dL despite 100 mL/hour D5W:

• First give 5-10 gram bolus of concentrated dextrose (D50 or D25) 4
• Then increase D5W rate to 150-200 mL/hour temporarily 1
• Recheck glucose in 15 minutes and adjust accordingly 4
• Investigate underlying cause (excess insulin, sepsis, adrenal insufficiency, liver failure) 1