D5LRS Use in a 2-Month-Old Infant
Yes, D5LRS (5% dextrose in lactated Ringer's solution) can be safely used in a 2-month-old infant for maintenance IV fluids or resuscitation, provided the infant does not have severe head trauma or traumatic brain injury. 1, 2
Primary Recommendation for Pediatric IV Fluids
The American Academy of Pediatrics recommends isotonic solutions with appropriate dextrose (2.5-5%) and potassium chloride as the standard approach for pediatric patients 28 days to 18 years requiring maintenance IV fluids. 1
Either normal saline or balanced crystalloids like Ringer's lactate are acceptable isotonic options, with sodium concentrations ranging from 130-154 mEq/L. 1
D5LRS combines the benefits of a balanced crystalloid (lactated Ringer's) with appropriate dextrose concentration (5%), making it suitable for maintenance fluids in infants. 1, 3
Clinical Evidence Supporting D5LRS in Infants
Clinical trials assessing Ringer-lactate solution with 0.9-1% dextrose in pediatric patients suggest it is appropriate for routine infusion during the perioperative period. 3
Research in infants undergoing cardiac surgery demonstrated that lactated Ringer's with 5% dextrose (D5RL) maintains appropriate glucose levels without causing clinically significant hyperglycemia. 4
Studies confirm that lactated Ringer's solution infusion does not falsely increase circulating lactate concentrations when administered at resuscitation rates, making it safe for clinical use. 5
Critical Contraindications to Avoid
Never use D5LRS in infants with severe head trauma or traumatic brain injury. Lactated Ringer's has an osmolarity of 273-277 mOsm/L, making it slightly hypotonic compared to plasma (275-295 mOsm/L), which can worsen cerebral edema. 2
In cases of severe TBI, use 0.9% saline with dextrose instead, as it is isotonic with an osmolarity of 308 mOsm/L. 2
Avoid D5LRS in suspected or proven rhabdomyolysis or crush syndrome due to the potassium content (4 mmol/L) in lactated Ringer's. 2
Advantages of D5LRS Over Alternatives
Balanced electrolyte composition: D5LRS provides sodium (130 mmol/L), potassium (4 mmol/L), chloride (108 mmol/L), calcium (0.9 mmol/L), and lactate (27.6 mmol/L), which more closely resembles plasma than normal saline. 2
Prevents hyperchloremic acidosis: Unlike large volumes of 0.9% saline, D5LRS avoids the risk of hyperchloremic metabolic acidosis. 2
Appropriate dextrose concentration: The 5% dextrose prevents hypoglycemia in fasting infants while avoiding excessive hyperglycemia. 3, 4
Clinical Algorithm for Fluid Selection in 2-Month-Old Infants
Step 1: Assess for contraindications
- Check for severe head trauma, TBI, or increased intracranial pressure → If present, use D5 normal saline instead. 2
- Check for rhabdomyolysis or crush syndrome → If present, use dextrose in normal saline. 2
Step 2: Determine clinical scenario
- For maintenance fluids: D5LRS is appropriate and recommended. 1, 3
- For severe dehydration/resuscitation: Use isotonic crystalloid boluses (20 mL/kg) of lactated Ringer's or normal saline until circulation normalizes, then transition to D5LRS for maintenance. 6, 1
Step 3: Monitor appropriately
- Monitor blood glucose levels, especially in the first few hours of administration. 4, 7
- Monitor electrolytes, particularly sodium, to prevent hyponatremia. 1
Common Pitfalls to Avoid
Never use hypotonic solutions (sodium <130 mEq/L) for maintenance IV fluids in hospitalized infants, as they significantly increase hyponatremia risk (number needed to harm = 7.5). 1
Do not withhold dextrose from maintenance fluids in fasting infants, as this exposes them to hypoglycemia risk without preventing hyperglycemia during stress responses. 4
Always add appropriate potassium chloride to maintenance fluids (typically 20 mEq/L) unless contraindicated by hyperkalemia or renal failure. 6, 1