Can a patient with potential diabetes or impaired renal function make D10 (10% Dextrose) Normal Saline Solution from D5 (5% Dextrose) Normal Saline Solution?

Can D10NSS Be Made from D5NSS?

No, a patient cannot make D10 (10% dextrose) normal saline solution from D5 (5% dextrose) normal saline solution—this requires pharmacy preparation by combining two separate IV solutions in precise proportions.

Why This Cannot Be Done at the Bedside

• D10NSS is not simply "double strength" D5NSS—it requires adding additional dextrose to achieve the higher concentration 1
• The FDA labeling for dextrose solutions specifies that concentrated dextrose solutions require proper dilution and should not be prepared without appropriate pharmaceutical protocols 1
• Standard transport equipment lists include pre-made solutions of normal saline and 5% dextrose separately, but do not include instructions for bedside mixing to create D10 solutions 2

Proper Preparation Method

• To create D10NSS, pharmacy must combine equal volumes of D20 (20% dextrose) with normal saline, or add the appropriate amount of concentrated dextrose (typically D50) to D5NSS in calculated proportions 1
• This is not a bedside nursing procedure—it requires sterile pharmaceutical compounding to ensure accurate concentration and prevent contamination 1

Clinical Context for D10 Use

• D10 normal saline provides 100 g/L of glucose compared to D5's 50 g/L, making it appropriate for persistent hypoglycemia requiring ongoing glucose supplementation 3
• When treating hypoglycemia, D10 administered in 5g (50 mL) aliquots is as effective as D50 but results in lower post-treatment glucose levels (median 6.2 mmol/L vs 9.4 mmol/L) and requires smaller total doses 4
• For patients with renal compromise requiring both glucose supplementation and volume, D10 normal saline (isotonic) maintains better hemodynamic stability than hypotonic solutions 3

Critical Safety Considerations

• Blood electrolyte monitoring is essential during prolonged use of any concentrated dextrose solution, with particular attention to potassium and phosphate deficits 1
• Blood glucose should be monitored hourly or more frequently, especially in diabetic patients or those with renal dysfunction 3, 1
• Once serum glucose reaches 250-300 mg/dL in hyperglycemic states, fluids should be changed to D5W with appropriate electrolytes to prevent complications 5

Common Pitfall to Avoid

• Never attempt to create D10 solutions by bedside mixing or improvisation—order the properly compounded solution from pharmacy 1
• Improper concentration can lead to inadequate treatment of hypoglycemia or dangerous hyperglycemia, and contamination risks are significant with non-sterile compounding 1