What are the contents and uses of D5 (Dextrose 5%) IV solution?

D5 (Dextrose 5%) IV Solution: Composition and Clinical Uses

Composition

D5 solutions contain 5 grams of dextrose per 100 mL (50 grams per liter), and can be combined with various electrolyte solutions to create different formulations with distinct clinical applications. 1

Common D5 Formulations

• D5 in water (D5W): Contains only 5% dextrose with no electrolytes, providing essentially no renal osmotic load once dextrose is metabolized 2

• D5 in 0.9% normal saline (D5NS): Contains 50 grams dextrose plus 154 mEq/L sodium and 154 mEq/L chloride, with osmolarity of 308 mOsm/L 3

• D5 in 0.45% normal saline (D5 1/2NS): Contains 50 grams dextrose plus 77 mEq/L sodium and 77 mEq/L chloride, with osmolarity of 154 mOsm/L 3

• D5 in 0.2% normal saline: Contains 50 grams dextrose plus 34 mEq/L sodium and 34 mEq/L chloride, with osmolarity of 78 mOsm/L 3

• D5 lactated Ringer's: Contains 50 grams dextrose plus 130 mEq/L sodium, 109 mEq/L chloride, 4 mEq/L potassium, 3 mEq/L calcium, and 28 mEq/L lactate as buffer, with osmolarity of 273 mOsm/L 3

Primary Clinical Uses

Diabetic Ketoacidosis (DKA)

Switch from normal saline to D5 1/2NS or D5 0.45-0.75% saline when serum glucose reaches 250 mg/dL during DKA treatment to prevent hypoglycemia while continuing insulin therapy to clear ketoacidosis. 2

• This prevents hypoglycemia while allowing continued insulin administration to resolve ketoacidosis 2
• Requires hourly glucose monitoring during acute resuscitation, then every 2-4 hours once stable 2

Hypernatremic Dehydration

D5W (dextrose 5% in water) is the preferred solution for hypernatremic dehydration because it provides free water without adding sodium, allowing controlled decrease in plasma osmolality. 2

• The dextrose is rapidly metabolized, leaving essentially free water to correct the hypernatremia 2
• Correction rate must not exceed 8 mEq/day for hyponatremia or 3 mOsm/kg H₂O per hour for hyperosmolar states to prevent cerebral edema 2
• Critical caveat: D5W should never be administered as a bolus due to risk of rapid sodium decrease and brain edema 3

Pediatric Maintenance Fluids

For pediatric patients unable to take oral intake who require maintenance fluids, D5 1/2NS is appropriate after initial volume expansion, particularly when serum sodium is normal or elevated. 2

• Infusion rate typically 1.5 times the 24-hour maintenance requirements 2
• For infants at risk for hypoglycemia, D10 normal saline may be needed to meet glucose requirements of 4-6 mg/kg/min 2
• Pediatric patients under 20 years require particularly close observation for cerebral edema during osmolality correction 2

Fasting Patients Unable to Self-Regulate Intake

For patients who cannot self-regulate fluid intake and must fast for >4 hours, D5W at usual maintenance rate is reasonable, providing no renal osmotic load and typically decreasing urine volume considerably. 2

• Regular blood glucose monitoring is essential as glucose infusion can lead to hyperglycemia with subsequent osmotic diuresis 2
• Pediatric patients unable to take oral intake should receive 2-3 L/m²/d of one quarter normal saline/5% dextrose 2

Acute Hypoglycemia Management

For acute hypoglycemia, administer 0.5-1.0 g/kg of glucose, which requires 2-4 mL/kg of D25W or can be given as D10 or D25 solution slowly. 4

• Blood glucose levels must be monitored when using any dextrose-containing solution, especially in diabetic patients 4
• IV site requires continuous monitoring during administration for signs of infiltration 4

Geriatric Dehydration

Subcutaneous rehydration with D5 solutions (such as half-normal saline-glucose 5% or 5% dextrose with 4 g/L NaCl) can be used effectively in elderly patients with similar rates of adverse effects to intravenous infusion. 2, 5

• Geriatric patients require careful monitoring for fluid overload to minimize risk of pulmonary edema 2

Critical Contraindications and Pitfalls

Neurosurgical and Traumatic Brain Injury Patients

Hypotonic dextrose-containing solutions are absolutely contraindicated in neurosurgical patients and traumatic brain injury patients due to risk of cerebral edema. 2

• 0.9% saline is the recommended first-line therapy for traumatic brain injury, not dextrose-containing solutions 2
• Maintaining normal plasma osmolarity is crucial in neurosurgical patients 2

Hyponatremia Risk

D5-containing hypotonic fluids (D5W, D5 1/4NS, D5 1/2NS) can contribute to hyponatremia and cerebral edema in vulnerable populations, particularly in patients with syndrome of inappropriate antidiuresis (SIAD). 3, 2

• Hyponatremic encephalopathy is a medical emergency that can be fatal or lead to irreversible brain injury if inadequately treated 3
• Nonosmotic stimuli of AVP release include pain, nausea, stress, postoperative state, hypovolemia, medications, pneumonia, and meningitis 3

Fluid Overload Monitoring

Patients with cardiac or renal compromise require frequent assessment of cardiac, renal, and mental status during fluid resuscitation with D5-containing solutions to minimize risk of fluid overload and pulmonary edema. 2, 4

Special Clinical Scenarios

Nephrogenic Diabetes Insipidus

In hospitalized patients with nephrogenic diabetes insipidus, D5W matches the hypotonic urinary losses (very low sodium concentration) and should not be administered as a bolus. 3

• Isotonic fluids are appropriate only for acute fluid resuscitation in hypovolemic shock, which is exceedingly rare in NDI patients 3
• Following isotonic fluid administration, sufficient free water must be provided to allow excretion of the renal osmotic load 3

Continuous Renal Replacement Therapy (CRRT)

D5W can be infused prefilter in patients receiving CRRT to prevent overcorrection of severe hyponatremia, with calculated amounts ensuring sodium correction does not exceed 8 mEq/day. 6

• This prevents osmotic demyelination syndrome while delivering recommended effluent volume of at least 20-25 mL/kg/hr 6

Medication Vehicle

D5 normal saline is commonly used as a vehicle for medication administration, including vasopressors, but the dextrose content must be considered in patients with diabetes or glucose metabolism disorders. 1