Total Daily Carbohydrate Intake from D5 at 55 mL/hour
A patient receiving D5 (5% dextrose) IV fluids at 55 mL per hour will receive approximately 66 grams of carbohydrates in 24 hours.
Calculation
- D5 contains 5 grams of dextrose per 100 mL 1
- At 55 mL/hour × 24 hours = 1,320 mL total daily volume
- Total carbohydrates: (1,320 mL ÷ 100 mL) × 5 grams = 66 grams per day
Clinical Context and Adequacy
This carbohydrate delivery is insufficient as sole nutritional support and represents only partial glucose provision. The 66 grams of carbohydrates provides approximately 264 kcal of energy (at 4 kcal/gram), which falls far short of adequate nutritional requirements 1.
Comparison to Recommended Carbohydrate Intake
- Critically ill patients should receive 200-300 grams of dextrose per day as part of their nutritional regimen 1
- Standard parenteral nutrition recommends approximately 3.0-3.5 g/kg body weight/day of glucose, which equals 210-245 grams for a 70 kg patient 2
- The D5 infusion at 55 mL/hr provides only 27-31% of recommended carbohydrate intake for a typical adult 1
When This Rate is Appropriate
This limited carbohydrate delivery may be appropriate in specific clinical scenarios:
- Acute illness management: During acute illness in diabetic patients, ingestion of 150-200 grams of carbohydrate daily (along with medication adjustments) is recommended to prevent starvation ketosis 3
- Clear/full liquid diets: Hospitalized patients on liquid diets should receive 200 grams of carbohydrate per day in equally divided amounts; liquids should not be sugar-free as patients require carbohydrate and calories 3
- Temporary glucose provision: D5 at this rate may serve as a bridge while awaiting enteral nutrition initiation 1
- Prevention of starvation ketosis: In settings of prolonged fasting, glucose-containing IV fluids provide safety benefits to mitigate ketone generation 4
Important Clinical Caveats
Blood glucose monitoring is essential when administering dextrose-containing fluids to avoid both hypoglycemia and hyperglycemia 1. The maximum rate at which dextrose can be infused without producing glycosuria is 0.5 g/kg body weight/hour, with about 95% retention at 0.8 g/kg/hr 5.
For patients with diabetes or hyperglycemia risk (critically ill, sepsis, steroid therapy), an initial carbohydrate infusion rate of 1-2 g/kg body weight/day is recommended, with close glucose monitoring 2. The 66 grams provided by D5 at 55 mL/hr falls within this conservative range for a 33-66 kg patient.
This rate should not be considered adequate sole nutrition. If the patient cannot eat for more than 12 hours, short-term glucose provision of 2-3 g/kg/day should be considered, which would require higher infusion rates or more concentrated dextrose solutions 1. Additionally, thiamine should be administered prior to starting glucose infusion to reduce the risk of Wernicke's encephalopathy when using dextrose as part of nutritional support 1.