Does Dextrose (D-glucose) 5% infusion cause Hypocalcemia (low calcium levels)?

From the Guidelines

Dextrose 5% does not directly cause hypocalcemia, but it can contribute to a decrease in serum calcium levels through dilutional effects. When D5W is administered intravenously, it expands the intravascular volume, which can dilute the concentration of calcium in the blood, potentially leading to a transient decrease in measured serum calcium levels. This effect is generally mild and clinically insignificant in most patients with normal calcium homeostasis, as supported by the study published in Anaesthesia in 2014 1. However, patients who are already hypocalcemic or have impaired calcium regulation mechanisms may experience more noticeable effects. Additionally, the glucose in D5W can stimulate insulin release, which may cause a slight shift of calcium into cells, further contributing to lower serum calcium levels.

Key Considerations

• The study published in Critical Care in 2013 1 highlights the importance of maintaining ionised calcium levels, especially in critically ill patients, but does not directly address the effect of D5W on calcium levels.
• For patients at risk of hypocalcemia (such as those with hypoparathyroidism, vitamin D deficiency, or critical illness), clinicians should monitor calcium levels when administering large volumes of D5W and consider calcium supplementation if necessary, as suggested by the principles of calcium homeostasis discussed in the Critical Care study 1.
• In routine clinical practice with standard D5W infusions, significant hypocalcemia is rarely a concern in patients with normal calcium metabolism.

Clinical Implications

• Clinicians should be aware of the potential for dilutional effects on serum calcium levels when administering D5W, especially in patients with pre-existing calcium imbalances.
• Monitoring of calcium levels and consideration of calcium supplementation may be necessary in high-risk patients receiving large volumes of D5W.
• The use of D5W should be balanced with the potential risks and benefits, taking into account the individual patient's calcium homeostasis and overall clinical condition.

From the Research

Dextrose 5% and Hypocalcemia

• The provided studies do not directly address whether Dextrose 5% causes hypocalcemia.
• However, it is mentioned in the study 2 that 5% dextrose can be used as a vehicle for calcium gluconate infusion to treat hypocalcemia.
• Another study 3 compares the use of 5% dextrose in 0.9% normal saline with non-dextrose-containing crystalloids as the initial intravenous replacement fluid in elective surgery, but it does not discuss the relationship between Dextrose 5% and hypocalcemia.
• The other studies 4, 5, 6 focus on the treatment and management of hypocalcemia, but do not provide information on whether Dextrose 5% causes hypocalcemia.

Treatment of Hypocalcemia

• According to the study 2, severe hypocalcemia can be treated with intravenous calcium gluconate, and 5% dextrose can be used as a vehicle for the infusion.
• The study 5 discusses the optimization of infusional calcium gluconate for preventing hypocalcemic reactions during therapeutic plasma exchange.
• The study 6 provides an overview of hypocalcemic disorders, including their symptoms, diagnosis, and treatment options.
• The study 4 discusses the use of calcium salts, including calcium gluconate, in the treatment of hypocalcemia.