How to Prepare 5% Dextrose in Normal Saline
To prepare 5% dextrose in normal saline (D5NS), you cannot simply mix commercially available solutions—this is a premixed formulation that must be obtained as a manufactured product from pharmacy suppliers, as it requires precise pharmaceutical compounding to achieve the exact 5% dextrose concentration in 0.9% sodium chloride.
Why Manual Mixing Is Not Appropriate
- Attempting to combine D5W (5% dextrose in water) with normal saline will not yield D5NS, as this would dilute the dextrose concentration below 5% and alter the sodium chloride concentration 1
- The final osmolality and electrolyte composition would be unpredictable and potentially harmful if prepared by bedside mixing 1
Obtaining D5NS for Clinical Use
- D5NS must be ordered as a premixed solution from the pharmacy, where it is manufactured under sterile conditions with precise concentrations of both dextrose (50 grams/L) and sodium chloride (0.9%) 2
- This solution is commercially available in standard IV bags (typically 250 mL, 500 mL, or 1000 mL volumes) from pharmaceutical manufacturers 3
Storage and Stability Considerations
- D5NS should be stored in glass containers when possible, or used within 6 hours if stored in polyvinyl chloride (PVC) bags, due to potential plasticizer leaching 3
- The solution remains stable for 24 hours in glass containers at room temperature 3
- When used as a vehicle for medication infusions, the compatibility of specific drugs with D5NS must be verified, as some medications require specific diluents 3, 4
Clinical Context for D5NS Use
- D5NS is commonly used for maintenance fluid therapy and as a vehicle for certain medication infusions 2
- For amphotericin B deoxycholate specifically, the drug should be reconstituted in 5% dextrose (not D5NS), with normal saline administered separately before and after infusion to prevent nephrotoxicity 2
- D5NS should not be used for acute volume resuscitation, as the dextrose component provides minimal intravascular volume expansion once metabolized 5, 6
Critical Safety Points
- Never attempt bedside preparation of D5NS by mixing separate solutions—this creates risk for dosing errors and contamination 1
- Verify the specific clinical indication, as many situations requiring "dextrose and saline" actually call for separate administration of D5W and normal saline rather than the combined D5NS formulation 2
- Monitor blood glucose when administering any dextrose-containing solution, as even 500 mL of D5NS can cause transient hyperglycemia (>10 mmol/L in 72% of patients) 6