From the Guidelines
D5W (5% Dextrose in Water) is used for hypernatremia, particularly in cases where patients are unable to maintain adequate fluid intake, such as vomiting or diarrhea, and oral rehydration has failed 1.
Key Considerations
- The use of D5W in hypernatremia is recommended because it delivers no renal osmotic load, which reduces the risk of worsening hypernatremia 1.
- The initial rate of fluid administration should be calculated based on physiological demand, with a routine maintenance rate of 100 ml/kg/24 h for the first 10 kg in children, 50 ml/kg/24 h for 10-20 kg, and 20 ml/kg/24 h for the remaining weight, and 25-30 ml/kg/24 h in adults 1.
- The goal of treatment is to slowly decrease plasma osmolality, with a target decrease in serum sodium levels of no more than 1-2 mEq/L/hour to avoid cerebral edema.
Administration Guidelines
- D5W should be administered intravenously, with the rate adjusted based on the patient's serum sodium levels and clinical response 1.
- Salt-containing solutions, such as NaCl 0.9%, should be avoided due to their high renal osmotic load, which can exacerbate hypernatremia 1.
From the Research
Use of D5W in Hypernatremia
- D5W (5% Dextrose in Water) is used to treat hypernatremia, as evidenced by a study published in 2023 2, which compared the effectiveness of enteral free water vs. parenteral D5W in treating ICU-acquired hypernatremia.
- The study found that both enteral free water and parenteral D5W are effective for treating ICU-acquired hypernatremia, with parenteral D5W being slightly more effective than enteral free water in lowering serum sodium levels 2.
- Another study published in 1972 3 mentioned that 5% dextrose in water solutions can be used to treat hypernatremia by forcing fluids either by mouth or intravenously.
- However, it is worth noting that D5W is not typically used as a first-line treatment for hypernatremia, and its use may depend on the specific clinical context and the patient's individual needs.
Mechanism of Action
- The mechanism of action of D5W in treating hypernatremia is related to its ability to provide free water and help lower serum sodium levels 2, 3.
- D5W can help to dilute the sodium in the blood and increase the amount of water in the body, which can help to correct hypernatremia.
Comparison with Other Treatments
- A study published in 2023 2 compared the effectiveness of enteral free water vs. parenteral D5W in treating ICU-acquired hypernatremia and found that both treatments are effective, with parenteral D5W being slightly more effective.
- Another study published in 2014 4 suggested that dissolving drugs in dextrose 5% may partially prevent potentially harmful sodium overloading and hypernatremia.