D5W — 5% Dextrose in Water

• Core dose: Not a medication with fixed "dose"; infusion rate depends on indication (e.g., hypernatremia correction: calculate free-water deficit and replace gradually; DKA: switch when glucose ~200–250 mg/dL)
• Onset/duration: Dextrose rapidly metabolized by cells; water distributes across total body water compartments; ongoing effects depend on fluid-electrolyte balance
• Key danger: Hyponatremia risk (provides free water without sodium); hyperglycemia in non-DKA patients; NOT for volume resuscitation (minimal sustained intravascular expansion); avoid in TBI/elevated ICP
• Special: Isotonic in bag (~252 mOsm/L) but becomes hypotonic after dextrose metabolism → free water; contains NO electrolytes; provides ~170 kcal/L; used for hypernatremia correction, medication carrier, or maintaining glucose in DKA

Carbohydrate solution / hypotonic free-water source (physiologically hypotonic after metabolism)

Mechanism of Action (Pharmacodynamics):

• Provides free water after rapid cellular uptake and metabolism of dextrose to CO₂ and H₂O (insulin-mediated)
• Lowers serum tonicity and expands total body water with minimal sustained intravascular volume effect
• Supplies 170 kcal/L of carbohydrate energy

Disposition (Pharmacokinetics/Physiology):

• Dextrose is transported into cells (insulin-dependent in many tissues) and metabolized
• The administered water distributes across total body water compartments
• No discrete drug half-life; clinical effects depend on ongoing electrolyte/solute and water balance

• Hypernatremia: Free-water replacement when enteral water is not feasible or insufficient
• Over-correction of chronic hyponatremia: Re-lowering Na⁺ with D5W (often combined with desmopressin)
• Diabetic ketoacidosis (DKA) / HHS: Add dextrose to IV fluids once serum glucose reaches ~200–250 mg/dL to allow ongoing insulin while avoiding hypoglycemia (typically D5 in a sodium-containing solution)
• Medication carrier: For compatible drugs when a non-sodium diluent is desired; parenteral nutrition base component (not a complete PN)

Contraindications:

• Acute symptomatic hyponatremia or high risk of hyponatremia (SIADH, postop pediatrics, CNS disease) — D5W can worsen hyponatremia
• Elevated intracranial pressure, acute ischemic stroke, or TBI — avoid hypotonic fluids; use isotonic or hypertonic solutions per protocol
• Uncontrolled hyperglycemia or hyperosmolar states prior to insulin initiation — dextrose can exacerbate hyperglycemia

Cautions:

• Fluid-sensitive states (HF, cirrhosis, renal failure) — risk of volume overload

Metabolic:

• Hyperglycemia
• Hypokalemia (insulin-mediated intracellular shift)
• Hyponatremia (water gain)
• Hyperosmolarity if excessive

Volume:

• Peripheral/pulmonary edema in susceptible patients

Local IV:

• Phlebitis
• Infiltration
• Infection risk relates to IV access/device

Insulin:

• Facilitates dextrose uptake; anticipate K⁺ shifts and glucose reductions
• Monitor closely in DKA/HHS

Blood Products:

• Do NOT Y-site with PRBCs or blood components (hemolysis/pseudoagglutination risk)

Phenytoin (Parenteral):

• Incompatible with dextrose solutions (precipitation)
• Use 0.9% NaCl or LR as diluent when appropriate and per labeling

Parenteral Nutrition:

• Complex admixture — follow institutional compatibility policies
• Verify Y-site stability for any co-infused medication

Frequent Labs:

• Serum sodium every 2–6 h during active (re)correction
• Serum glucose at least hourly in insulin-treated patients
• Serum osmolality as indicated

Electrolytes:

• K⁺, Cl⁻, bicarbonate/base excess
• Renal function and urine output

Neurologic Exam:

• During dysnatremia therapy (headache, confusion, seizure)
• Watch for overly rapid Na⁺ shifts

• Generic/Official: Dextrose Injection, USP (5%)
• Common Names: D5W, D5, 5% dextrose in water

• May be given via peripheral IV (osmolarity ~250 mOsm/L)
• Use pumps for controlled correction in dysnatremias
• Do NOT administer simultaneously with blood products through the same tubing (hemolysis/pseudoagglutination)
• Avoid as diluent for phenytoin (precipitation) and other known incompatible drugs; confirm Y-site/admixture compatibility

Adults:

• Hypernatremia: Calculate free-water deficit and replace gradually with D5W (and/or enteral water). Typical safe correction limits: ≤10–12 mEq/L/24 h (≤8 mEq/L/24 h in high-risk)
• Hyponatremia over-correction: D5W infusion titrated with desmopressin to re-lower to a safe trajectory ("DDAVP clamp")
• DKA/HHS: Once glucose ≤200–250 mg/dL, add dextrose to fluids (e.g., D5-0.45% NaCl at 150–250 mL/h) to maintain glucose 150–200 mg/dL while continuing insulin
• Maintenance (select cases): Avoid as sole maintenance in most adults due to hyponatremia risk; prefer isotonic maintenance unless a specific free-water indication exists

Pediatrics:

• AAP guideline: Isotonic solutions with dextrose and K⁺ are preferred for maintenance; avoid hypotonic maintenance fluids in most children
• D5W is reserved for targeted free-water therapy (e.g., hypernatremia correction) with frequent sodium/glucose monitoring
• Bolus therapy for shock/dehydration: Should be isotonic (LR/0.9% NaCl); do NOT use D5W boluses

• DailyMed. (2024–2025). Dextrose Injection, USP (5%) — Prescribing information: composition, pH, osmolarity. https://dailymed.nlm.nih.gov/
• Umpierrez, G. E., et al. (2024). Hyperglycemic crises in adults with diabetes: A consensus report. Diabetes Care, 47(8), 1257–1283. https://doi.org/10.2337/dci24-0016
• American Diabetes Association. (2025). Diabetes care in the hospital (Standards of Care in Diabetes—2025). Diabetes Care, 48(Suppl 1), S321–S338.
• Feld, L. G., et al. (2018). Maintenance IV fluids in children (AAP guideline). Pediatrics, 142(6), e20183083.
• Medscape. (2024). Hypernatremia: Treatment & Management; DKA: Treatment & Management.
• FDA label. (2025). Dextrose Injection (5%) — Administration and transfusion precautions (no blood co-infusion).
• Keir, A. K., et al. (2014). Coinfusion of dextrose-containing fluids and RBCs: in-vitro effects. Transfusion, 54(9), 2386–2394.
• Suzuki, R., et al. (2023). Enteral free water vs. parenteral D5W for ICU hypernatremia. JPEN, 47(8), 1736–1744.