From: "Steve Harris" <sbharris@ix.RETICULATEDOBJECTcom.com> Newsgroups: sci.med.nursing,sci.med Subject: Re: ringers lactate question Date: Tue, 22 Apr 2003 18:24:02 -0700 Message-ID: <b84pvh$lbp$1@slb1.atl.mindspring.net> "Orac" <orac@mac.com> wrote in message news:orac-04F61F.20500622042003@rcache2.srv.hcvlny.cv.net... > In article <93gbav0nn030fjhgv3gtq8ol7pc2auvhh7@4ax.com>, > mapsitna@attbi.com wrote: > > > Emma Chase VanCott <7elc@qlink.queensu.ca> wrote: > > > > >I haven't heard of that. > > >How is that different than D5W? > > > > Same stuff, different concentrations. D5W = 5% dextrose, D50 = 50%. > > > > D50 is used to reverse severe hypoglycemia. It's given as an IV > > bolus, typically in 50cc ampules. One or two amps will usually > > reverse even profound hypoglycemia in minutes whereas D5W is too > > dilute to be useful in emergent situations (though I've seen it done > > in a pinch - 500cc of D5 equals the sugar of 50cc of D50). > > Of course, then one has to be careful about giving too much hypotonic > fluid. D5NS or D5-1/2NS might be a better choice "in a pinch." COMMENT D5W isn't hypotonic, it's isotonic. Yes, your body will metabolize off the glucose slowly and give free water, but then the same will happen when you drink plain water at the same rate. No difference. If you have kidneys, they know what to do with free water. There's no difference between a liter of D5W hanging in a bag going into a patient, and a liter of icewater in a pitcher on the patient's bedtable which the patient is drinking, and yet I've seen residents have a fit about one when the other doesn't bother them. It's as though they think there is something magical about the IV route of free water that causes it to send patients straight into hyponatremic delirium or something. Of course, that's a stupid way to think for any reasonable rate of IV fluid replacement. So pervasive is the prejudice against D5W as IV hydration, that I've even seen D5W/0.2NS ordered in patients who are on a low salt (1000 mg Na) diet. Here this poor patient is limited to 1 gram Na in the diet while getting 2 grams of sodium at least in the IV, just because some resident thinks that D5W will make the patient turn toes up and die. Gahh. This never fails to provoke a lection in basic mineral management and physiology from yrs truly. SBH From: "Steve Harris" <sbharris@ix.RETICULATEDOBJECTcom.com> Newsgroups: sci.med.nursing,sci.med Subject: Re: ringers lactate question Date: Wed, 23 Apr 2003 19:52:50 -0700 Message-ID: <b87jjt$6ms$1@slb5.atl.mindspring.net> " CBI" <00doc at mindspring dot com> wrote in message news:b879cr$4lh$1@slb5.atl.mindspring.net... > I would just add that the "%" refers to the meaning in chemistry - grams > per deciliter (100cc), not the percentage by weight or volume or any > other measure. > > -- > CBI, MD It's pretty close to % wt, of course. |