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.