D5 water and Cerebral Edema - page 2

What is your opinion or reaction when pt's with CHI, cerebral edema, and ICP monitoring are ordered D5 water for hypernatremia? I hate it when D5W is ordered to fix hypernatremia. We have all seen... Read More

  1. by   PMFB-RN
    Is this a trick question? Patients with cerebral edema would of course never have D5W ordered or running.
  2. by   turnforthenurse
    Quote from cardiacrocks
    I am not an ICU nurse, I do work on a specialty cardiac floor. I was wondering and I know this isn't your question, but how often are you checking blood sugars when someone is on dextrose IV? I know DI is not DM, but what if the person has DM, even if they don't it can increase blood sugar then you have a whole new range of issues as well. I was just wondering.
    Blood sugar frequency would depend on the physician. Typically with a dextrose IV we don't check blood sugars any more often than the routine AC&HS checks...if the patient is on TPN, we typically check Q6H or Q4H, depending on the physician's preference. If a patient is NPO and on a tube feed, we typically check Q4H. Once again, it depends on the physician.
  3. by   turnforthenurse
    Quote from PMFB-RN
    Is this a trick question? Patients with cerebral edema would of course never have D5W ordered or running.
    I'm not a neuro ICU nurse, but this was my thought exactly...because infusing a hypotonic solution too rapidly could worsen cerebral edema, just like how infusing a hypertonic solution too rapidly can lead to cerebral dehydration.
  4. by   hodgieRN
    Quote from cardiacrocks
    I am not an ICU nurse, I do work on a specialty cardiac floor. I was wondering and I know this isn't your question, but how often are you checking blood sugars when someone is on dextrose IV? I know DI is not DM, but what if the person has DM, even if they don't it can increase blood sugar then you have a whole new range of issues as well. I was just wondering.
    Almost all of them are on insulin gtts, which means they are getting Accuchecks every hr. And some of these pts are getting a lot of insulin!
  5. by   hodgieRN
    Thank you for the response concerning free water vs d5w, especially those who said D5w water is never used or free water via the gut was always used. I was being curious. When my parents tried to explain something to me as a kid, my response was always "why, why, why." I just thought about the fact that the hypotonic fluid orders are definitely initiated for pt's undergoing organ donation, but sometimes I feel like there is a vague area with pt's that simply have a severe brain injury. And by SBI, I mean a pt who is not brain dead, but might be considered a candidate. Almost as if the order might be a little premature by changing to IV fluid in pt's who still have somewhat of a chance. When someone is really sick, I feel like there is something I can change...even if it won't impact the big picture. In general, I always have these micromanaging hypotheticals that buzz around my mind. That maybe I can consider or carryout a small, tiny detail that might stabilize a situation. I like to believe that if I get a pt who has an ICP of 26 during shift change, I will be able to stabilize it at 15 when I leave. If one detail seems hopeless, I feel I have to fix it or get it as close to normal as I can. So, this post was about picking your thought processes. The little things that you guys may consider when facing a treatment for one thing that could negatively affect another.
  6. by   IckuRN
    I have never heard of D5W /c CHI. I guess I have never given water boluses OG while the ICP was still an issue either. And I am a bit shocked anyone but NeuroSx is allowed to come near the chart, much less change IVF's! I orient this week into a new facility, so I will see if they are any different.
    TY for sharing!
  7. by   prep8611
    Jefferson hospital's neuro icu doesn't even carry fluids with dextrose on the floor.

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