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 these pts (which are also receiving mannitol) get this order and the ICP starts climbing as the hours go by. People automatically assume, "He's probably herniating." But if I look on the chart and D5w is ordered, I feel it's adding to the problem and not all is lost. I think D5W should be viewed as a high-risk medication just like 3% NaCl. I would even go as far to say that D5W should only be permitted if the infusion specifically lists the number of hrs to infuse....like 3% NACL. I actually have an issue with all hypotonic fluids in neurological pts. Most neurosurgeons order hypertonic fluids to decrease the likelihood of increased cerebral edema. As soon as the Na level is elevated, that D5w order pops up. Personally, I think free H20 via a feeding tube is much more stable way of treating hypernatremia than continous intravenous infusion.