D5 water and Cerebral Edema - page 2

by hodgieRN

15,865 Views | 19 Comments

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... Read More


  1. 1
    Seems like a good solution is frequent enough lyte labs to titrate hypertonic drips to prevent "overshooting?"
    ~*Stargazer*~ likes this.
  2. 2
    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.

    One liter of D5W contains approximately 200 calories, less than a glass of whole milk. Does that help?
  3. 0
    Quote from CPhT2RNstudent
    Both of the trauma I Neuro ICU's I have worked at do not use D5W. We use H2O in the gut. Different facilities have different protocols, but the ones I have worked at view dextrose fluids in a negative light when it comes to neuro pt's.
    Same with the neuro ICU I worked. Rarely did we use D5W for lowering sodium. We used water flushes down the peg/NG for lowering sodium.
  4. 0
    Is this a trick question? Patients with cerebral edema would of course never have D5W ordered or running.
  5. 0
    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.
  6. 0
    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.
  7. 0
    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!
  8. 0
    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.
  9. 0
    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!
  10. 2
    Jefferson hospital's neuro icu doesn't even carry fluids with dextrose on the floor.
    IckuRN and PMFB-RN like this.


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