COPD management

nurseprnRN, BSN, RN · Sep 14, 2013

A liter of D5W has about 200 calories in it (do the math-- how many gm of sugar in a liter make a 5% solution, and how many calories are there per gram of sugar?), and at that rate the person would get all of 600 calories for a 24 hour period. So no, D5W is not given for its calories.

I can't think of one unless this person has a serious water deficit, as evidenced by a very elevated serum sodium, and even at that, this is a helluva lot of water to be pouring into someone. What else do you know about this patient?

Clroys · Sep 14, 2013

The question came from a case study so they didn't give me much to go by. The patient came in for a respiratory infection. He is a 2 pack-a-day smoker with a Hx of COPD. Currently he has sortness of breath accompanied by coughing and thick, yellow mucous. BP 150/80, resp 32, temp 100.6f. Dr has ordered Rocephin, IV D5W, Theodur, Albuterol via nebulizer, O2 2L/min, Prednisone, Guaifenesin, and Proventil.

I know what all of the other meds are for, but I'm not understanding the D5W. I know its only 600 calories in a 24hr period, but COPD patients need a high intake of calories and protein. My rational was that he must need the extra calories from the D5W added on to his regular diet.

StudentOfHealing · Sep 14, 2013

What is the route for Rocephin ...??? Rocephin is a abx, maybe its being given IVPB and it goes with the D5.

I'm probably wrong... Hehe idk.

Just a guess.

akulahawkRN, ADN, RN, EMT-P · Sep 14, 2013

I'm just going to guess, but perhaps the doc wants to get some free water onboard to do some rehydration and also to push some fluid into the lungs to help with thinning the secretions. Perhaps the patient is quite dry, therefore having extra-thick secretions in the lungs. Just a wild guess... and I could be WAY off the mark on this one.

Esme12, ASN, BSN, RN · Sep 14, 2013

These patients tend to be very hemo-concentrated and have a large loss with the typical tachypnea. They also have extra energy losses with the use of accessory muscles. However these patients run low NA levels due to some of the meds they take.

without knowing other labs it is impossible to say why D5W was chosen...but hydration and work load needing extra caloric support would be the best educated guess.

nurseprnRN, BSN, RN · Sep 16, 2013

The question came from a case study so they didn't give me much to go by. The patient came in for a respiratory infection. He is a 2 pack-a-day smoker with a Hx of COPD. Currently he has sortness of breath accompanied by coughing and thick, yellow mucous. BP 150/80, resp 32, temp 100.6f. Dr has ordered Rocephin, IV D5W, Theodur, Albuterol via nebulizer, O2 2L/min, Prednisone, Guaifenesin, and Proventil.
I know what all of the other meds are for, but I'm not understanding the D5W. I know its only 600 calories in a 24hr period, but COPD patients need a high intake of calories and protein. My rational was that he must need the extra calories from the D5W added on to his regular diet.

Well, alas, I'm not understanding it either, since this is basically water given IV and enough to disrupt the serum sodium, which does nobody any good. Not enough calories to count for doodly, either. I mean, give the man a cup of good ice cream at snack and that's 600 calories, and it's nicer. :)

If you get an answer from your faculty I'd be interested to hear it. Perhaps they're thinking that better hydration would loosen his secretions (BTW, "mucous" is the adjective; "mucus" is the noun. And "rationale" is the noun; "rational" is the adjective). But D5W is wrong for that too. A puzzlement.