5% dextrose in 1/2 NS?

I don't understand this. I know of 5DW and 1/2 NS but combining them together? Would this be isotonic, hyper/hypotonic? Can somebody help me figure this out?

15 Answers

Specializes in med/surg, telemetry, IV therapy, mgmt.

This is a standard IV solution. I'm thinking that what may be confusing you is the way it is written. It is written a number of different ways:

  • D5 1/2 NS
  • D5/0.45 NS
  • Dextrose 5% in 0.45% Normal Saline
  • Dextrose 5% in 1/2 Normal Saline
  • 5% Dextrose in 0.45% Normal Saline
  • 5% Dextrose in 1/2 Normal Saline

It is a hypertonic solution. A hypertonic solution is one that has an osmolality greater than 340 mOsm/kg. Hypertonic solutions exert more osmotic pressure than the extracellular fluid so when these solutions are infused, fluid gets pulled into the vascular system. You want to monitor patients receiving any hypertonic solutions for fluid overload, particularly if they are being given at a rapid rate of infusion.

The osmolality of 5DW and 1/2 NS is 405 m/Osm/liter and it's pH is about 4.4. It contains 50 grams of dextrose and 77 mEq of sodium and 77 mEq of chloride. The remainder is just sterile water.

Specializes in med/surg, telemetry, IV therapy, mgmt.
l.a.m.b said:
Love your answer. Can you explain to me how hypotonic fluids work and LR?

Hypotonic solutions have an osmolality of less than 240 mOsm/liter. They exert less osmotic pressure than the fluid in the extracellular compartment which allows water to be drawn from the extracellular fluid. Blood cells will draw these solutions into them causing the blood cells to swell and burst.

There is only one hypotonic solution in common use and that is 0.45% sodium chloride (1/2 Normal Saline). It has an osmolality of 155, a pH of 5.6, and contains 77 mEq of sodium and 77 mEq of chloride.

Continuous infusion can cause dilution and depletion of electrolytes because of the small amount of sodium in this particular mixture resulting in hyponatremia. Because there are no calories in the solution, the patient is going to become calorie depleted as well if it is infused for a long period. Isn't it interesting that adding 5% Dextrose to it to make 5% Dextrose in 0.45% Normal Saline makes it a hypertonic solution?

Lactated Ringers solution has an osmolarity of 275 mOsm/liter and a pH of 6.6. It contains 130 mEq of sodium, 4 mEq of potassium, 3 mEq of calcium, 109 mEq of chloride, and 28 grams of lactate. It is an Isotonic solution.

It is also called Hartmann's solution.

It is primarily used to treat hypovolemia and when the patient's oral intake is limited, absent or fluid losses are very high. It does not, however, supply enough electrolytes for maintenance and does not contain any magnesium. The lactate is a buffer that when metabolized produces bicarbonate.

Complications connected with the infusion of LR (Lactated Ringers) are overhydration, electrolyte excess (particularly sodium), electrolyte dilution, and calorie depletion. Patient can also develop metabolic alkalosis if LR is run over long periods of time. It shouldn't be used in patients with liver disease because the lactate is metabolized in the liver. You will commonly see LR used for surgical patients. Adding 5% dextrose to LR makes the solution hypertonic.

Isotonic solutions have the same tonicity as plasma so that when they are infused into a vein, water neither enters or leaves the cells. These kinds of IV solutions are used to expand the extracellular fluid volume and do not cause any fluid to move from into or out of the blood cells. Isotonic solutions have an osmolality of 240 to 340 mOsm/liter.

Other isotonic solutions are:

  • 0.9% Sodium Chloride
  • 5% Dextrose and Water
  • Ringer's solution
  • 2.5% Dextrose in 0.45% Sodium Chloride
  • 2.5% Dextrose in 1/2 strength Lactated Ringer's
  • 6% Dextran and 0.9% Sodium Chloride
  • 10% Dextran and 0.9% Sodium Chloride

The only difference between Ringer's solution and Lactated Ringer's solution is that Lactated Ringer's has the 28 grams of lactate in it. Otherwise, the solutions have the identical other components.

sewnew said:
Interesting...If that is the case, would D5W 1/2 NS still be contraindicated in a dehydrated patient?

D5.45NS is a common solution for maintenance and rehydration. Little dextrose for the calories and the .45NS will push fluid back into the cells and help lower the Na levels.

There is a system to how this all works.

First you give NS or LR to temporarily correct the fluid volume loss and reestablish sufficient circulation.

Then you give D5.45NS to rehydrate and push fluids from the veins into the cells, all the while giving some much needed calories.

Think of D5.45NS as Koolaid or a sports drink. Lots of free water with a bit of sugar for energy.

Specializes in ICU, Med-Surg.
hotshot12345 said:
I don't understand this. I know of 5DW and 1/2 NS but combining them together? Would this be isotonic, hyper/hypotonic? Can somebody help me figure this out?

thanks

It's hypertonic in the bag. Hypotonic in the bloodstream, since RBC's metabolize the 5% dextrose quickly, leaving behind the 0.45% saline which has an osmolality of about 155 mOsm/L

Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.

There is d5.9%, d5.2% and d5.45%. half-normal saline (0.45% nacl), often with "d5" (5% dextrose), contains 77 meq/l of na and cl and 50 g/l glucose.

Quarter-normal saline (0.22% nacl) has 39 meq/l of na and cl and always contains 5% dextrose for osmolality reasons

Chart of Commonly Transfused Blood Products (1).doc

Chart of Commonly Transfused Blood Products.doc

hotshot12345 said:
I don't understand this. I know of 5DW and 1/2 NS but combining them together? Would this be isotonic, hyper/hypotonic? Can somebody help me figure this out?

The "best answer" given for your information leaves out one CRUCIAL bit of information. While D5 1/2 NS is hypertonic in the bag, upon intravenous administration it becomes hypotonic- because the body absorbs the glucose (almost immediatelt) leaving only 1/2 NS being absorbed into the vascular space. If this fluid is given inappropriately, it can lead to the swelling and lysis of cells.

This solution is indicated for patients who are an prolonged NPO status. The 170 calories in a bag of D5W helps with a patient who is NPO- because they have no oral intake.

Giving this solution and not knowing it is hypotonic on administration can be detrimental to your patient! Water intoxication, ECF osmolarity decreases, hydrostatic pressure increases, and fluids shift into the intracellular space, so all body compartments expand and dilutional electrolyte imbalances occur.

Hope this is helpful!

Specializes in ER.

Love your answer. Can you explain to me how hypotonic fluids work and LR?

Is there such a thing as D5W/0.5 NS???

I don't think so.... I know there is a .45% ns though. Anything combined with 5% or 10% dextrose is HYPERtonic...

sewnew said:
Is there such a thing as D5W/0.5 NS???

Nothing standard. Pharm can technically make any number of combinations of fluids by mixing inhouse but that would be so expensive you will never see it.

Keep in mind D5W 1/2NS is hypertonic for about 5 minutes or so. The dextrose is quickly metabolized in about 5 minutes leaving only .45NS, turning hypotonic.

Thank you for the replies. I contacted the instructor and it was a typo on the slide. She had meant D5W/0.45 NS.

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