ICP and D5NS

[RookieRoo]

Hi guys, wondering if you could help me out with something.

I'm a new orienting on a general ICU. Recently I had my first pt with increased ICP due to hemorrhage and there was some confusion among MDs, pharmacists, and neuro consult about which fluids were appropriate. Neuro said to hang D5NS, everyone else thought it would increase ICP.

The only research I can find says that D5NS, but not D5W, is fine for increased ICP. Admittedly, however, I am having trouble pinpointing specific articles. Can someone point me in the right direction?

[nycsurg]

I can't really imagine how there was confusion. NS is pretty much the only fluid you would use for a Neuro pt. (Well, that or hypertonic saline or bicarb)

[JVoEDrn]

I imagine that administering NSD5 is an attempt to keep the BGLs in a consistent range since a higher mortality rate is associated with hyper/hypo glycemia. Pts with TBI require strict glucose level monitoring for that very reason. Some info:

Challenges in Glycemic Control in Perioperative and Critically Ill Patients: Blood Glucose Control in the Trauma Patient

[chare]

I can't really imagine how there was confusion. NS is pretty much the only fluid you would use for a Neuro pt. (Well, that or hypertonic saline or bicarb)

Really? What do you base this on?

[Mully]

Main thing is you don't want anything hypotonic. Isotonic or a little hypertonic (Like D5NS) is okay. Hypotonic fluid like D5W (It actually starts isotonic, but as the dextrose gets metabolized it becomes hypotonic) will cause fluid to move into cells creating edema and increased ICP. Hypertonic fluid will actually pull from fluid into the vascular space. Just keep checking BMPs.