Levophed works better in D5 vs. NS

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Okay, through experience I know Levo works better in D5 vs NS AND I know D5 is a no-no in neuro pts but we use it all the time without issues. What are your opinions and experiences?

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Specializes in Critical Care.

What do you mean by it "works better"?

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Levophed mixed in D5 brings the BP up further than when mixed in NS. Not sure why, but it does...I've removed second pressers by just switching the fluid the Levophed was mixed in from NS to D5.

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Levophed mixed in D5 brings the BP up further than when mixed in NS. Not sure why, but it does...I've removed second pressers by just switching the fluid the Levophed was mixed in from NS to D5.

Not doubting that you believe what you're saying, but unless you do (or produce) an RCT with a lot of patients, it's just an interesting anecdotal claim.

As far as using D5W all the time (in brain trauma?) without issues, what do you mean by "without" issues", and how much are the patients getting?

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Levo can be mixed in either, correct? In my experience it works better in D5. I need to give you a study? Okay I guess I'll move on to another reference.

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Levo can be mixed in either, correct? In my experience it works better in D5. I need to give you a study? Okay I guess I'll move on to another reference.

You don't need to offer an RCT for me to be convinced you believe that. It's clear you do believe that. You do need to offer at least one for anyone else to believe it though.

But if it's all the same to you, keep mixing it in D5W. The thinking on free water and brain injury hasn't changed too much as far as I'm aware, though.

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Specializes in SICU,CTICU,PACU.

I believe levo in d5w holds its concentration better?/longer but I don't think it actually increases the BP more than being mixed in ns. That is my understanding of why it is mixed in d5w rather than ns ideally.

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Well honestly I just wanted to opinions on the D5 in neuro patients. Didn't realize it wasn't common knowledge that if worked better.

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I believe levo in d5w holds its concentration better?/longer but I don't think it actually increases the BP more than being mixed in ns. That is my understanding of why it is mixed in d5w rather than ns ideally.

Historically, pressors, inopressors and inotropes were mixed in D5W because the thinking went that D5W would not contribute to volume over load in the vulnerable patient population. Even in patients that might benefit by more "isotonic" solutions, ie, not in congestive failure, but rather suffering from distributive falls in cardiac output, drips were mixed in dextrose solutions because that's the way we always mixed them and we didn't change the formulation based on the problems the patient was having. We'd treat individual problems independent of the background infusions they were receiving.

Now that we understand the consequences of hyperglycemia and free water better, we take a more nuanced approach to what we mix our vasoactive/inotropic agents in. It's just good medicine.

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Specializes in Critical Care.

D5 potentially increases ICP which your body responds to initially by increasing blood pressure, so it's quite possible that the difference you are seeing is correct, but the bigger question is it's really better that the patient's BP is higher due to a response to increased ICP.

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D5 potentially increases ICP which your body responds to initially by increasing blood pressure, so it's quite possible that the difference you are seeing is correct, but the bigger question is it's really better that the patient's BP is higher due to a response to increased ICP.

But in the case that you were titrating to MAP/CPP, would you not see an increase in NE requirement as the brain were swelling?

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