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Can anyone tell me what the difference btwn D5NS and D5W is?
D5NS vs D5W?
- Thread starter DancingFajitas
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Literally, one is 5% dextrose in water and the other is 5%dextrose in normal saline. Clinically, the difference is that D5W adds hypotonic fluid to the intravascular space while D5NS adds isotonic fluid.
If you've ever heard the Goljan lectures, he says that the only reason we give D5W is because the hospital can't charge 35 dollars for a bag of plain W. This is usually pretty true IMO.
If you've ever heard the Goljan lectures, he says that the only reason we give D5W is because the hospital can't charge 35 dollars for a bag of plain W. This is usually pretty true IMO.
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Pure water damages veins, that is why D5 is given instead.
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Yep, not a good idea to give free water IV. PO/NGT/PEG only
N
njbmd
Actually, it's not the veins but those pesky little red cells that don't like to be exposed to hypotonic solutions. A 5% dextrose or a normal saline solution is hypertonic to blood plasma.
The most common solution that I use for giving "water" is D5 and 1/2 NS which is kind to erythrocytes and feeds the brain at the same time. The 1/2 NS adds water but isn't as hypotonic as D5W.
If I am interested in quick volume expansion, it's lactated ringers (think about why the lactate is good in this case) that I use. It's isotonic with plasma to keep the red cells happy.
Funny how many people don't give free water with tube feedings. I always give the patients a "drink of water" with their tube feedings.
4
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Yeah, I'm on a surgery sub-I now, and everyone's on D5 1/2NS with 20meq of KCl, pretty much. Your sodium is supposed to be 135-145, and NS has 154 in it. It's also got 154 of chloride, which is even higher than your serum choride.
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Yes, almost always an excellent idea, if only to prevent the midnight phone call that the tube is clogged.
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d5W is typically too hypotonic, and d5NS too hypertonic, so usually you go with the inbetween. I personally don't care for that much dextrose because i dont think it adds much nutrition anyhow, and ends up screwing up my diabetics. but that's the population i see.
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and 1/2 NS is 77 mEqs of sodium and of chloride, which is even lower than your serum numbers . . . the question being, what is the point, and why does it matter . . . or more appropo WHEN does it matter
it matters when their chloride and sodium levels start to creep up (well mostly chloride), you know the cause and can respond appropriately. It came up on one of my pancreatitis patients I had during medicine sub-I
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Exactly. You're giving the pt about 6g of sugar by running your fluids at 125cc/hr. A can of Coca-Cola has... OVER 40 GRAMS OF SUGAR! Granted patients' metabolic rates usually aren't up there doing the tango, but the presence/absence of a sip of Coke an hour isn't going to affect anybody's disposition outta there. It's just another voodoo that makes the team feel better - they're providing 'nutrition' so it's perfectly OK to leave a patient NPO over the weekend for his procedure Monday. Better (and by better I mean easier) than somebody having to put in the orders Sunday right?
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and how did this matter? was the patient symptomatic?