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FionaS

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OK, so critical care seems as good a place as anywhere to ask this question!

I've been looking at junior doctors knowledge of fluid prescribing in general, and one of the questions I asked was the electrolyte composition of various commonly prescribed fluids - Normal Saline, DexSaline, 5% Dex, Hartmann's and Gelo.

Now, most people got N Saline right (phew!), but as I had thought, everyone hugely overestimated the amount of sodium in DexSaline.

I personally don't like DexSaline, and hardly ever prescribe it. It got me thinking though - when should it be used? I've seen it used in paeds, but no where else, but then I'm fairly new to the whole doctoring lark.

So here's my question: What is DexSaline actually for?

(For those who want to know - 154 mmol Na in N Saline, 30 mmol (not 70-75!) in DexSaline)
 

psychbender

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I'm just a second-year med student, but I'd imagine it'd just be used for rehydration in pediatrics to deal with the hypernatremia caused by losing more water than salt in diarrhea or other fluid loss situations, but where renal function remains [mostly] normal. Then again, I've always seen cautions against using hypotonic solutions such as this, as they may cause hyponatremia--especially post-op or in truly sick kids (decreased urine output). So basically, I don't know, either.

I wonder, would you ever give this to an adult who is hypernatremic?
 

Phlegm

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I am currently a second year fellow in CC, and while clearly not the most experienced poster on this forum, I have never seen DexSaline used in adult critical care. Perhaps someone with more peds experience or ED background may have more info. The only fluid close in composition that I use is D5 quarter NS, but then I'm adding 2 amps of bicarb to it.
 

waterski232002

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Personally, I have never used or even heard of DexSaline. I'm an EM resident and we always bolus isotonic fluids. It's usually NS, except LR in trauma (surgical preference--less of an iatrogenic induced metabolic acidosis when rapidly bolusing massive amounts of fluids over short periods of time, ie burn pts, hemorrhagic shock). I will occasionally bolus D5NS in patients with severe dehydration/starvation/intractable vomiting (usually alcoholic ketoacidosis, hyperemesis gravidarum, or any patient with large urine ketones who can't tolerate a meal or hasn't been cleared for a surgical vs non-surgical issue).

The only cases I use hypotonic fluids in adults is for maintenance or volume replacement with significant hypernatremia. It is always run in slowly, and never bolused. The usual scenario is DKA when the Na level normalizes, however, the corrected Na reveals that they're actually hypernatremic. You frequently have to change over to 1/2 NS. Another option is to switch to LR which also decreases the amount of Na and Cl loading (and will also reduce iatrogenic hyperchloremic acidosis) and will also correct the Bicarb much faster... thus closing the AG faster as well.

In peds, we also only bolus isotonic fluids... always NS at my institution, and all kids get started on maintenance fluids D5NS. We never use hypotonic fluids even for maintenance administration. There have been many cases of children on hypotonic maintenance fluids without adequate fluid/electrolyte monitoring who have developed severe hyponatremia, cerebral edema, and death under an unattentive eye. This is especially true of DKA in peds patients. On the other hand, I realize that we are unique, and most institutions still calculate the maintenance Na requirement and give D5 1/4 NS or D5 1/2 NS to peds patients.
 
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