DEXTROSE 5% AND SODIUM CHLORIDE 0.45%
Clinical safety rating
safeNo significant drug interactions Can cause hypernatremia and fluid overload.
Dextrose 5% provides a source of calories and hydration; sodium chloride 0.45% provides electrolytes and maintains osmotic balance. Dextrose is metabolized to carbon dioxide and water, yielding energy. Sodium chloride dissociates to maintain extracellular fluid volume and osmolality.
| Metabolism | Dextrose undergoes glycolysis and subsequent oxidation via the citric acid cycle. Sodium chloride is not metabolized; it is excreted unchanged by the kidneys. |
| Excretion | Dextrose is metabolized to carbon dioxide and water, with negligible renal excretion of intact dextrose under normal conditions. Sodium and chloride are primarily excreted renally; sodium excretion is regulated by glomerular filtration and tubular reabsorption, while chloride follows sodium. In patients with normal renal function, >90% of infused sodium and chloride are excreted in urine within 24-48 hours. |
| Half-life | Dextrose: not applicable as it is rapidly metabolized; the half-life of infused glucose is approximately 1.5-2 hours in healthy individuals, but prolonged in conditions like diabetes. Sodium: biological half-life is 10-20 hours, depending on fluid balance and renal function. |
| Protein binding | Dextrose: negligible binding to plasma proteins. Sodium: minimal binding (approx. 0-10%) to albumin and other proteins. Chloride: not significantly protein bound. |
| Volume of Distribution | Dextrose: distributes into total body water, approximately 0.55-0.65 L/kg (based on 60% of body weight as water in adults). Sodium: distributes into extracellular fluid, approximately 0.20-0.25 L/kg. Chloride: similar to sodium, extracellular fluid, approximately 0.20 L/kg. |
| Bioavailability | Intravenous: 100% for all components. |
| Onset of Action | Intravenous: rapid correction of hypovolemia and hypoglycemia occurs within minutes; volume expansion begins immediately, with clinical effects on blood pressure and heart rate within 5-10 minutes. |
| Duration of Action | Volume expansion: 1-2 hours for isotonic or hypotonic solutions, as fluids redistribute and are excreted. Glucose effect: 30-60 minutes for blood glucose elevation, but duration depends on metabolic state and renal function. |
| Molecular Weight | Dextrose: 180.16 Da; Sodium chloride: 58.44 Da |
Intravenous administration; typical adult dose is 1000-2000 mL over 24 hours, rate adjusted based on patient's fluid and electrolyte status. Maximum infusion rate is 1000 mL per hour.
| Dosage form | INJECTABLE |
| Renal impairment | For GFR < 10 mL/min: reduce to 50% of standard dose or avoid due to risk of volume overload and hypernatremia; monitor closely for signs of fluid overload and electrolyte disturbances. |
| Liver impairment | Not required: no dose adjustment needed for hepatic impairment. |
| Pediatric use | Intravenous; dose based on daily maintenance fluid requirements: 0-10 kg: 100 mL/kg/day; 10-20 kg: 1000 mL + 50 mL/kg for each kg over 10; >20 kg: 1500 mL + 20 mL/kg for each kg over 20. Infusion rate adjusted to patient's clinical status. |
| Geriatric use | Use with caution: lower initial doses and slower infusion rates recommended to avoid fluid overload; monitor renal function and electrolyte balance. |
| 1st trimester | Generally considered safe; dextrose and sodium chloride are physiologic components. Use only if clearly needed with caution for maternal hyperglycemia and fluid/electrolyte balance. |
| 2nd trimester | Generally considered safe; monitor for maternal hyperglycemia and electrolyte disturbances. No known teratogenic risk. |
| 3rd trimester | Generally considered safe; avoid excessive fluid volumes due to risk of maternal fluid overload and fetal hyponatremia. Monitor maternal glucose and electrolytes. |
Clinical note
No significant drug interactions Can cause hypernatremia and fluid overload.
| FDA category | Animal |
| Placental transfer | Dextrose: crosses placenta via facilitated diffusion; maternal hyperglycemia can cause fetal hyperglycemia and hyperinsulinemia. Sodium chloride: freely crosses placenta; fetal serum levels correlate with maternal levels. |
| Breastfeeding | Excreted in breast milk: dextrose and sodium chloride are normal components. No known adverse effects on infant at recommended doses. Use caution with large volumes or high concentrations due to potential maternal electrolyte disturbances. |
| Lactation Rating | Safe |
| Teratogenic Risk | No known teratogenic risk. Dextrose and sodium chloride are physiologic substances. In trimester 1, no increased risk of major malformations. In trimesters 2 and 3, use is safe when indicated for maternal hydration or electrolyte balance; avoid excessive dextrose causing maternal hyperglycemia which can lead to fetal hyperinsulinism and neonatal hypoglycemia. |
| Fetal Monitoring | Monitor maternal serum glucose, electrolytes, and fluid balance. In pregnancy, monitor fetal heart rate and uterine activity during infusion if using for labor or tocolysis. Assess for maternal signs of fluid overload (edema, dyspnea). In neonates, monitor glucose and electrolytes if mother received high doses near delivery. |
| Fertility Effects | No known adverse effects on fertility. Dextrose and sodium chloride are physiologic and do not impair reproductive function. |
■ FDA Black Box Warning
None
| Common Effects | fluid replacement |
| Serious Effects |
Severe hyperglycemia (e.g., diabetic ketoacidosis unless corrected)Hypertonic solutions (concentrations >5% dextrose) are contraindicated in intracranial or intraspinal hemorrhage (if not premixed)Severe fluid overload states (e.g., pulmonary edema, congestive heart failure)Anuria with acute renal failure requiring fluid restrictionHypersensitivity to any component
| Precautions | Use with caution in patients with congestive heart failure, renal impairment, or hyperglycemia, Monitor serum glucose, electrolytes, and fluid status, Risk of hyperglycemia and hyperosmolar syndrome in patients with diabetes mellitus or stress-induced insulin resistance, Not for use in patients with intracranial or intraspinal hemorrhage or in patients who are comatose with hyperglycemia |
| Food/Dietary | Avoid excessive intake of high-sodium foods such as processed snacks, canned soups, and fast foods to prevent exacerbation of sodium overload. No specific food interactions with dextrose; however, diabetic patients should monitor carbohydrate intake and adjust insulin accordingly. Alcohol may impair glucose metabolism and enhance hypoglycemia risk; avoid or limit consumption. |
| Clinical Pearls | This isotonic solution (D5 0.45% NaCl) provides 170 kcal/L as dextrose and 77 mEq/L sodium, 77 mEq/L chloride. Use cautiously in patients with hyponatremia or sodium retention (heart failure, cirrhosis, renal impairment). Monitor serum glucose in diabetic patients; may cause hyperglycemia. Not suitable for resuscitation due to low sodium content. Avoid in patients with known allergy to corn-derived dextrose. |
| Patient Advice | Report any shortness of breath, swelling in legs, or rapid weight gain, as these may indicate fluid overload. · Inform your healthcare provider if you have diabetes, as this solution contains sugar and may affect blood glucose levels. · Tell your doctor if you have a history of kidney problems, heart failure, or high blood pressure. · Do not consume extra salt or salty foods without consulting your doctor. · Notify your nurse immediately if you experience pain, redness, or swelling at the infusion site. |
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