Intravascular Volume Expansion Guidelines
Introduction to Volume Expansion
- The American Journal of Kidney Diseases recommends that Dextrose 5% (D5W) should not be used for intravascular volume expansion due to its hypotonic nature and distribution primarily to intracellular spaces after glucose metabolism 1, 2
- D5W is a hypotonic solution that distributes primarily into intracellular spaces after the glucose is metabolized, which can exacerbate ischemic brain edema rather than expand intravascular volume 3
Recommended Solutions for Intravascular Volume Expansion
- The American Journal of Kidney Diseases recommends using isotonic crystalloids such as 0.9% saline as first-line fluids for intravascular volume expansion 1
- Isotonic solutions distribute more evenly into extracellular spaces (interstitial and intravascular) and are better for volume expansion 3
- The KDOQI Work Group recommends using isotonic crystalloids rather than colloids for initial management of expansion of intravascular volume in patients at risk for AKI or with AKI 1
Special Considerations for Volume Expansion
- Albumin is appropriate for specific clinical scenarios, such as patients with liver disease, especially those with spontaneous bacterial peritonitis, and patients undergoing large-volume paracentesis 1
- Starch-containing fluids should be avoided in patients at risk of AKI or with AKI 1
- Albumin should be avoided in patients with traumatic brain injury 1
Potential Harms of D5W for Volume Expansion
- Hypotonic solutions like D5W can exacerbate cerebral edema in patients with acute ischemic stroke 3
- The rapid metabolism of glucose in D5W effectively turns it into free water, which can worsen hyponatremia 2
Appropriate Uses for D5W
- D5W may be appropriate in specific situations, such as treatment of hypernatremia with adequate hemodynamic stability, as a vehicle for medication administration, and when glucose is needed to prevent hypoglycemia while continuing other treatments 2, 5