D5 (Dextrose 5%) IV Solution: Composition and Clinical Uses

Composition and Formulations

D5 solutions contain 5 grams of dextrose per 100 mL, and can be combined with various electrolyte solutions to create different formulations with distinct clinical applications, as recommended by the American Academy of Pediatrics 1
D5 in 0.9% normal saline (D5NS) contains 50 grams dextrose plus 154 mEq/L sodium and 154 mEq/L chloride, with osmolarity of 308 mOsm/L, according to the Pediatrics journal 2, 3, 4

The American Academy of Pediatrics recommends switching from normal saline to D5 1/2NS or D5 0.45-0.75% saline when serum glucose reaches 250 mg/dL during DKA treatment to prevent hypoglycemia while continuing insulin therapy to clear ketoacidosis 5
D5W (dextrose 5% in water) is the preferred solution for hypernatremic dehydration because it provides free water without adding sodium, allowing controlled decrease in plasma osmolality, as stated by the Praxis Medical Insights 5
For pediatric patients unable to take oral intake who require maintenance fluids, D5 1/2NS is appropriate after initial volume expansion, particularly when serum sodium is normal or elevated, according to the Praxis Medical Insights 5

Hypotonic dextrose-containing solutions are absolutely contraindicated in neurosurgical patients and traumatic brain injury patients due to risk of cerebral edema, as recommended by the Praxis Medical Insights 5
D5-containing hypotonic fluids can contribute to hyponatremia and cerebral edema in vulnerable populations, particularly in patients with syndrome of inappropriate antidiuresis (SIAD), according to the Pediatrics journal 5, 2, 3, 4

In hospitalized patients with nephrogenic diabetes insipidus, D5W matches the hypotonic urinary losses and should not be administered as a bolus, as stated by the Nature Reviews Nephrology journal 6
D5 normal saline is commonly used as a vehicle for medication administration, including vasopressors, but the dextrose content must be considered in patients with diabetes or glucose metabolism disorders, according to the Praxis Medical Insights 1

In patients with marked volume loss, isotonic crystalloid solutions without dextrose are recommended to effectively replace both water and electrolytes, avoiding the osmotic complications of hypotonic dextrose fluids. 7

During the initial phase of hypovolemic shock, dextrose‑containing intravenous solutions are inappropriate because they fail to provide the necessary electrolyte replacement required for rapid hemodynamic stabilization. 7