IV 5% Dextrose Administration for Starvation Ketosis

Dosing Guidelines

The American Academy of Pediatrics recommends that for pediatric patients, 5% dextrose (D5W) should be administered as a constant infusion with appropriate maintenance electrolytes at 100 mL/kg per 24 hours, which equals approximately 7 mg/kg/min 1, 2
Titrate the rate to achieve normoglycemia, as hyperglycemia can have adverse central nervous system effects 1

The American Academy of Pediatrics recommends that 5% dextrose (D5W) is the preferred concentration for treating starvation ketosis 1
Higher concentrations like D50W are irritating to veins; dilution to 25% dextrose or lower is desirable 1

Blood glucose levels should be monitored carefully during treatment 1, 2
Sodium and potassium levels should also be monitored regularly 1
For patients receiving insulin infusions alongside dextrose, blood glucose should be monitored every 1-2 hours 3

Hypoglycemia may recur depending on the etiology, requiring continued monitoring 1
Rapid administration of concentrated dextrose solutions may lead to complications such as cardiac arrest and hyperkalemia 3
Overtreatment with dextrose can lead to hyperglycemia, which has its own adverse effects 1

In settings of unplanned or unavoidable prolonged fasting, glucose-containing intravenous fluids provide safety benefits to mitigate ketone generation in adult patients, according to the American Society of Anesthesiologists 4, 5
Avoid prolonged starvation periods in high-risk patients, such as those on certain medications or with metabolic vulnerabilities, and ensure adequate hydration alongside glucose administration to prevent compounded ketosis, as recommended by the American Society of Anesthesiologists 4, 5