D-5 as IVF resuscitation?

Q: 68 years old female patient is admitted to ICU with urosepsis. The pharmacy has informed a shortage of Lactated Ringer's (LR) solution and other resuscitation fluids, except for D-5/0.9 saline solution. What is the downside of using D-5 inside resuscitation fluid?

 

 

Answer: Acidosis may worsen.

 

At the cellular level, most of the D-5 is diverted to lactate production in hypoperfused patients, exacerbating acidosis. It also has no resuscitation effect at the vascular level.

 

 

#shock

#resuscitation

#acidosis

 

 

 

Recommended readings:

 

1. Brown RM, Semler MW. Fluid Management in Sepsis. J Intensive Care Med. 2019 May;34(5):364-373. doi: 10.1177/0885066618784861. Epub 2018 Jul 9. PMID: 29986619; PMCID: PMC6532631.

 

2. Rochwerg B, Alhazzani W, Sindi A, Heels-Ansdell D, Thabane L, Fox-Robichaud A, Mbuagbaw L, Szczeklik W, Alshamsi F, Altayyar S, Ip WC, Li G, Wang M, Wludarczyk A, Zhou Q, Guyatt GH, Cook DJ, Jaeschke R, Annane D; Fluids in Sepsis and Septic Shock Group. Fluid resuscitation in sepsis: a systematic review and network meta-analysis. Ann Intern Med. 2014 Sep 2;161(5):347-55. doi: 10.7326/M14-0178. PMID: 25047428.

 

3. Tinawi M. New Trends in the Utilization of Intravenous Fluids. Cureus. 2021 Apr 21;13(4):e14619. doi: 10.7759/cureus.14619. PMID: 34040918; PMCID: PMC8140055.