Abstract
BackgroundThe choice of intravenous infusion products for critically ill patients has been studied extensively because it can affect prognosis. However, there has been little research on drug diluents in this context. The purpose of this study is to evaluate the impact of diluent choice (saline or 5% dextrose in water [D5W]) on electrolyte abnormalities, blood glucose control, incidence of acute kidney injury (AKI), and mortality.MethodsThis before-after, two-group comparative, retrospective study enrolled adult patients who stayed for more than 48 h in a general intensive care unit from July 2015 to December 2018. We changed the default diluent for intermittent drug sets in our electronic ordering system from D5W to saline at the end of 2016.ResultsWe included 844 patients: 365 in the D5W period and 479 in the saline period. Drug diluents accounted for 21.4% of the total infusion volume. The incidences of hypernatremia and hyperchloremia were significantly greater in the saline group compared to the D5W group (hypernatremia 27.3% vs. 14.6%, p < 0.001; hyperchloremia 36.9 % vs. 20.4%, p < 0.001). Multivariate analyses confirmed the similar effects (hypernatremia adjusted odds ratio (OR), 2.43; 95% confidence interval (CI), 1.54–3.82; hyperchloremia adjusted OR, 2.09; 95% CI, 1.31–3.34). There was no significant difference in the incidences of hyperglycemia, AKI, and mortality between the two groups.ConclusionsChanging the diluent default from D5W to saline had no effect on blood glucose control and increased the incidences of hypernatremia and hyperchloremia.
Highlights
Management of serum electrolyte and glucose levels among critically ill patients is essential because these abnormalities have been reported to be associated with acute kidney injury (AKI) and mortality [1,2,3,4]
The median levels of serum sodium, chloride, baseline creatinine, and blood glucose at intensive care unit (ICU) admission were all in the normal range
One before-after study, in which the drug diluent was changed from saline to 5% dextrose in water (D5W), reported that the incidence of hyperchloremia decreased, without difficulty in blood glucose control [6]
Summary
Management of serum electrolyte and glucose levels among critically ill patients is essential because these abnormalities have been reported to be associated with acute kidney injury (AKI) and mortality [1,2,3,4]. Clinicians pay attention to the choice of intravenous infusion products which may have affected the abnormalities [5]. The total amount of diluents administered may be high enough to introduce abnormalities in serum electrolyte and glucose levels. The choice of intravenous infusion products for critically ill patients has been studied extensively because it can affect prognosis. The purpose of this study is to evaluate the impact of diluent choice (saline or 5% dextrose in water [D5W]) on electrolyte abnormalities, blood glucose control, incidence of acute kidney injury (AKI), and mortality
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
