D5w/nacl 0.9% Inj, 1000ml
It is used to give fluids to the body when more fluids and electrolytes are needed.It is used as a way to give other drugs as a shot.It may be given to you for other reasons. Talk with the doctor.
Drug Class
Fluid and Electrolyte Replenisher; Caloric Agent
Pharmacologic Class
Crystalloid Solution; Carbohydrate; Electrolyte
Pregnancy Category
Category C (use only if clearly needed, as with any IV fluid)
FDA Approved
Jan 1970
DEA Schedule
Not Controlled
Overview
What is this medicine?
This medication is an intravenous fluid, often called an 'IV drip.' It's a mixture of water, a small amount of sugar (dextrose), and salt (sodium chloride). It's given directly into your vein to help your body get enough fluids, electrolytes (like salt), and a little bit of energy when you can't drink or eat enough, or when your body needs extra support.
How to Use This Medicine
Proper Use of This Medication
To use this medication correctly, follow your doctor's instructions and read all the information provided. This medication is administered as an infusion into a vein over a period of time. Your doctor may instruct you on how to self-administer this medication.
Before and after handling the medication, wash your hands thoroughly. Do not use the solution if it appears cloudy, is leaking, or contains particles. Additionally, do not use the solution if it has changed color.
To dispose of used needles and sharp objects, use a designated needle/sharp disposal box. Never reuse needles or other items. When the disposal box is full, follow local regulations for proper disposal. If you have any questions or concerns, consult your doctor or pharmacist.
Storage and Disposal
Typically, this medication is administered in a hospital or doctor's office. If you need to store it at home, follow the storage instructions provided by your doctor.
Missed Dose
If you miss a dose, contact your doctor to determine the best course of action.
To use this medication correctly, follow your doctor's instructions and read all the information provided. This medication is administered as an infusion into a vein over a period of time. Your doctor may instruct you on how to self-administer this medication.
Before and after handling the medication, wash your hands thoroughly. Do not use the solution if it appears cloudy, is leaking, or contains particles. Additionally, do not use the solution if it has changed color.
To dispose of used needles and sharp objects, use a designated needle/sharp disposal box. Never reuse needles or other items. When the disposal box is full, follow local regulations for proper disposal. If you have any questions or concerns, consult your doctor or pharmacist.
Storage and Disposal
Typically, this medication is administered in a hospital or doctor's office. If you need to store it at home, follow the storage instructions provided by your doctor.
Missed Dose
If you miss a dose, contact your doctor to determine the best course of action.
Lifestyle & Tips
- Report any discomfort at the IV site (pain, swelling, redness).
- Report any changes in how you feel, such as shortness of breath, swelling, excessive thirst, or confusion.
Available Forms & Alternatives
Available Strengths:
Dosing & Administration
Adult Dosing
Standard Dose:
Highly individualized based on patient's fluid, electrolyte, and caloric needs. Typically 1000-3000 mL/24 hours, administered intravenously at a rate determined by clinical condition.
Dose Range:
1000 - 3000 mg
Condition-Specific Dosing:
dehydration:
Rate adjusted to correct fluid deficit, typically 100-250 mL/hour.
maintenance:
50-125 mL/hour for maintenance fluid and electrolyte needs.
hypovolemia:
Rapid infusion (e.g., 500-1000 mL over 30-60 minutes) may be used in acute situations, followed by slower rates.
Pediatric Dosing
Neonatal:
Not established (use with extreme caution due to risk of hypernatremia, hyperglycemia, and fluid overload; specific neonatal formulations or careful calculations of individual components are preferred).
Infant:
Dosing is highly individualized based on weight, age, and clinical condition. Typical maintenance fluid rates are 100 mL/kg/day for first 10 kg, 50 mL/kg/day for next 10 kg, 20 mL/kg/day for remaining weight. Electrolyte and glucose needs must be carefully monitored.
Child:
Dosing is highly individualized based on weight, age, and clinical condition. Typical maintenance fluid rates are 100 mL/kg/day for first 10 kg, 50 mL/kg/day for next 10 kg, 20 mL/kg/day for remaining weight. Electrolyte and glucose needs must be carefully monitored.
Adolescent:
Dosing is highly individualized based on weight, age, and clinical condition, often approaching adult doses. Electrolyte and glucose needs must be carefully monitored.
Dose Adjustments
Renal Impairment:
Mild:
Adjustment needed: Monitor fluid balance and electrolytes closely. May require reduced infusion rates to prevent fluid overload.
Moderate:
Adjustment needed: Significant reduction in infusion rate and frequent monitoring of fluid status, serum electrolytes (especially sodium, potassium), and renal function. Risk of fluid overload and electrolyte imbalances is increased.
Severe:
Adjustment needed: Use with extreme caution. Often contraindicated or used only in very small volumes with intensive monitoring. Risk of fluid overload, hypernatremia, and other electrolyte disturbances is high.
Dialysis:
Considerations: Fluid and electrolyte administration must be precisely managed in conjunction with dialysis schedule and ultrafiltration goals. Often, specific electrolyte-free or low-electrolyte solutions are preferred, or fluid is restricted.
Hepatic Impairment:
Mild:
Adjustment: Monitor fluid balance and electrolytes. No specific dose adjustment for the solution itself, but underlying hepatic dysfunction may alter fluid distribution and electrolyte handling.
Moderate:
Adjustment: Monitor fluid balance and electrolytes closely. Patients with significant hepatic impairment (e.g., cirrhosis with ascites) are prone to fluid retention and hyponatremia; use with caution and reduced rates.
Severe:
Adjustment: Use with extreme caution. Patients with severe hepatic impairment are at high risk for fluid overload, ascites, and electrolyte disturbances. Fluid restriction and careful monitoring are paramount.
Pharmacology
Mechanism of Action
D5W/NaCl 0.9% provides water, electrolytes (sodium and chloride), and calories (dextrose). Dextrose is rapidly metabolized, providing free water and calories. Sodium chloride helps maintain extracellular fluid volume and tonicity. The solution is isotonic in the bag but becomes physiologically hypotonic as dextrose is metabolized, allowing for distribution of free water into intracellular and extracellular compartments.
Pharmacokinetics
Absorption:
Bioavailability:
100% (intravenous administration)
Tmax:
Immediate (onset of action)
FoodEffect:
Not applicable (IV administration)
Distribution:
Vd:
Approximately 0.6 L/kg (total body water for water component); sodium and chloride distribute primarily in the extracellular fluid (approx. 0.2 L/kg). Dextrose distributes throughout total body water.
ProteinBinding:
Not applicable (electrolytes and dextrose do not bind significantly to plasma proteins)
CnssPenetration:
Yes (water, sodium, chloride, and glucose readily cross the blood-brain barrier)
Elimination:
HalfLife:
Variable (depends on fluid status, renal function, and metabolic rate; water and electrolytes are continuously exchanged and excreted)
Clearance:
Renal (for water and electrolytes); metabolic (for dextrose)
ExcretionRoute:
Renal (water, sodium, chloride); respiratory (CO2 from dextrose metabolism)
Unchanged:
Not applicable (components are either metabolized or excreted as part of normal physiological processes)
Pharmacodynamics
OnsetOfAction:
Immediate
PeakEffect:
Within minutes (for fluid and electrolyte distribution)
DurationOfAction:
Variable (depends on infusion rate, patient's fluid status, and renal function; components are continuously utilized and excreted)
Confidence:
Medium
Safety & Warnings
Side Effects
Urgent Side Effects: Seek Medical Help Right Away
Although rare, some people may experience severe and potentially life-threatening side effects while taking this medication. If you notice any of the following symptoms, contact your doctor or seek immediate medical attention:
Signs of an allergic reaction, such as:
+ Rash
+ Hives
+ Itching
+ Red, swollen, blistered, or peeling skin with or without fever
+ Wheezing
+ Tightness in the chest or throat
+ Trouble breathing, swallowing, or talking
+ Unusual hoarseness
+ Swelling of the mouth, face, lips, tongue, or throat
Signs of fluid and electrolyte problems, including:
+ Mood changes
+ Confusion
+ Muscle pain or weakness
+ Fast or abnormal heartbeat
+ Severe dizziness or fainting
+ Increased thirst
+ Seizures
+ Feeling extremely tired or weak
+ Decreased appetite
+ Difficulty urinating or changes in urine output
+ Dry mouth
+ Dry eyes
+ Severe nausea or vomiting
Signs of skin infection, such as:
+ Oozing
+ Heat
+ Swelling
+ Redness
+ Pain
Swelling, warmth, numbness, color changes, or pain in a leg or arm
Chest pain or pressure
Fever
Shortness of breath
Sudden weight gain
Swelling in the arms or legs
Other Possible Side Effects
Like all medications, this drug can cause side effects. While many people may not experience any side effects or only minor ones, it's essential to discuss any concerns with your doctor. If you experience any of the following side effects or any other unusual symptoms, contact your doctor for guidance:
Irritation or swelling at the injection site
* Pain at the injection site
Reporting Side Effects
This list is not exhaustive, and you may experience other side effects not mentioned here. If you have questions or concerns about side effects, consult your doctor. You can also report side effects to the FDA at 1-800-332-1088 or online at https://www.fda.gov/medwatch.
Although rare, some people may experience severe and potentially life-threatening side effects while taking this medication. If you notice any of the following symptoms, contact your doctor or seek immediate medical attention:
Signs of an allergic reaction, such as:
+ Rash
+ Hives
+ Itching
+ Red, swollen, blistered, or peeling skin with or without fever
+ Wheezing
+ Tightness in the chest or throat
+ Trouble breathing, swallowing, or talking
+ Unusual hoarseness
+ Swelling of the mouth, face, lips, tongue, or throat
Signs of fluid and electrolyte problems, including:
+ Mood changes
+ Confusion
+ Muscle pain or weakness
+ Fast or abnormal heartbeat
+ Severe dizziness or fainting
+ Increased thirst
+ Seizures
+ Feeling extremely tired or weak
+ Decreased appetite
+ Difficulty urinating or changes in urine output
+ Dry mouth
+ Dry eyes
+ Severe nausea or vomiting
Signs of skin infection, such as:
+ Oozing
+ Heat
+ Swelling
+ Redness
+ Pain
Swelling, warmth, numbness, color changes, or pain in a leg or arm
Chest pain or pressure
Fever
Shortness of breath
Sudden weight gain
Swelling in the arms or legs
Other Possible Side Effects
Like all medications, this drug can cause side effects. While many people may not experience any side effects or only minor ones, it's essential to discuss any concerns with your doctor. If you experience any of the following side effects or any other unusual symptoms, contact your doctor for guidance:
Irritation or swelling at the injection site
* Pain at the injection site
Reporting Side Effects
This list is not exhaustive, and you may experience other side effects not mentioned here. If you have questions or concerns about side effects, consult your doctor. You can also report side effects to the FDA at 1-800-332-1088 or online at https://www.fda.gov/medwatch.
Seek Immediate Medical Attention If You Experience:
- Shortness of breath or difficulty breathing
- Swelling in your hands, feet, or ankles
- Rapid weight gain
- Headache or dizziness
- Confusion or unusual drowsiness
- Increased thirst or dry mouth
- Frequent urination or lack of urination
- Muscle weakness or cramps
Before Using This Medicine
Before Taking This Medication: Important Information to Share with Your Doctor
It is essential to inform your doctor about the following:
Any allergies you have, including allergies to this medication, its components, or other substances, such as foods or drugs. Be sure to describe the symptoms you experienced as a result of the allergy.
All medications you are currently taking, including prescription and over-the-counter (OTC) drugs, natural products, and vitamins. This information will help your doctor and pharmacist identify potential interactions between this medication and other substances.
* Any existing health problems, as this medication may interact with certain conditions.
To ensure your safety, it is crucial to verify that this medication can be taken with all your current medications and health conditions. Never start, stop, or adjust the dosage of any medication without first consulting your doctor.
It is essential to inform your doctor about the following:
Any allergies you have, including allergies to this medication, its components, or other substances, such as foods or drugs. Be sure to describe the symptoms you experienced as a result of the allergy.
All medications you are currently taking, including prescription and over-the-counter (OTC) drugs, natural products, and vitamins. This information will help your doctor and pharmacist identify potential interactions between this medication and other substances.
* Any existing health problems, as this medication may interact with certain conditions.
To ensure your safety, it is crucial to verify that this medication can be taken with all your current medications and health conditions. Never start, stop, or adjust the dosage of any medication without first consulting your doctor.
Precautions & Cautions
It is essential to inform all your healthcare providers, including doctors, nurses, pharmacists, and dentists, that you are taking this medication.
If your medication contains potassium, consult your doctor before using any salt substitutes or products that also contain potassium.
If your medication contains dextrose and you have diabetes (high blood sugar), discuss this with your doctor to ensure safe management of your condition.
Regular blood tests are crucial while taking this medication. Follow your doctor's instructions regarding the frequency and timing of these tests, and discuss the results with your doctor.
When administering this medication to newborns, exercise caution due to the potential for increased risk of side effects in this age group.
If you are pregnant, planning to become pregnant, or are breastfeeding, notify your doctor. It is crucial to discuss the benefits and risks of this medication to both you and your baby to make an informed decision.
If your medication contains potassium, consult your doctor before using any salt substitutes or products that also contain potassium.
If your medication contains dextrose and you have diabetes (high blood sugar), discuss this with your doctor to ensure safe management of your condition.
Regular blood tests are crucial while taking this medication. Follow your doctor's instructions regarding the frequency and timing of these tests, and discuss the results with your doctor.
When administering this medication to newborns, exercise caution due to the potential for increased risk of side effects in this age group.
If you are pregnant, planning to become pregnant, or are breastfeeding, notify your doctor. It is crucial to discuss the benefits and risks of this medication to both you and your baby to make an informed decision.
Overdose Information
Overdose Symptoms:
- Fluid overload (pulmonary edema, peripheral edema, elevated blood pressure, dyspnea)
- Hypernatremia (thirst, lethargy, confusion, seizures, coma)
- Hyperglycemia (polyuria, polydipsia, fatigue, blurred vision, diabetic ketoacidosis in susceptible patients)
- Electrolyte imbalances (e.g., hypokalemia due to dilution, hyperchloremic acidosis)
What to Do:
Discontinue infusion, administer diuretics for fluid overload, correct electrolyte imbalances, administer insulin for hyperglycemia, provide supportive care. Call 1-800-222-1222 (Poison Control) for specific guidance.
Drug Interactions
Major Interactions
- Corticosteroids (may increase sodium and fluid retention)
- Drugs causing sodium retention (e.g., NSAIDs, some antihypertensives) - risk of fluid overload
- Drugs causing hyperglycemia (e.g., some antipsychotics, corticosteroids) - risk of exacerbated hyperglycemia
Moderate Interactions
- Diuretics (may alter electrolyte balance, requiring careful monitoring)
- Insulin (may require dose adjustment due to dextrose content)
Monitoring
Baseline Monitoring
Serum Electrolytes (Na, K, Cl, HCO3)
Rationale: To establish baseline fluid and electrolyte status and identify pre-existing imbalances.
Timing: Prior to initiation of therapy
Renal Function (BUN, Creatinine)
Rationale: To assess kidney's ability to handle fluid and electrolytes.
Timing: Prior to initiation of therapy
Blood Glucose
Rationale: To assess baseline glucose levels, especially in diabetic patients or those at risk for hyperglycemia.
Timing: Prior to initiation of therapy
Fluid Status (Weight, Vital Signs, Edema)
Rationale: To assess baseline hydration status and identify signs of fluid overload or deficit.
Timing: Prior to initiation of therapy
Routine Monitoring
Fluid Intake and Output (I&O)
Frequency: Every 4-8 hours or continuously
Target: Balanced I&O or as clinically indicated
Action Threshold: Significant positive or negative fluid balance; notify provider for imbalances outside target.
Serum Electrolytes (Na, K, Cl)
Frequency: Daily or more frequently (e.g., every 6-12 hours) depending on clinical status
Target: Na: 135-145 mEq/L; K: 3.5-5.0 mEq/L; Cl: 98-106 mEq/L
Action Threshold: Values outside normal range; notify provider for significant deviations.
Blood Glucose
Frequency: Every 4-6 hours, especially in diabetic patients or those on high infusion rates
Target: 70-180 mg/dL (or as per institutional protocol)
Action Threshold: Persistent hyperglycemia (>180 mg/dL) or hypoglycemia (<70 mg/dL); notify provider for adjustments.
Vital Signs (BP, HR, RR)
Frequency: Every 4-8 hours or more frequently as needed
Target: Within patient's normal range
Action Threshold: Significant changes indicating fluid overload (e.g., elevated BP, crackles) or dehydration (e.g., tachycardia, hypotension).
Body Weight
Frequency: Daily
Target: Stable or as desired
Action Threshold: Rapid weight gain (>1-2 kg/day) indicating fluid retention.
Symptom Monitoring
- Signs of fluid overload (e.g., dyspnea, crackles, peripheral edema, jugular venous distension)
- Signs of hypernatremia (e.g., thirst, lethargy, confusion, seizures, coma)
- Signs of hyperglycemia (e.g., polyuria, polydipsia, fatigue, blurred vision)
- Signs of electrolyte imbalance (e.g., muscle weakness, cramps, arrhythmias)
Special Patient Groups
Pregnancy
Generally considered safe and often used during pregnancy for hydration, labor, or medical conditions requiring IV fluids. However, fluid and electrolyte balance must be carefully monitored to avoid complications for both mother and fetus. Category C.
Trimester-Specific Risks:
First Trimester:
Generally low risk when indicated and monitored.
Second Trimester:
Generally low risk when indicated and monitored.
Third Trimester:
Generally low risk when indicated and monitored. Can be used during labor and delivery.
Lactation
Considered safe during lactation. The components (water, dextrose, sodium, chloride) are natural constituents of breast milk and are not expected to cause adverse effects in the infant when administered to the mother.
Infant Risk:
Low risk (L1)
Pediatric Use
Use with extreme caution, especially in neonates and infants, due to increased risk of fluid overload, hypernatremia, and hyperglycemia. Dosing must be precisely calculated based on weight, age, and clinical status. Close monitoring of fluid balance, electrolytes, and blood glucose is essential. Risk of hyponatremia is also a concern if free water is given excessively without adequate sodium.
Geriatric Use
Use with caution. Elderly patients are more susceptible to fluid overload, electrolyte imbalances (especially hypernatremia or hyponatremia), and renal impairment. Reduced infusion rates and close monitoring of fluid status, cardiac function, and electrolytes are often necessary.
Clinical Information
Clinical Pearls
- D5W/NaCl 0.9% is isotonic in the bag but becomes physiologically hypotonic after dextrose is metabolized, providing free water. This makes it useful for patients needing both free water and some sodium, but caution is needed in patients at risk for cerebral edema.
- Always assess patient's fluid status, electrolyte levels, and renal function before and during administration.
- Incompatible with certain drugs; always check compatibility before adding medications to the bag or administering via the same line.
- Risk of fluid overload is significant, especially in patients with cardiac, renal, or hepatic impairment. Monitor for signs of pulmonary edema.
- Risk of hyperglycemia, especially in diabetic patients, critically ill patients, or those receiving high infusion rates. Monitor blood glucose regularly.
- Avoid rapid infusion in patients with severe dehydration or hypernatremia, as rapid correction can lead to complications like cerebral edema or osmotic demyelination syndrome.
Alternative Therapies
- 0.9% Sodium Chloride (Normal Saline) - for pure volume expansion without free water or calories.
- Lactated Ringer's Solution (LR) - for volume expansion and electrolyte replacement, with lactate as a bicarbonate precursor.
- Dextrose 5% in Water (D5W) - for free water and calories, without electrolytes.
- Plasma-Lyte A - balanced crystalloid solution.
- Oral Rehydration Solutions (ORS) - for mild to moderate dehydration when oral intake is possible.
Cost & Coverage
Average Cost:
$5 - $20 per 1000mL bag
Generic Available:
Yes
Insurance Coverage:
Tier 1 (Preferred Generic) or covered under medical benefit for inpatient/outpatient administration
General Drug Facts
If your symptoms or health problems do not improve or worsen over time, it is essential to contact your doctor for further guidance. To ensure safe use, never share your medication with others, and do not take medication prescribed to someone else. Store all medications in a secure location, out of reach of children and pets, to prevent accidental ingestion. Dispose of unused or expired medications properly. Unless instructed otherwise, avoid flushing medications down the toilet or pouring them down the drain. If you are unsure about the correct disposal method, consult your pharmacist for advice. Many communities offer drug take-back programs, which your pharmacist can help you locate. Some medications may come with an additional patient information leaflet; check with your pharmacist to see if this applies to your prescription. If you have any questions or concerns about your medication, discuss them with your doctor, nurse, pharmacist, or other healthcare provider. In the event of a suspected overdose, immediately contact your local poison control center or seek emergency medical attention. Be prepared to provide information about the medication taken, the amount, and the time it occurred, as this will aid in providing appropriate treatment.