Saline versus 5% dextrose in water as a drug diluent for critically ill patients: a retrospective cohort study
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RESEARCH
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Saline versus 5% dextrose in water as a drug diluent for critically ill patients: a retrospective cohort study Yukari Aoyagi*, Takuo Yoshida, Shigehiko Uchino, Masanori Takinami and Shoichi Uezono
Abstract Background: The 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. Methods: This 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. Results: We 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. Conclusions: Changing the diluent default from D5W to saline had no effect on blood glucose control and increased the incidences of hypernatremia and hyperchloremia. Keywords: Critical care, Diluent, Saline, Dextrose in water, Hyperglycemia, Hypernatremia
Introduction 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 [1–4]. Thus, clinicians pay attention to the choice of intravenous infusion products which may have affected the abnormalities [5]. On the other hand, research focusing on the choice of drug diluents has been limited. We believe that the drug diluents may play an important role because critically ill
patients generally require many types of drugs, including antibiotics and sedatives [6, 7]. The total amount of diluents administered may be high enough to introduce abnormalities in serum electrolyte and glucose levels. It is therefore necessary to investigate the impact of diluents on those abnormalities. The purpose of the present study is to evaluate the effect of drug diluents in critically ill patients. We hypothesized that changing the default diluent from D5W to saline would improve blood glucose control without inducing electrolyte abnormalities.
* Correspondence: [email protected] Intensive Care Unit, Depart
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