Why is nitro infused with D5W vs. 0.9% NS?

[CWATT]

As the title asks, why do we prepare nitro infusions with D5W versus 0.9% normal saline?

Also, one of my protocols states that the PVC material IV bags are made of absorb the Nitro. They don't make any recommendations for adjusting or re-calculating the concentration though. Has anyone heard this before? Do you take any further actions to ensure your patient is receiving the intended dose?


Thanks,
- C

 

[Tigger]

As the title asks, why do we prepare nitro infusions with D5W versus 0.9% normal saline?

Also, one of my protocols states that the PVC material IV bags are made of absorb the Nitro. They don't make any recommendations for adjusting or re-calculating the concentration though. Has anyone heard this before? Do you take any further actions to ensure your patient is receiving the intended dose?


Thanks,
- C

We mixed nitro in saline bags as does the helicopter service here. I'm told that the bags don't absorb NTG, at least the ones we carry.

 

[NomadicMedic]

I'd always run Tridil in glass bottles. And I believe the diluent is preference of the person mixing the drip. According to the package insert, it can be mixed with D5w or normal saline.

 

[E tank]

It's mid to late 20th century intuitive recommendations. The thinking was that the D5W would quickly convert to free water and leave the intravascular space thereby not contributing to fluid overload in CC patients with a lot of drips and/or the inability to handle "a lot" of fluid. We were mixing most everything in D5W, not just NTG.

When we realized that NS doesn't stay intravascular for a very long time either and realizing that too much sugar is more often an issue, NS became an option. Now we rarely use D5 for anything other than maintenance fluid on the wards.

 

[CWATT]

The thinking was that the D5W would quickly convert to free water and leave the intravascular space thereby not contributing to fluid overload in CC patients with a lot of drips and/or the inability to handle "a lot" of fluid. We were mixing most everything in D5W, not just NTG.

When we realized that NS doesn't stay intravascular for a very long time either and realizing that too much sugar is more often an issue, NS became an option. Now we rarely use D5 for anything other than maintenance fluid on the wards.

Building on @E tank's answer:

According to the below YouTube video, 25% of 0.9% NaCl (Saline) stays intravascular where as 8.5% of D5W stays intravascular because the glucose is rapidly metabolized in the liver thus creating a hypotonic solution which rapidly redistributes throughout the body's fluid compartments.

 

[E tank]

Right...and even then, what NS remains is gone in about 6 hours with normal renal function.