The next patient is a sick metabolic kid, the kind you dread because you can never remember all those metabolic pathways from medical school. Citrullinemia, maple syrup urine disease, gluteric acidemia – it makes your eyes cross.
The next patient is a sick metabolic kid, the kind you dread because you can never remember all those metabolic pathways from medical school. Citrullinemia, maple syrup urine disease, gluteric acidemia – it makes your eyes cross. Fortunately, there’s one common denominator: they are all threatened when they are metabolically stressed because they go into a catabolic state and crank out whatever toxic metabolite they can’t handle. Your goal is to stop catabolism and convert them to an anabolic state. How do you do that? D10 at about 1 and a half to twice maintenance while you look up their particular disorder and what else they are going to need. Fine, easy. So you ask the nurse for a bag of D10 and she says “we’re fresh out of that” or “we don’t have that here”. Time for the home-grown approach. How do you make your own D10?
Take a liter bag of D5 and two amps of D50. Withdraw from the bag of D5 100cc, the volume that is in your two amps of D50 so you don’t overfill and pop the bag. Now inject the two amps of D50 into the bag. Shaken, not stirred. Voila – you now have 10% dextrose.
3 Comments
You have actually just described how to make D9.5! Which is great! Unless an MD writes to give D10, in which case, it’s now a med error, because you just made and gave D9.5, not D10. I only say this because I had a partner get burned in court because he did this with a bad outcome patient. Well, the lawyer was able to discredit his testimony by proving he didn’t even know how to mix D10, or what concentration he actually mixed, which proved incompetence. SO, make sure the MD writes D9.5 if you do it this way so you’re covered!
Please show us how did you compute and make it D9.5% rather than D10%. Please explain.
Not John, but removing 100mL from the liter of D5 leaves you with 45g of glucose in 900 mL of fluid in the bag.
Add your 50g of glucose from the 100mL of D50 and now you have 95g of glucose in 1000mL, which is D9.5.