I’m doing medicine nights this month and every morning I staff the new patients with my attending. A very high proportion of these patients are chest pain and urgent surgery candidates, so many of them end up being NPO for several hours. I usually start LR, especially if they are volume down. But yesterday she asked me “what does LR not contain that the patient needs?” My answer was phosphate; her answer was sugar. She then asked me to give all my fasting patients D5 NS or D5 LR, despite my protests that gluconeogenesis exists. Her response was that everyone will become hypoglycemic and “go into ketoacidosis” after a few hours. I’ve NEVER witnessed this.
My question is does anyone have a source that D5 is neutral or even harmful in otherwise in non-hypoglycemic hospitalized patients? Ive heard in passing that it is indeed harmful. I’ve tried searching but there is too much noise out there.
Edit: she specifically asked me to send her an article that supports the notion that IV dextrose isn’t necessary in a fasting state. Maybe I’ll ask
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