A marathon runner is taken to the emergency department (ED) following a race in which the runner became disoriented, complained of a significant headache, and was dizzy

Question

The client reports drinking several bottles of water immediately following the race. A new ED nurse starts an IV of D5W on this client and the symptoms become worse. Another nurse notices the IV fluids and discusses her concerns regarding the IV fluid with the new nurse. What are the concerns? 1. D5W breaks down into free water when the glucose is metabolized and is increasing the degree of the client's hyponatremia.
2. D5W is the IV fluid of choice and should be infusing at a faster rate.
3. D5W is only given to clients who are admitted to an acute care setting, not those in the ED.
4. D5W increases the sodium for this client too rapidly.

Answer 1

D5W breaks down into free water when the glucose is metabolized and is increasing the client's hyponatremia.

Rationale: The marathon runner is at risk for alteration in sodium—either hypernatremia due to the excessive sweating from physical exertion of running 26.2 miles or hyponatremia from losing excessive sodium. However, when the runner drank large quantities of water following the race, the runner's risk for developing hyponatremia increased, especially if the runner's electrolytes were already low. The D5W breaks down into free water when the glucose is metabolized and makes the circulating sodium levels even lower. D5W is not the IV fluid of choice when hyponatremia is suspected. D5W can be utilized for many other clients, as appropriate, in various settings, not just a medical surgical inpatient setting. D5W does not increase the sodium in a client.