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REVIEW ARTICLE
Year : 2022  |  Volume : 6  |  Issue : 2  |  Page : 36-42

0.9% sodium chloride versus dextrose 5% in water safety as medication's diluents in critically ill patients: Meta-analysis of observational studies


1 Department of Pharmaceutical Care, King Abdulaziz University Hospital; Department of Pharmaceutical Care, King Fahad Armed Forces Hospital, Jeddah, Saudi Arabia
2 Department of Pharmaceutical Care, King Abdulaziz University Hospital, Jeddah, Saudi Arabia
3 Department of Pharmacy Practice, Faculty of Pharmacy, King Abdulaziz University, Jeddah, Saudi Arabia; College of Pharmacy, University of Arizona, Tucson, AZ, United States
4 Department of Pharmacy Practice, College of Pharmacy, Princess Nourah bint Abdulrahman University, Riyadh, Saudi Arabia
5 Department of Pharmacy Practice, College of Pharmacy, Princess Nourah bint Abdulrahman University; Department of Pharmaceutical Care, King Abdulaziz Medical City; King Abdullah International Medical Research Center; College of Pharmacy, King Saud bin Abdulaziz University for Health Sciences; Saudi Critical Care Pharmacy Research (SCAPE) Platform, Riyadh, Saudi Arabia
6 Department of Pharmacy Practice, Faculty of Pharmacy, King Abdulaziz University, Jeddah; Saudi Critical Care Pharmacy Research (SCAPE) Platform, Riyadh, Saudi Arabia

Correspondence Address:
Samiah Alsohimi
Pharmaceutical Care Department , King Abdulaziz University Hospital; Pharmaceutical Care Department, King fahad Armed Forces Hospital, Jeddah
Saudi Arabia
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/sccj.sccj_11_22

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Adverse drug effects such as electrolyte abnormalities and acid-base disturbances are commonly associated with intravenous (IV) fluids administered in the intensive care units (ICUs). Although several studies have addressed the risk associated with resuscitative fluids in ICU patients, limited data evaluating the safety of IV medications diluents and their association with clinical outcomes in critical care settings. We conducted a systematic review and meta-analysis to compare the safety of 0.9% sodium chloride (0.9% NaCl) and dextrose 5% in water (D5W) as drug diluents in ICU settings. We searched PubMed, MEDLINE, Cochrane Library bibliographic databases, and conference abstracts for studies comparing medication diluents in adult critically ill patients. Our primary outcome was the risk of hypernatremia. The secondary outcomes included hyperchloremia, acute kidney injury (AKI) rate, ICU length of stay (LOS), ICU mortality, and hospital mortality. Three observational studies were included (1549 patients), all received 0.9% NaCl as standard diluents and D5W was the comparison. Our results shows that hypernatremia and hyperchloremia were significantly higher in 0.9% NaCl group (risk ratio [RR], 1.84; 95% confidence interval [CI], 1.38–2.47; P ≤ 0.001; I = 0%), (RR, 1.78; 95% CI, 1.38–2.31; P < 0.001, I2 = 0%), respectively. There was no significant difference in AKI risk, hyperglycemia, and hospital mortality between the groups. However, the 0.9% NaCl group has a longer ICU LOS (mean difference 0·407, 0·062–0·752; P = 0.021). The utilization of D5W as medication diluent in critical care settings was associated with a lower incidence of hypernatremia and hyperchloremia, In addition, may be associated with shorter ICU LOS.


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