Unfortunately, during this time, the nurses failed to notice the infusion rate error or recognize that an infusion of plain D5W alone or an infusion rate of 200 mL/hour was unsafe for a six-year-old child.
In addition to the administration of hypotonic parenteral solutions, such as D5W or 2/3 and 1/3, oral and enteral intake may be a source of electrolyte-free water that contributes to the development of acute hyponatremia (e.
Although outside of the body the osmolarity of D5W is 250 mOsmol/L and similar to blood, once a litre of D5W solution is infused and the dextrose is metabolized, the entire litre (1, 000 mL) of solution is free water.
Thus, for every 1 litre of 2/3 and 1/3 infused, 444 mL (two thirds of the 667 mL of electrolyte-free water) will move into cells; for every 1 litre of D5W infused, 667 mL (two-thirds of the entire litre) will move into the body cells--including brain cells.
In this case, Lyftogt treated the lateral sural nerve and lower saphenous nerve where they cross over the Achilles tendon with D5W.
The injection of D5W to the osteofibrous tunnel entrances and along the nerve course immediately relieves pain and improves range of motion.