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Can we give dns 500 ml in periods first day?

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"Fluid Therapy"[MeSH Terms] AND "Postoperative Period"[MeSH Terms]

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dextrose normal saline (DNS) 500 ml first postoperative day maintenance fluid recommendation

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I read "periods first day" as the post-operative period, day 1. If you meant something else (menstruation, a medical patient, a child), tell me and I'll redo it.
Short answer: Yes, 500 mL of DNS (5% dextrose in 0.9% saline) is acceptable on day 1. It is a reasonable isotonic fluid early after surgery, but one 500 mL bag does not meet a full day's needs. It should be one part of a plan based on the patient's volume status, not a fixed order.
Why it fits
  • Schwartz's says postoperative fluid should follow the patient's estimated volume status and ongoing losses, and that an isotonic solution should be used in the initial postoperative period. Its switch to 5% dextrose in 0.45% saline comes after the first 24 to 48 hours, in patients who cannot tolerate enteral feeding. - Schwartz's Principles of Surgery, 11th Ed, "Postoperative Fluid Therapy"
  • DNS contains 154 mEq/L sodium, so it counts as isotonic. It also supplies about 25 g of dextrose per 500 mL, roughly 85 kcal.
How much a day needs
  • Mulholland's gives adult maintenance as 100 mL/kg for the first 10 kg, 50 mL/kg for the next 10 kg, and 20 mL/kg for each kg above that. A 70 kg adult needs about 2,500 mL/day. - Mulholland and Greenfield's Surgery, 7e, "Maintenance Fluid Therapy"
  • The same text lowers the amount above 20 kg to 15 mL/kg/day in cardiac disease or elderly patients.
  • Another source suggests giving about 75% of the usual maintenance on day 1, because ADH is raised after surgery. - Anesthesia Guide
  • Count all other fluids first: the intraoperative fluid, IV drug infusions, and any oral intake. Then add measured losses from vomiting, a nasogastric tube, drains and urine.
  • The usual target is urine output above 0.5 mL/kg/hr. Also check vital signs and daily weight. - Mulholland and Greenfield's Surgery, 7e
Practical points
  • 500 mL is often one bag run over about 6 to 8 hours as part of a 24-hour plan, alternating with Ringer's lactate or normal saline. Alternating avoids giving too much dextrose or free water.
  • In diabetes, sepsis or the stress response, the dextrose can raise blood sugar, so check glucose.
  • A lot of hypotonic or dextrose-based fluid early after surgery raises the risk of hyponatremia. Balanced isotonic fluids such as Ringer's lactate or Plasma-Lyte are often preferred for maintenance in surgical patients. - Zero to Finals
  • Add potassium only if urine output and renal function are adequate. - Schwartz's
  • Use less in heart failure, renal failure or elderly patients, and in hypernatremia.
  • Use more, with a different fluid, if the patient is bleeding, hypovolemic or has high drain, nasogastric or vomit losses.
Recent evidence check: I searched PubMed for systematic reviews and meta-analyses from the last two years on fluid therapy in the postoperative period. The three that came up covered intraoperative goal-directed therapy, fluids during cardiac arrest, and albumin. None of them changes the advice above.
If you tell me the patient's age, weight, type of surgery, diabetes status and heart and kidney function, I can work out a specific 24-hour fluid plan.
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