Monday July 21, 2008


Q: 6 elderly patients have been brought from nursing home in summer season due to heatstroke after AC (aircondioner) stop working in the facility. Nursing staff established IV (intravenous) lines quickly on arrival. You ordered lab work and 'cooling protocol' along with fluid resuscitation. But before IV fluid resuscitation starts which IV infusion is recommended?


Answer: Thiamine and Dextrose (D-50)

Hypoglycemia is very common in patients with heatstroke and actually may be a manifestation of underlying liver failure; therefore, infusion of dextrose 50% is recommnded in all patients with heatstroke.

Most of these patients are on malnutrition side and possibly thiamine deficient. Infusion of Dextrose may precipitate Wernicke's Encephalopathy* in these patients, therefore it is always a good idea to administer Thiamine before D-50 or addition of D-5 in IV fluid resuscitation.


* Disorder was described 25 years ago by Carl Wernicke as a triad of acute mental confusion, ataxia, opthalmoplegia