The next patient is a sick metabolic kid, the kind you dread because you can never remember all those metabolic pathways from medical school. Citrullinemia, maple syrup urine disease, gluteric acidemia – it makes your eyes cross. Fortunately, there’s one common denominator: they are all threatened when they are metabolically stressed because they go into a catabolic state and crank out whatever toxic metabolite they can’t handle. Your goal is to stop catabolism and convert them to an anabolic state. How do you do that? D10 at about 1 and a half to twice maintenance while you look up their particular disorder and what else they are going to need. Fine, easy. So you ask the nurse for a bag of D10 and she says “we’re fresh out of that” or “we don’t have that here”. Time for the home-grown approach. How do you make your own D10?

Take a liter bag of D5 and two amps of D50. Withdraw from the bag of D5 100cc, the volume that is in your two amps of D50 so you don’t overfill and pop the bag. Now inject the two amps of D50 into the bag. Shaken, not stirred. Voila – you now have 10% dextrose.