The intravenous (IV) fluid infusion plays a very vital part in managing patients especially those who are admitted to hospital. The most important concern is to prescribe the IV fluid that is appropriate and clearly has the indication. For that, it requires an understanding of the physiology of fluid and electrolyte homeostasis, physiological responses to injury and disease, as well as knowledge of the properties of intravenous fluids. Glucose what we commonly known as sugar has a strong value in our regular diet. There are certain therapeutic indications for glucose; Glucose 5% is indicated for the treatment of carbohydrate and fluid depletion; 2. Glucose 5% is also used as a vehicle and diluent for compatible medicinal products for parenteral administration; 3. Dextrose 20%, 30%, 40%, 50% and 70% solutions are used for protein and nutrients in intravenous feeding formulations. There are some indications for IV therapy such as- a) Administration of prescribed IV fluids and medication b) To maintain and correct electrolyte imbalance c) Administration of emergency and lifesaving medication – where rapid effect is required d) Administration of blood and blood products e) Administration of Total Parenteral Nutrition f) Administration of medication that may not be administered by any other route. Also in medical practice, one cannot start IV fluid therapy without proper knowledge and training. In Bangladesh, the scenario is somehow different and alarming. It has become a remedy of weakness, particularly in the rural areas and as well as slum areas. People visit the local pharmacies or the village doctors for their problems. They can buy medicines without the prescription. If they complain of weakness, IV glucose saline or normal saline is prescribed and given in the pharmacy or at the patients’ home and that has been happening for many years. Unfortunately, the area is yet to be addressed in Bangladesh and there is scanty of literature.
The study was conducted in Noakhali district of Bangladesh. A total of two hundred samples were selected and data were collected by face to face interview. The queries regarding intravenous saline infusion were related to the health status of the participants, a source of the idea about learning of recovery of weakness by infusion of intravenous saline, activities during the period of weakness and awareness of the side effects of IV glucose.
Health and awareness of IV infusion of glucose saline
Usually, the infusion of saline is prescribed by the physician along with other drugs when there is clear indication of infusion of IV glucose saline. But in Bangladesh, the scenario is somehow different. One can buy medicine from any pharmacy without a prescription and even they can be infused with IV infusion in either pharmacy or at home by the people who run the pharmacies. So this radical approach by the nonprofessional persons who run the pharmacies has been going on for many years. Among two hundred participants about their recent health condition and 25% of them replied that they were feeling weak. Around 38% of the respondents took IV glucose infusion in their lifetime and the reason was only weakness. It is a serious concern. Among them, 68% didn’t visit a medical practitioner. The majority of the participants (around 45%) learned the ‘idea of infusion to cure weaknesses’ from family members and village practitioners or pharmacy personals who sale medicine. In Bangladesh people has the common perception that if someone feels weak, IV glucose saline infusion can reduce weakness to some extent.
Safe and effective prescribing of intravenous fluids requires an understanding of the physiology of fluid and electrolyte homeostasis, physiological responses to injury and disease, as well as knowledge of the properties of intravenous fluids. The major concern in Bangladesh is the lack of awareness among the general population about using of IV glucose saline. It won’t be easy to change the perception of using IV glucose saline for weakness. The regulatory authorities can play important roles to restrict the unscientific use of IV infusion as well as media can play roles in improving the awareness of general population.