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dextrose (D50W, DGlucose, glucose)

 

Classes: Glucose-Elevating Agents; Metabolic & Endocrine, Other

Dosing and uses of D50W, DGlucose (dextrose)

 

Adult dosage forms and strengths

intravenous solution

  • 2.5%
  • 5%
  • 10%
  • 20%
  • 30%
  • 50%
  • 70%

oral liquid

  • 55%

 

Hypoglycemia

IV: 10-25 g (ie, 20-50 mL 50% solution or 40-100 mL of 25%)

PO: 4-20 g as a single dose; may repeat after 15 min if self-montoring of blood glucose shows continued hypoglycemia

 

Pediatric dosage forms and strengths

intravenous solution

  • 2.5%
  • 5%
  • 10%
  • 20%
  • 30%
  • 50%
  • 70%

oral liquid

  • 55%

 

Hypoglycemia

Dilute before IV administration, may give more concentrated solution peripherally in emergency (ie, 12.5-25%)

< 6 months

  • 0.25-0.5 g/kg/dose (1-2 mL/kg/dose of 25% solution) IV; not to exceed 25 g/dose

Infants > 6 months and Children

  • 0.5-1 g/kg up to 25 g (2-4 mL/kg/dose of 25% solution) IV; not to exceed 25 g/dose

Adolescents

  • IV: 10-25 g (ie, 20-50 mL 50% solution or 40-100 mL of 25%)
  • PO: 4-20 g as a single dose; may repeat after 15 min if self-montoring of blood glucose shows continued hypoglycemia

 

D50W, DGlucose (dextrose) adverse (side) effects

Frequency not defined

Hyperosmolarity

Edema

Venous thrombosis

Tachypnea

Fever

Hypermolar syndrome

Hypervolemia

Phlebitis

Diarrhea

Polydipsia

Pulmonary edema

Cerebral hemorrhage

Mental confusion, unconsciousness

Cerebral ischemia

Hypophosphatemia

Hypomagnesemia

Hyperglycemia

Injection site extravasation

Tissue necrosis

 

Warnings

Contraindications

Documented hypersensitivity; severe dehydration

 

Cautions

Use caution in DM or carbohydrate intolerance

Give 5% or 10% dextrose to avoid reactive hypoglycemia when highly concentrated dextrose infusion is abruptly withdrawn

An unexpected rise in blood glucose level in a stable patient may be an early symptom of infection; monitor for signs and symptoms of infection and laboratory parameters

Significant hypokalemia may occur from administration of potassium free IV dextrose solutions

Significant hyponatermia or water intoxication may occur from low sodium or sodium-free IV dextrose solution

Use caution in patients with diabetes mellitus; reduce the rate of infusion to reduce the possibilities of causing hyperglycemia and glycosuria

Increased serum osmolality and possible intracerebral hemorrhage may occur from rapid or excessive dextrose administration

Rebound hypoglycemia may occur following abrupt withdrawaL

Hypertonic solutions (>10%) may cause thrombosis when infused through peripheral veins; best to infuse through a central venous catherer

Monitor changes in fluid balance, electrolyte concentrations, and acid-base balance during prolonged use

Caution advised, to avoid air embolism, when infusing medication

Monitor glucose levels and for possible hyperglycemia when treating pediatric patients

Dextrose injection contains aluminum that may be toxic; patients with impaired renal function, and preterm infants, at higher risk;. limit aluminum to <4 mcg/kg/day

Parenteral nutrition associated with liver disease; increased risk in patients who receive parenteral nutrition for extended periods of time, especially preterm infants; monitor liver function tests, if abnormalities occur consider discontinuation or dosage reduction

Monitor blood glucose and administer insulin as needed

 

Pregnancy and lactation

Pregnancy category: C/A (oral)

Maternal and fetal hyperglycemia may occur during labor and delivery; monitor

Lactation: Excretion in milk unknown; use with caution

 

Pregnancy categories

A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.

B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.

C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.

D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.

X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.

NA: Information not available.

 

Pharmacology of D50W, DGlucose (dextrose)

Mechanism of action

Parenteral dextrose is oxidized to carbon dioxide and water, and provides 3.4 cal/g of d-glucose

 

Pharmacokinetics

Bioavailability: Rapidly absorbed

Metabolism: dextrose (the monosaccharide glucose) is used, distributed and stored by body tissues and is metabolized to carbon dioxide and water with the release of energy

Metabolites: Carbon dioxide and water

Onset of action: 10 min (hypglycemia)

Peak plasma time: 40 min (PO)

 

Administration

IV Administration

Hypertonic dextrose solutions are preferably administered via an IV catheter placed into a large central vein

If hypertonic (10%) dextrose solutions are administered peripherally, use a large arm vein, if possible, alternate injection site daily

Except in the emergency treatment of severe hypoglycemia, higher concentrations of dextrose injections (e.g., 20% and higher) should be administered via central veins and only after appropriate dilution

When used for the emergency treatment of hypoglycemia, hypertonic dextrose injections may be administered slowly via a peripheral vein

Include final filter to administration protocol and visually inspect container