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Dextrose

Pronunciation

Class: Caloric Agents
VA Class: TN100
Brands: BD Glucose, Glutose, Insta-Glucose

Introduction

Carbohydrate caloric agent; monosaccharide.a b c d e f i j

Uses for Dextrose

Parenteral Nutrition and Hydration

Used as a parenteral source of calories and water for parenteral nutrition and hydration.a b c d e f i j

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Hypertonic dextrose injections (concentration >5%) are used to provide adequate calories in a minimal volume of water.a

May be admixed with amino acids injections or other compatible IV fluids to provide parenteral nutrition.a b c d j

Hypoglycemia

10–25% dextrose injections used in neonates and infants to restore blood glucose concentrations in the treatment of acute symptomatic hypoglycemia.a i

50% dextrose injections used in adults and children to restore blood glucose concentrations in the treatment of hypoglycemia resulting from insulin excess or other causes.a

Used orally for the management of hypoglycemia in conscious diabetics.a g h

Dextrose Dosage and Administration

Administration

Administer orally, by slow IV injection, or slow IV infusion.a b c d e f i

Concentrated dextrose solutions should not be administered by sub-Q or IM injection.b c d f i

Oral Administration

Administer orally as a gel or a chewable tablet for the management of acute symptomatic hypoglycemia in conscious patients who are able to swallow.a g

To administer gel, squeeze appropriate dose from tube into mouth and swallow.g

IV Administration

Administer hypertonic dextrose solutions (e.g., >5%) slowly; rapid administration may produce substantial hyperglycemia and hyperosmolar syndrome.a b c d j (See Hyperglycemia and Hyperosmolar Syndrome under Cautions.)

It is preferable to administer hypertonic dextrose solutions via an IV catheter placed into a large central vein, and only after appropriate admixture or dilution.a b c d i j

Hypertonic dextrose solutions may be administered slowly via a large peripheral vein, preferably through a small bore needle.a b c d e f If possible, alternate the injection site daily.a

Ensure that the needle (or catheter) is within the vein lumen and avoid extravasation.b d e f i (See Infusion Site Reactions under Cautions.)

Administer concentrated dextrose solutions (≥10%) only after appropriate dilution,b c d except in the emergency treatment of severe hypoglycemia.a

Rate of Administration

Usually, administer by IV infusion at a rate of 0.5 g/kg per hour.a Approximately 95% of dextrose is retained when infused at a rate of 0.8 g/kg per hour.b c d (See Prescribing Limits under Dosage and Administration.)

For hypoglycemia in children and adults, administer 50% dextrose injection slowly (e.g., 3 mL/minute).a

For hypoglycemia in neonates and infants, administer 10–25% dextrose injection slowly.a

Dosage

Each 1 gram of hydrous dextrose provides approximately 3.4 calories.a

Dextrose gel contains 40% glucose; each dose (1.3 ounces) provides 15 g of carbohydrates and 60 calories.g

Each chewable tablet provides 5 g of carbohydrates and 20 calories; each dose (3 tablets) provides 15 g of carbohydrates.h

Determine dosage based on the age, weight, clinical condition, fluid and electrolyte balance, glucose concentration, and acid-base balance of the patient.a e j

Caloric Values and Calculated Osmolarities of Various Dextrose Injections a

Dextrose (%)

Calories/L

Calc. Osmolarity (mOsm/L)

2.5

85

126

5

170

250

7.7

260

390

10

340

505

11.5

390

580

20

680

1010

25

850

1330

30

1020

1515

38

1290

1920

40

1360

2020

50

1700

2525

60

2040

3030

70

2380

3530

Pediatric Patients

Select dosage and infusion rate with caution in pediatric patients, especially in neonates and low-birthweight infants.b d e i j

Parenteral Nutrition and Hydration
IV

Calculate dosage based on patient’s weight, clinical condition, and laboratory results.e

Hypoglycemia
Oral

Gel: 15 g.g Repeat dose after 15 minutes, if necessary.g

Chewable tablet: 15 g (3 tablets).h Repeat dose after 10–20 minutes, if necessary.a

Some clinicians recommend consideration of an additional dose if hypoglycemic symptoms are still present and a blood glucose increase of ≥20 mg/dL is not achieved within 20 minutes.a

IV

Neonates and infants: 250–500 mg/kg as a single dose (1–2 mL of 25% dextrose injection) in neonates.i In severe cases or in older infants, higher or repeated single doses up to a maximum 10–12 mL of 25% dextrose injection may be required.i Subsequently, if required, administer 10% dextrose injection by continuous IV infusion to stabilize blood glucose concentrations.i Alternatively, 2 mL/kg of 10–25% dextrose injection in neonates and infants.a

Children: 20–50 mL of 50% dextrose injection administered slowly (e.g., 3 mL/minute).a In severe cases, repeated doses and supportive therapy may required.a

Adults

Parenteral Nutrition and Hydration
IV

Calculate dosage based on age, weight, clinical condition, fluid and electrolyte balance, and acid-base balance of the patient.a

Hypoglycemia
Oral

Gel: 15 g.g Repeat dose after 15 minutes, if necessary.g

Chewable tablet: 15 g (3 tablets).h Repeat dose after 10–20 minutes, if necessary.a

Some clinicians recommend consideration of an additional dose if hypoglycemic symptoms are still present and a blood glucose increase of ≥20 mg/dL is not achieved within 20 minutes.a

IV

20–50 mL of 50% dextrose injection administered slowly (e.g., 3 mL/minute).a In severe cases, repeated doses and supportive therapy may be required.a

When patients do not respond to or tolerate dextrose, consider the use of other drugs (e.g., glucagon, corticosteroids, epinephrine).a

Prescribing Limits

Pediatric Patients

Parenteral Nutrition and Hydration
IV

Children: Maximum infusion rate without producing glycosuria: 0.5 g/kg per hour.a b c d f Maximum infusion rate 0.8 g/kg per hour.a

Hypoglycemia
IV

Neonates and infants: Maximum 10–12 mL of 25% dextrose injection in severe cases or in older infants.i

Children: Maximum infusion rate without producing glycosuria: 0.5 g/kg per hour.a b c d f Maximum infusion rate 0.8 g/kg per hour.a

Adults

Parenteral Nutrition and Hydration
IV

Maximum infusion rate without producing glycosuria: 0.5 g/kg per hour.a b c d f Maximum infusion rate 0.8 g/kg per hour.a

Hypoglycemia
IV

Maximum infusion rate without producing glycosuria: 0.5 g/kg per hour.a b c d f Maximum infusion rate 0.8 g/kg per hour.a

Special Populations

No specific dosage recommendations for special populations.b c d e

Cautions for Dextrose

Contraindications

  • Simultaneous administration of dextrose solutions (without electrolytes) with blood through the same infusion set; risk of RBC cell pseudoagglutination.a b c d

  • Hypertonic Dextrose Solutions
  • Hypersensitivity to corn products.a e f j

  • Anuria.a j

  • Hepaticj or diabetic coma.a

  • Intracranial or intraspinal hemorrhage.a b c d i j

  • Dehydrated patients with delirium tremens.a b c d j

Warnings/Precautions

Warnings

Administer concentrated dextrose injections under supervision of a qualified clinician familiar with IV technique and possible complications.j

Hyperglycemia and Hyperosmolar Syndrome

Risk of hyperglycemia and/or hyperosmolar syndrome (e.g., dehydration, hypovolemia, mental confusion, loss of consciousness) with rapid administration, especially in patients with chronic uremia and known carbohydrate intolerance.a b c d i Administer hypertonic dextrose solutions slowly.a b c d i

Monitor blood and urine glucose levels; administration of insulin may be required.a b d

When infusions of concentrated dextrose are discontinued, consider a 5 or 10% dextrose substitute solution to prevent rebound hypoglycemia.a b d

Fluid and/or Solute Overload

Possible fluid and/or solute overload resulting in dilution of serum electrolytes, overhydration, congested conditions, or pulmonary edema.a b c d e (See Electrolyte Disturbances under Cautions.)

Risk of dilutional conditions is inversely proportional to the electrolyte concentration administered.a e Risk of solute overload and resultant congestive conditions with peripheral and/or pulmonary edema is directly proportional to the electrolyte concentration administered.a e

Aluminum Content

Concentrated dextrose solutions (e.g., 10, 20, 30, 40, 50, and 70%) contain aluminum; may reach toxic levels with prolonged parenteral administration if kidney function is impaired, including in premature neonates.b c d j If such patients receive parenteral aluminum in amounts >4–5 mcg/kg daily, aluminum may accumulate at levels associated with CNS and bone toxicity.b c d j Tissue loading may occur at even lower rates of administration.b c d j (See Pediatric Use under Cautions.)

Infusion Site Reactions

Infusion site and other reactions (e.g., fever, infection at the injection site, venous thrombosis, hypervolemia, extravasation, phlebitis extending from injection site) possible.a b c d e i j May occur because of the solution (e.g., contamination) or administration technique.a b c d e i j

Hypertonic dextrose injections may cause local pain or venous irritation or damage.a e j (See IV Administration under Dosage and Administration.) If adverse effects occur, discontinue infusion; evaluate patient and institute appropriate therapeutic measures; save remainder of fluid for examination, if necessary.a b c d e i j

General Precautions

Electrolyte Disturbances

Possible hypokalemia and hypophosphatemia after prolonged use of concentrated dextrose solutions.b c d e

As patient’s condition warrants and during prolonged therapy, evaluate changes in fluid balance, electrolyte concentrations, and acid-base balance, both clinically and via laboratory determinations.a b c d e j Correct fluid and electrolyte imbalances and provide essential vitamins and minerals, if necessary.b c d e

Patients with substantial electrolyte losses (e.g., resulting from protracted nasogastric suctioning, vomiting, diarrhea, or GI fistula drainage) may require additional electrolyte supplementation.a e

Use of Fixed Combinations

When dextrose is used in fixed combination with sodium chloride or alcohol, consider the cautions, precautions, and contraindications associated with sodium chloride and alcohol.e f

Diabetes

Use with caution in patients with known subclinical or overt diabetes mellitus.a b c d j

Use with caution in infants of diabetic mothers except when indicated in hypoglycemic neonates.i

Specific Populations

Pregnancy

Category C.b c d e f i j

Lactation

Not known whether dextrose is excreted into milk.e Use with caution in nursing women.e j

Pediatric Use

Risk of glucose intolerance and hyperglycemia in pediatric patients, especially in low-birthweight infants and neonates.d e i j Use solutions containing ≥10% dextrose with caution in low-birthweight premature neonates;b e i j monitor glucose levels frequently.b d e i j

Risk of increased serum osmolality and possible intracerebral hemorrhage with excessive or rapid administration in low-birthweight infants.b d j

Concentrated dextrose solutions contain aluminum, which may be toxic in premature neonates and in individuals with impaired kidney function.b c d j Premature neonates are at particular risk because of immature kidneys and because they require large amounts of calcium and phosphate solutions, which contain aluminum.b c d j (See Aluminum Content under Cautions.)

Safety and efficacy of dextrose and alcohol injection and dextrose and sodium chloride injection not established.e f

Dextrose gel not recommended for children <2 years of age.g

Common Adverse Effects

Fever,a b c d e i j injection site infection,a b c d e i j extravasation.a b c d e i j

Interactions for Dextrose

Specific Drugs

Drug

Interaction

Comments

Digoxin

Electrolyte disturbances (i.e., hypokalemia) produced by large doses of dextrose may predispose digitalized patients to toxicityk (see Electrolyte Disturbances under Cautions)

Additional potassium may be required in fasting patients with normal renal functione

Dextrose Pharmacokinetics

Absorption

Bioavailability

Following oral administration, rapidly absorbed from the small intestine.a

Onset

Following oral tablet administration, blood glucose concentration increases usually occur within 10–20 minutes.a

Following oral tablet administration of a 20-g dose of dextrose in hypoglycemic patients, mean blood glucose concentration increased by 32 mg/dL 20 minutes after administration.a

Duration

Following oral administration, blood glucose concentrations peak at about 40 minutes.a

Plasma Concentrations

Following oral tablet administration, a 15-g dose provides an approximate 30-mg/dL increase in blood glucose concentration.h

Distribution

Extent

Not known whether dextrose is distributed into human milk.e

Elimination

Metabolism

Readily metabolized to carbon dioxide and water.a b c d e i

Stability

Storage

Parenteral

Solutions for Injection

Dextrose (10, 20, 30, 40, 50, or 70%): 20–25°C (may be exposed to 40°C); avoid excessive heat and protect from freezing.b c d j

Dextrose and sodium chloride: 25°C (may be exposed to 40°C); avoid excessive heat and protect from freezing.e

Dextrose and alcohol: 25°C (may be exposed to 40°C); avoid excessive heat and protect from freezing.f

Actions

  • Increases blood glucose concentrations and provides calories and water.a b c d e f i j

  • May aid in minimizing liver glycogen depletion, exert a protein-sparing action, and decrease or prevent ketosis.a b c d e i

  • Induces diuresis.a e j

Advice to Patients

  • Advise diabetic patients to carry dextrose (glucose) in the form of a gel or tablet in case of a hypoglycemic event.g h

  • Importance of informing clinician of existing or contemplated concomitant therapy, including prescription and OTC drugs and dietary products, as well as any concomitant illnesses.b

  • Importance of women informing clinicians if they are or plan to become pregnant or plan to breast-feed.b

  • Importance of advising patients of other important precautionary information.b (See Cautions.)

Preparations

Excipients in commercially available drug preparations may have clinically important effects in some individuals; consult specific product labeling for details.

* available from one or more manufacturer, distributor, and/or repackager by generic (nonproprietary) name

Dextrose

Routes

Dosage Forms

Strengths

Brand Names

Manufacturer

Oral

Gel

40% (w/w)

Glutose

Paddock

Insta-Glucose

Valeant

Tablets, chewable

5 g*

BD Glucose

Becton Dickinson

Parenteral

Injection

2.5%*

2.5% Dextrose Injection

Baxter, Hospira

5%*

5% Dextrose Injection

Braun, Hospira, IMS

10%*

10% Dextrose Injection

Abraxis, Baxter, Braun, Hospira

20%*

20% Dextrose Injection

Baxter, Braun, Hospira

25%*

25% Dextrose Injection

Hospira

30%*

30% Dextrose Injection

Baxter, Braun, Hospira

38%*

38% Dextrose Injection

Braun

40%*

40% Dextrose Injection

Baxter, Braun, Hospira

50%*

50% Dextrose Injection

Abraxis, Astra, Baxter, Braun, Hospira

60%*

60% Dextrose Injection

Baxter, Braun, Hospira

70%*

70% Dextrose Injection

Baxter, Braun, Hospira

Dextrose is also commercially available in combination with amino acids, dextran or hetastarch, electrolytes and potassium chloride for IV administration.

* available from one or more manufacturer, distributor, and/or repackager by generic (nonproprietary) name

Alcohol in Dextrose

Routes

Dosage Forms

Strengths

Brand Names

Manufacturer

Parenteral

Injection

5% Alcohol in 5% Dextrose*

5% Alcohol and 5% Dextrose Injection

Baxter, Braun, Hospira

10% Alcohol and 5% Dextrose*

10% Alcohol and 5% Dextrose Injection

Braun

* available from one or more manufacturer, distributor, and/or repackager by generic (nonproprietary) name

Dextrose and Sodium Chloride

Routes

Dosage Forms

Strengths

Brand Names

Manufacturer

Parenteral

Injection

2.5% Dextrose and 0.45% Sodium Chloride*

2.5% Dextrose and 0.45% Sodium Chloride Injection

Baxter, Braun, Hospira

3.3% Dextrose and 0.30% Sodium Chloride

3.3% Dextrose and 0.30% Sodium Chloride Injection

Braun

5% Dextrose and 0.11% Sodium Chloride*

5% Dextrose and 0.11% Sodium Chloride Injection

Braun

5% Dextrose and 0.2% Sodium Chloride*

5% Dextrose and 0.2% Sodium Chloride Injection

Baxter, Braun

5% Dextrose and 0.225% Sodium Chloride*

5% Dextrose and 0.225% Sodium Chloride Injection

Hospira

5% Dextrose and 0.3% Sodium Chloride*

5% Dextrose and 0.3% Sodium Chloride Injection

Hospira

5% Dextrose and 0.33% Sodium Chloride*

5% Dextrose and 0.33% Sodium Chloride Injection

Baxter, Braun

5% Dextrose and 0.45% Sodium Chloride*

5% Dextrose and 0.45% Sodium Chloride Injection

Baxter, Braun, Hospira

5% Dextrose and 0.9% Sodium Chloride*

5% Dextrose and 0.9% Sodium Chloride Injection

Baxter, Braun, Hospira

10% Dextrose and 0.2% Sodium Chloride*

10% Dextrose and 0.2% Sodium Chloride Injection

Braun

10% Dextrose and 0.45% Sodium Chloride*

10% Dextrose and 0.45% Sodium Chloride Injection

Braun

10% Dextrose and 0.9% Sodium Chloride*

10% Dextrose and 0.9% Sodium Chloride Injection

Baxter, Braun, Hospira

Dextrose and sodium chloride are also commercially available in combination with electrolytes and potassium chloride (see Potassium Supplements 40:12) for IV administration.

AHFS DI Essentials. © Copyright, 2004-2014, Selected Revisions August 1, 2008. American Society of Health-System Pharmacists, Inc., 7272 Wisconsin Avenue, Bethesda, Maryland 20814.

References

a. AHFS drug information 2008. McEvoy GK, ed. Dextrose. Bethesda, MD: American Society of Health-System Pharmacists; 2008: 2746-7.

b. Hospira. Dextrose 50% and 70% injection, USP package insert. Lake Forest, IL. 2006 Jul.

c. Hospira. Dextrose 10% injection, USP package insert. Lake Forest, IL. 2006 Jul.

d. Hospira. Dextrose 20%,30%, 40%, 50% and 70% for injection, USP package insert. Lake Forest, IL. 2005 Sept.

e. B. Braun Medical Inc. Dextrose and Sodium Chloride Injection, USP package insert. Irvine, CA. 2004 Nov.

f. B. Braun Medical Inc. Dextrose 5% and alcohol 5% and 10% injections, USP package insert. Irvine, CA;1999 Jun.

g. Paddock Laboratories. Glutose 15 g dextrose (glucose) gel patient information.

h. BD. BDGlucose 5 g tablet patient information.

i. Hospira. Dextrose monohydrate 25% injection, solution prescribing information. Lake Forest, IL; 2004 Jul.

j. Baxter Healthcare. Dextrose injection 20%, 50% and 70% injection, USP package insert. Deerfield, IL.2000 Dec.

k. AHFS drug information 2008. McEvoy GK, ed. Cardiac Glycosides General Statement. Bethesda, MD: American Society of Health-System Pharmacists; 2008:1686-93.

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