- Administer concentrated dextrose in water only after suitable dilution. Administer hypertonic dextrose solutions slowly. Too rapid administration may result in significant hyperglycemia and possible hyperosmolar syndrome
- Remain aware of the symptoms of hyperosmolar syndrome, such as mental confusion and loss of consciousness, especially in patients with chronic uremia and those with known carbohydrate intolerance
- IV administration of these solutions may result in fluid and/or solute overloading causing dilution of serum electrolyte concentrations, overhydration, congested states or pulmonary edema
- Toxic levels of aluminum are present in this drug. Long term parenteral administration in presence of renal impairment results in toxic levels of aluminum. Particularly premature neonates are at higher risk as their kidneys are immature and they require larger amounts of calcium and phosphate solutions which contain aluminum
- Long term infusion of isotonic or hypotonic dextrose in water can increase the volume of extracellular fluid and cause water intoxication
- Avoid simultaneous administration of solutions containing dextrose without electrolytes with blood through the same infusion set as possibility of agglomeration exists
- Patients with impaired kidney function, including premature neonates receiving parenteral levels of aluminum at >4-5 mcg/kg/day accumulate aluminum at levels associated with CNS and bone toxicity. Tissue loading can occur at even lower rates of administration
- Administer hypertonic dextrose solutions >5% concentration slowly preferably through a small bore needle into a large vein to minimize venous irritation
- Administer concentrated dextrose via central vein after appropriate admixture or dilution when required
- Electrolyte deficits, particularly in serum potassium and phosphate may occur during long term use of concentrated dextrose solutions
- Monitor blood electrolytes and correct fluid and electrolyte imbalances. Also provide essential vitamins and minerals as needed
- For minimizing hyperglycemia and consequent glycosuria it is desirable for monitoring blood and urine glucose and if necessary add insulin. On abrupt withdrawal of concentrated dextrose infusion it is advisable to follow it with the administration of 5% or 10% dextrose to avoid rebound hypoglycemia
- Hypokalemia may occur during parenteral administration of hypertonic dextrose solutions. Add Sufficient amounts of potassium to dextrose solutions to fasting patients with good renal function, especially those on digitalis therapy
- Exercise care to insure that the needle (or catheter) is well within the lumen of the vein and that extravasation does not occur
- Avoid administration of concentrated dextrose solutions subcutaneously or intramuscularly
- Avoid administration unless solution is clear and container is undamaged. Discard unused portion
- Increased serum osmolality and possible intracerebral hemorrhage may occur in very low birth weight infants on excessive or rapid administration of dextrose injection
- For minimizing the risk of possible incompatibilities arising from mixing this solution with other additives that may be prescribed inspect the final infusate for cloudiness or precipitation immediately after mixing prior to administration and periodically during administration
- Take care to discontinue pumping action before the container runs dry or air embolism may occur if administration is controlled by a pumping device
- Replace IV administration apparatus at least once every 24 hrs
- Avoid using plastic container in series connection
Cautions: Use cautiously in
- Renal insufficiency
- Patients with known subclinical or overt diabetes mellitus
- Neonates
- Chronic alcoholics or severely malnourished patients
- Hypervolemia
- Urinary tract obstruction
- Impending or frank cardiac decompensation
- Carbohydrate intolerance
Pregnancy Category:C
Breastfeeding: Manufacturer advises caution.
