dextrose

REMS

IV: Lower-concentration (2.5–11.5%) injection provides hydration and calories.
Higher concentrations (up to 70%) treat hypoglycemia and in combination with amino acids provide calories for parenteral nutrition.
50%—treatment of hypoglycemia (hyperinsulinemia or insulin shock).
PO: Corrects hypoglycemia in conscious patients.

Contraind./Precautions ⬆ ⬇

Contraindicated in:

Hypersensitivity;
Clinically significant hyperglycemia;
Hypertonic solution (>5%) should not be given to patients with CNS bleeding or anuria or who are at risk of dehydration.

Use Cautiously in:

Known diabetic patients (frequent lab assessment necessary to quantitate appropriate doses);
Chronic alcoholics or severely malnourished patients (administration requires initial pretreatment with thiamine);
Underlying CNS disease and renal impairment;
Postoperative patients (↑ risk of hyponatremia);
Pedi: Neonates (excess/rapid infusion of solutions >10% may ↑ risk of intracerebral hemorrhage);
Pedi: ↑risk of hyponatremia in children;
Geri: ↑risk of hyponatremia in older adults.

Adv. Reactions/Side Effects ⬆ ⬇

Endo: inappropriate insulin secretion (long-term use)

F and E: hypokalemia, hypophosphatemia, fluid overload, hypomagnesemia, hyponatremia

Local: local pain/irritation at IV site (hypertonic solution)

Metab: glycosuria, hyperglycemia

Misc: HYPERSENSITIVITY REACTIONS (INCLUDING ANAPHYLAXIS)

Interactions ⬆ ⬇

Drug-drug:

Will alter requirements for insulin or oral hypoglycemic agents in diabetic patients.

Availability ⬆ ⬇

(Generic available)

Chewable tablets: 4 g; 5 g^OTC
Oral gel: 40%^OTC
Solution for injection: 2.5%; 5%; 10%; 20%; 25%; 30%; 40%; 50%; 60%; 70%
In combination with: sodium chloride, other electrolytes, and amino acids.

Route/Dosage ⬆ ⬇

Hydration (as 5% solution)

IV (Adults and Children ): 0.5–0.8 g/kg/hr.

Hypoglycemia

PO (Adults and Children ): Conscious patients: 10–20 g, may repeat in 10–20 min.
IV (Adults ): 20–50 mL of 50% solution infused slowly (3 mL/min).
IV (Infants >6 mo and Children): 0.5–1 g/kg/dose (maximum of 25 g/dose) (as 25% dextrose).
IV (Infants ≤6 mo and Neonates): 0.25–0.50 g/kg/dose (maximum of 25 g/dose) (as 25% dextrose).

US Brand Names ⬆ ⬇

glucose, Glutose, Insta-glucose, Insulin Reaction

Action ⬆ ⬇

Provides calories.

Therapeutic effects:

Provision of calories.
Prevention and treatment of hypoglycemia.

Classifications ⬆ ⬇

Therapeutic Classification: caloric sources

Pharmacologic Classification: carbohydrates

Pharmacokinetics ⬆ ⬇

Absorption: Well absorbed following oral administration.

Distribution: Widely distributed and rapidly utilized.

Metabolism/Excretion: Metabolized to carbon dioxide and water. When renal threshold is exceeded, dextrose is excreted unchanged by the kidneys.

Half-Life: Unknown.

Time/Action Profile ⬆ ⬇

(effects on blood sugar in diabetic patients)

ROUTE	ONSET	PEAK	DURATION
PO	rapid	rapid	brief
IV	rapid	rapid	brief

Patient/Family Teaching ⬆ ⬇

Explain the purpose of dextrose administration to patient.
Instruct diabetic patient on the correct method for self-blood glucose monitoring.
Advise patient on when and how to administer dextrose products for hypoglycemia.

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Indications ⬇