Dextrose

AHFS Class: Caloric Agents (40:20)

VA Class: TN100

View the associated Essentials monograph.

Introduction

Dextrose is a carbohydrate caloric agent.

Uses

Dextrose injections are used as a source of calories and water for hydration. Dextrose and sodium chloride injections are used as a source of calories, sodium chloride, and water for hydration.

2.5–11.5% Dextrose injections are administered by peripheral IV infusion to provide calories and water for hydration; these injections may be admixed with amino acids injections or other compatible IV fluids to provide parenteral nutrition. Hypertonic dextrose injections (concentration greater than 5%) are used to provide adequate calories in a minimal volume of water. 40–70% Dextrose injections are concentrated sources of calories which are admixed with amino acids injections or other compatible IV fluids and administered via central veins to provide parenteral nutrition. 50% Dextrose injections are frequently used in adults and children to restore blood glucose concentrations in the treatment of hypoglycemia resulting from insulin excess or other causes. 10–25% Dextrose injections are used in neonates and infants to restore blood glucose concentrations in the treatment of acute symptomatic hypoglycemia.

Dextrose gel or chewable tablets are used orally for the management of hypoglycemia in conscious diabetics.

Dosage and Administration

Administration

Dextrose injections are administered IV. Hypertonic dextrose solutions are preferably administered via an IV catheter placed into a large central vein. If hypertonic (10%) dextrose solutions are administered peripherally, a large arm vein should be used and, if possible, the injection site should be alternated 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.

Concentrated dextrose gels and chewable dextrose tablets are administered orally in the management of acute symptomatic hypoglycemia.

Dosage

Dosage of dextrose depends on the age, weight, clinical condition, and fluid, electrolyte, and acid-base balance of the patient. Dextrose may usually be administered IV to healthy individuals at a rate of 0.5 g/kg per hour without producing glycosuria; the maximum infusion rate should generally not exceed 0.8 g/kg per hour.

For the treatment of hypoglycemia resulting from insulin excess or other causes in adults and children, the usual dose is 20–50 mL of 50% dextrose injection administered slowly (e.g., 3 mL/minute) IV; repeated doses and supportive therapy may be required in severe cases. For the treatment of acute symptomatic hypoglycemia in neonates and infants, the usual dose is 2 mL/kg of 10–25% dextrose injection administered slowly IV; higher or repeated doses may be required in severe cases, and subsequent continuous IV infusion of 10–15% dextrose injection may be necessary to maintain sufficient blood glucose concentrations. When patients do not respond to or tolerate dextrose, the use of other drugs (e.g., glucagon, corticosteroids, epinephrine) should be considered.

For the management of hypoglycemia in conscious diabetics, 10–20 g of dextrose may be administered orally as a gel or chewable tablets; the dose may be repeated in 10–20 minutes if necessary. Self monitoring of blood glucose concentration may be useful in determining whether a repeat dose is necessary; some clinicians recommend that if hypoglycemic symptoms are still present and a blood glucose increase of at least 20 mg/dL is not achieved within 20 minutes after oral administration of dextrose, the patient should consider administration of a repeat dose. Each gram of the 40% (w/w) dextrose gel provides 400 mg of dextrose (i.e., 25 g of gel provides 10 g of dextrose).

For further information on chemistry and stability, pharmacology, uses, cautions, and dosage and administration of dextrose, specialized references and the manufacturers’ labeling should be consulted.

Cautions

Adverse Effects

Reactions that may occur because of the solution (e.g., from contamination) or administration technique include fever, infection at the site of injection, venous thrombosis or phlebitis extending from the site of injection, and extravasation. If hypertonic dextrose solutions are infused too rapidly, local pain and, rarely, vein irritation may occur. Dextrose may usually be administered at a rate of 0.5 g/kg per hour without producing glycosuria. Hyperglycemia and glycosuria may occur as a result of the rate of administration or metabolic insufficiency; if undetected and untreated, this can lead to dehydration, hyperosmolar coma, and death. Appropriate treatment may include decreasing the infusion rate and administration of insulin. If an adverse effect occurs during administration of dextrose injection, the infusion should be discontinued, the patient evaluated, appropriate therapeutic measures instituted if necessary, and the remainder of the fluid saved for examination if necessary.

Precautions And Contraindications

Changes in fluid balance, electrolyte concentrations, and acid-base balance should be evaluated clinically and via periodic laboratory determinations during prolonged therapy with dextrose and in patients whose condition warrants such evaluation. Substantial changes may require additional electrolyte supplements or other appropriate therapy. Additional electrolyte supplementation may also be required in patients with substantial electrolyte losses resulting from conditions such as protracted nasogastric suctioning, vomiting, diarrhea, or GI fistula drainage.

Dextrose solutions should be used with caution in patients with overt or known subclinical diabetes mellitus or with carbohydrate intolerance for any reason. IV administration of dextrose may cause fluid and/or solute overload resulting in dilution of serum electrolytes, overhydration, congestive conditions, or pulmonary edema. The risk of dilutional conditions is inversely proportional to the electrolyte concentration administered, and the risk of solute overload and resultant congestive conditions with peripheral and/or pulmonary edema is directly proportional to the electrolyte concentration administered. IV administration of dextrose may result in hypokalemia, hypophosphatemia, and hypomagnesemia. Prolonged infusion of isotonic dextrose solutions may increase the volume of extracellular fluid and cause water intoxication. Rapid administration of hypertonic dextrose solutions may produce substantial hyperglycemia and hyperosmolar syndrome; patients should be observed for signs of mental confusion and loss of consciousness, especially those patients with chronic uremia or carbohydrate intolerance.

Prolonged parenteral nutrition with dextrose solutions may adversely affect the production of insulin; to avoid this potential adverse effect, and to minimize hyperglycemia and consequent glycosuria, it may be necessary to add insulin to the infusion. Blood and urinary glucose should be monitored periodically. When infusions of concentrated dextrose are discontinued, it is advisable to substitute a 5 or 10% dextrose solution to prevent rebound hypoglycemia.

Dextrose solutions which do not contain electrolytes should not be administered concomitantly with blood through the same IV infusion set because of the possibility of agglomeration. Hypertonic dextrose solutions are contraindicated in patients with anuria, or intraspinal or intracranial hemorrhage, and in patients with delirium tremens if such patients are already dehydrated. Hypertonic dextrose solutions are also contraindicated in patients with diabetic coma or known allergy to corn or corn products.

Pharmacology

Dextrose is readily metabolized; it increases blood glucose concentrations and provides calories. Dextrose may decrease body protein and nitrogen losses, promote glycogen deposition, and decrease or prevent ketosis if sufficient doses are given. Since dextrose is usually metabolized to carbon dioxide and water, administration of a solution of dextrose and water is equivalent to providing the same volume of free water. Following oral administration, dextrose, a monosaccharide, is rapidly absorbed from the small intestine principally by an active mechanism. In patients with hypoglycemia, increases in blood glucose concentration usually occur within 10–20 minutes and peak at about 40 minutes after oral administration of dextrose. In one study following oral administration of a 20-g dose of dextrose as tablets in hypoglycemic patients, mean blood glucose concentration increased by 32 mg/dL 20 minutes after administration.

Dextrose injection is capable of inducing diuresis depending on the volume administered and the clinical condition of the patient.

Chemistry

Dextrose is a monosaccharide usually obtained by the hydrolysis of starch (usually from corn), with the aid of hydrochloric or sulfuric acid. Dextrose contains one molecule of water of hydration or is anhydrous. The sugar occurs as colorless crystals or as a white, crystalline or granular powder and has a sweet taste. Dextrose is freely soluble in water, very soluble in boiling water, slightly soluble in alcohol, and sparingly soluble in boiling alcohol. Each gram of hydrous or anhydrous dextrose provides approximately 3.4 or 3.85 calories, respectively.

Dextrose injection is a sterile solution of hydrous dextrose in water for injection, and dextrose and sodium chloride injection is a sterile solution of hydrous dextrose and sodium chloride in water for injection. Dextrose injections and dextrose and sodium chloride injections have a pH of 3.5–6.5 and contain no bacteriostatic or antimicrobial agents or added buffers.

The caloric values and calculated osmolarities of the various dextrose injections are as follows:

Preparations

Dextrose is also commercially available in combination with amino acids (see Amino Acid Injections 40:20), dextran or hetastarch (see 40:12), electrolytes (see Electrolyte Solutions 40:12), and potassium chloride (see Potassium Supplements 40:12) for IV administration.

Dextrose

Routes	Forms	Strengths	Brand Names	Manufacturer
Oral	Gel	40% (w/w)	Glutose®	Paddock
			Insta-Glucose®	Valeant
	Tablets, chewable	5 g*	B-D 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

* available by nonproprietary name

Alcohol in Dextrose

Routes	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 by nonproprietary name

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

Dextrose and Sodium Chloride

Routes	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
		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

* available by nonproprietary name

Selected Revisions July 2006, © Copyright, January 1959, American Society of Health-System Pharmacists, Inc. 7272 Wisconsin Avenue, Bethesda, MD 20814.