Dextrose 50% Injection

Dextrose 50% Injection

Dextrose 50% Injection, USP is a sterile, nonpyrogenic, hypertonic solution of dextrose in water for injection as a fluid and nutrient replenisher for intravenous administration.

Each mL of fluid contains 0.5 g of hydrous dextrose, which provides 3.4 kcal/gram. The solution has a calculated osmolarity of 2.53 mOsmol/mL, a pH of 4.2 (3.2 to 6.5), and may contain sodium hydroxide and/or hydrochloric acid to adjust the ph.

The solution contains no bacteriostatic, antimicrobial, or buffering agents (except for pH adjustment) and is only intended for single-dose injection. When using smaller doses, the unused portion should be discarded along with the entire unit.

Dextrose 50% Injection, USP is a hexose sugar that is freely soluble in water and has the chemical formula C6H12O6 H2O (D-glucose monohydrate).

Pharmacology in Clinical Practice

This solution, when administered intravenously, restores blood glucose levels in hypoglycaemia and provides a source of carbohydrate calories.

Carbohydrate in the form of dextrose may help to reduce liver glycogen depletion and has a protein-sparing effect. Dextrose injection oxidises to carbon dioxide and water.

Water is a necessary component of all body tissues and accounts for roughly 70% of total body weight. The average normal adult requirement is two to three litres (1.0 to 1.5 litres each for insensible water loss by perspiration and urine production).

Various regulatory mechanisms keep the water balance in check. Water distribution is primarily determined by electrolyte concentrations in body compartments, and sodium (Na+) plays an important role in maintaining physiologic equilibrium.

Indications and Applications

In the treatment of insulin hypoglycemia (hyperinsulinemia or insulin shock), 50% Dextrose Injection is used to restore blood glucose levels. After dilution, the solution is also indicated for intravenous infusion as a source of carbohydrate calories in patients whose oral intake is restricted or insufficient to meet nutritional requirements. Slow infusion of hypertonic solutions is required to ensure proper dextrose utilisation and avoid hyperglycemia.

Warnings

Because 50% Dextrose Injection is hypertonic, it can cause phlebitis and thrombosis at the injection site. Too rapid administration may cause significant hyperglycemia and possibly hyperosmolar syndrome.

The doctor should be aware of hyperosmolar syndrome symptoms such as mental confusion and loss of consciousness, especially in patients with chronic uraemia and known carbohydrate intolerance.

This solution can cause fluid and/or solute overloading, resulting in dilution of serum electrolyte concentrations, overhydration, congested states, or pulmonary edoema when administered intravenously.

Incompatible additives are possible. Consult a pharmacist if one is available. When adding additives, use an aseptic technique, thoroughly mix, and do not store.

For the administration of peripheral veins:

To avoid venous irritation, the solution should be administered slowly, preferably through a small-bore needle into a large vein.

To administer via central venous catheter:

Only after adequate dilution should concentrated dextrose be administered via central vein.

Precautions

Use only if the solution is clear and the seal is intact. Remove any unused portion.

Electrolyte deficiencies, particularly in serum potassium and phosphate, can occur when using concentrated dextrose solutions for an extended period of time. Monitoring blood electrolytes is critical, and fluid and electrolyte imbalances must be corrected. As needed, essential vitamins and minerals should be provided.

It is preferable to monitor blood and urine glucose levels and, if necessary, add insulin to reduce hyperglycemia and glycosuria.

To avoid rebound hypoglycemia, it is best to administer a 5% or 10% dextrose injection after abruptly discontinuing a concentrated dextrose infusion.

In patients with known subclinical or overt diabetes mellitus, dextrose solutions should be used with caution.

Care should be taken to ensure that the needle is well within the vein lumen and that no extravasation occurs. If thrombosis occurs during administration, the injection should be stopped and corrective measures should be implemented.

Subcutaneous or intramuscular administration of concentrated dextrose solutions is not recommended.

Carcinogenesis, Mutagenesis, and Fertility Impairment

There have been no studies with solutions in polypropylene syringes to evaluate carcinogenic, mutagenic, or fertility effects.

Pregnancy

Dextrose has not been used in animal reproduction studies. It is also unknown whether dextrose can cause fatal harm or affect reproduction capacity when administered to a pregnant woman. Dextrose should only be given to a pregnant woman if absolutely necessary.

Mothers who are breastfeeding

It is unknown whether this medication is excreted in human milk. Because many drugs are excreted in human milk, a nursing mother should exercise caution when receiving 50% Dextrose Injection, USP.

Overdosage

Re-evaluate the patient and institute appropriate corrective measures if overhydration or solute overload occurs during therapy.

Administration and Dose

For the administration of peripheral veins:

The solution should be injected slowly. The maximum rate of dextrose infusion without causing glycosuria is 0.5 g/kg of body weight/hour. When infused at a rate of 0.8 g/kg/hr, approximately 95% of the dextrose is retained.

An intravenous injection of 10 to 25 gm of dextrose (20 to 50 mL of 50% dextrose) is usually sufficient in insulin-induced hypoglycemia. In severe cases, repeated doses and supportive care may be required.

Before injecting the dextrose, a blood glucose test should be performed. In such cases, dextrose should be administered as soon as possible without waiting for pre-treatment test results.

To administer via central venous catheter:

Slow intravenous infusion of 50% Dextrose Injection, USP is used for total parenteral nutrition.

• following admixture with amino acid solutions via an indwelling catheter with the tip placed in a large central vein, preferably the superior vena cava.

• for injection after dilution with sterile water. Dosage should be adjusted to meet the needs of each individual patient. During prolonged parenteral therapy or whenever the patient’s condition warrants it, clinical evaluation and periodic laboratory determinations are required to monitor changes in fluid balance, electrolyte concentrations, and acid-base balance.

The maximum rate of dextrose administration that does not cause glycosuria is the same as stated previously. Prior to use, parenteral drug products should be visually inspected for particulate matter and discoloration.