dextrose (d-glucose)
D2.5W , D5W , D10W , D20W , D25W , D30W , D38W , D40W , D50W , D60W , D70W

Pharmacologic classification: carbohydrate
Therapeutic classification: total parenteral nutrition component, caloric product, fluid volume replacement
Pregnancy risk category C


Available forms
Available by prescription only
Injection: 1,000 ml (2.5%, 5%, 10%, 20%, 30%, 40%, 50%, 60%, 70%); 500 ml (5%, 10%, 20%, 30%, 40%, 50%, 60%, 70%); 400 ml (5%); 250 ml (5%, 10%); 100 ml (5%); 70-ml pin-top vial (70% for additive use only); 50 ml (5% and 50% available in vial, ampule, and Bristoject); 10 ml (25%); 5-ml ampule (10%); 3-ml ampule (10%)

Indications and dosages
 Fluid replacement and calorie supplementation in patients who can’t maintain adequate oral intake or who are restricted from doing so. Adults and children: Dosage depends on fluid and caloric requirements. Use peripheral I.V. infusion of 2.5% or 5% solution or central I.V. infusion of 10% or 20% solution for minimal fluid needs. Use 50% solution to treat insulin-induced hypoglycemia. Use 25% to treat hypoglycemia in the neonate or older infant. Solutions from 10% to 70% are used diluted in admixtures, normally with amino acid solutions, and administered via a central vein.

Pharmacodynamics
Metabolic action: Dextrose is a rapidly metabolized source of calories and fluids in patients with inadequate oral intake. While increasing blood glucose levels, dextrose may decrease body protein and nitrogen losses, promote glycogen deposition, and decrease or prevent ketosis if sufficient doses are given. Dextrose also may induce diuresis. Parenterally injected doses of dextrose undergo oxidation to carbon dioxide and water. A 5% solution is isotonic and is administered peripherally. Concentrated dextrose infusions provide increased caloric intake with less fluid volume; they may be irritating if given by peripheral infusion. Solutions above 10% should be given only by central venous catheter.

Pharmacokinetics
Absorption: Administered I.V.
Distribution: As a source of calories and water for hydration, dextrose solutions expand plasma volume.
Metabolism: Metabolized to carbon dioxide and water.
Excretion: In some patients, dextrose solutions may produce diuresis.

Route Onset Peak Duration
I.V. Immediate Immediate Unknown


Contraindications and precautions
Contraindicated in patients in diabetic coma while blood glucose level remains excessively high. Concentrated solutions are contraindicated in patients with intracranial or intraspinal hemorrhage, in dehydrated patients with alcohol withdrawal syndrome, and in patients with severe dehydration, anuria, hepatic coma, or glucose-galactose malabsorption syndrome.
  Use cautiously in patients with cardiac or pulmonary disease, hypertension, renal insufficiency, urinary obstruction, or hypovolemia.

Interactions
Drug-drug. Additives: May be incompatible. Must be introduced aseptically, mixed thoroughly, and not stored.
Blood: May cause pseudoagglutination of RBCs. Don’t give with blood through same infusion set.
Corticosteroids, corticotropin: May cause increased serum glucose levels. Administer cautiously; monitor patient closely.
Insulin, oral hypoglycemics: May alter drug requirements and cause vitamin B complex deficiency. Monitor serum glucose levels.

Adverse reactions
CNS: confusion, unconsciousness in hyperosmolar hyperglycemic nonketotic syndrome, fever.
CV: pulmonary edema, exacerbated hypertension, heart failure in susceptible patients (with fluid overload); phlebitis, venous sclerosis, tissue necrosis (with prolonged or concentrated infusions, especially when administered peripherally).
GU: glycosuria, osmotic diuresis.
Metabolic: hyperglycemia, hypervolemia, hypovolemia, dehydration, hyperosmolarity (with rapid infusion of concentrated solution or prolonged infusion); hypoglycemia from rebound hyperinsulinemia.
Skin: sloughing and tissue necrosis, if extravasation occurs with concentrated solutions.
Other: vitamin B complex deficiency (with rapid termination of long-term infusion).

Effects on lab test results
• May increase or decrease glucose level.

Overdose and treatment
If fluid or solute overload occurs during I.V. therapy, reevaluate patient’s condition and institute appropriate corrective treatment. Decrease infusion rate or adjust insulin dosage as needed.

Special considerations
• Monitor infusion rate for maximum dextrose infusion of 0.5 g/kg/hour, using largest available peripheral vein and well-placed needle or catheter. However, hypertonic dextrose solutions may cause thrombosis if infused via peripheral vein; therefore, administer via central venous catheter.
• Avoid rapid administration, which may cause hyperglycemia, hyperosmolar syndrome, or glycosuria.
• Infuse concentrated solutions slowly; rapid infusion can cause hyperglycemia and fluid shifts.
• Hypertonic solutions are more likely than isotonic or hypotonic solutions to cause irritation; they should be administered into larger central veins.
• Depletion of pancreatic insulin production and secretion can occur. To avoid an adverse effect on insulin production, patient may need to have insulin added to infusions.
• Excessive administration of potassium-free solutions may result in hypokalemia. Potassium should be added to dextrose solutions and administered to fasting patients with good renal function; special precautions should be taken with patients receiving a cardiac glycoside.
• Infuse concentrated solutions via central venous catheter with meticulous aseptic technique because bacteria thrive in high-glucose environments.
• D5W or D10W solution is advisable upon discontinuation of concentrated dextrose infusions to avoid rebound hypoglycemia.
• Monitor fluid imbalance or changes in electrolyte levels and acid-base balance by periodic laboratory determinations during prolonged therapy. Additional electrolyte supplementation may be needed.
• Carefully monitor patient’s intake, output, and body weight, especially in patients with renal dysfunction.
• If fluid or solute overload occurs during I.V. therapy, reevaluate patient’s condition and institute appropriate corrective treatment. Decrease infusion rate or adjust insulin dosage as needed.
Pediatric patients
• Use cautiously in infants of diabetic women, except as may be indicated for newborn infants who are hypoglycemic.

Patient education
• Explain need for drug.
• Tell patient to report adverse effects promptly.

Reactions may be common, uncommon, life-threatening, or COMMON AND LIFE THREATENING.
◆ Canada only
◇ Unlabeled clinical use