Dextrose

# Dextrose ## Overview - **Classification**: Carbohydrate, Nutritional Supplement, Glucose Source - **Mechanism**: Provides readily available glucose as an essential energy substrate for cellular metabolism. It is metabolized to carbon dioxide and water, releasing energy. ## Primary Indications 1. **Hypoglycemia** - Emergency treatment of low blood sugar. 2. **Fluid & Calorie Replacement** - Component of parenteral nutrition (PN) or IV fluid therapy. 3. **Hyperkalemia** - Used with insulin to shift potassium intracellularly. ## Adult Dosing ### Standard Dosing **Hypoglycemia (Emergency)** - **Dose**: **25 g** (often as **50 mL of D50W** or **250 mL of D10W**) - **Frequency**: Once, may repeat if blood glucose remains low. - **Route**: Intravenous (IV) bolus over 1-3 minutes. **Fluid & Calorie Replacement (Component of IV Fluids/PN)** - **Dose**: Varies by concentration (e.g., D5W, D10W, D20W, D50W) and patient needs. - **Frequency**: Continuous infusion. - **Route**: Intravenous (IV) infusion. - **Maximum**: Individualized based on glucose tolerance and fluid status. Typical glucose utilization rate up to **5-7 mg/kg/min**. **Hyperkalemia** - **Dose**: **25-50 g** (as **50-100 mL of D50W**) - **Frequency**: Once, given concurrently with insulin (e.g., 10 units regular insulin IV). - **Route**: Intravenous (IV) bolus. ### Dose Adjustments - **Renal Impairment**: No direct dextrose dose adjustment. Monitor fluid balance, electrolytes, and blood glucose closely due to altered fluid excretion and potential for electrolyte disturbances. - **Hepatic Impairment**: No direct dextrose dose adjustment. Monitor blood glucose closely as hepatic glucose production/utilization may be impaired. - **Elderly Patients**: Use with caution. Monitor closely for fluid overload, hyperglycemia, and electrolyte imbalances. Start with lower infusion rates if fluid sensitive. ## Pediatric Dosing ### Neonates (0-28 days) - **Hypoglycemia (initial bolus)** - **Dose**: **0.2-0.5 g/kg** (e.g., **2-5 mL/kg of D10W**) - **Frequency**: Once, over 1-5 minutes. - **Maximum**: Do not exceed recommended dose per kg to avoid hyperglycemia and rebound hypoglycemia. - **Special Notes**: D10W is preferred to minimize osmolarity and vein irritation. - **Hypoglycemia (maintenance infusion)** - **Dose**: Initial Glucose Infusion Rate (GIR) **5-8 mg/kg/min**. Adjust based on blood glucose. - **Frequency**: Continuous infusion. - **Maximum**: Up to **10-12 mg/kg/min** depending on tolerance and underlying cause. ### Infants (1-12 months) - **Hypoglycemia (initial bolus)** - **Dose**: **0.5-1 g/kg** (e.g., **5-10 mL/kg of D10W** or **2-4 mL/kg of D25W**) - **Frequency**: Once, over 1-5 minutes. - **Maximum**: **25 g** (adult bolus dose). - **Special Notes**: D10W preferred for peripheral lines. D25W if fluid restriction or central access. - **Hypoglycemia (maintenance infusion)** - **Dose**: Initial GIR **5-8 mg/kg/min**. Adjust based on blood glucose. - **Frequency**: Continuous infusion. - **Maximum**: Similar to neonates; adjust based on tolerance. ### Children (1-12 years) - **Hypoglycemia (initial bolus)** - **Dose**: **0.5-1 g/kg** (e.g., **5-10 mL/kg of D10W**, or **2-4 mL/kg of D25W**, or **1-2 mL/kg of D50W**) - **Frequency**: Once, over 1-5 minutes. - **Maximum**: **25 g** (adult bolus dose). - **Special Notes**: D50W only for severe hypoglycemia or if very limited access; administer slowly and through central access if possible. - **Hypoglycemia (maintenance infusion)** - **Dose**: Initial GIR **4-6 mg/kg/min**. Adjust based on blood glucose. - **Frequency**: Continuous infusion. ### Adolescents (13-18 years) - **Dose**: Generally approach adult dosing recommendations. - **Maximum**: Adult maximum doses apply (e.g., **25 g** bolus for hypoglycemia). ## Safety Information ### Contraindications - **Absolute**: Known allergy to corn or corn products. - **Absolute**: Intracranial or intraspinal hemorrhage (unless hypoglycemia is life-threatening and carefully managed). - **Absolute**: Delirium tremens (without concurrent thiamine administration due to risk of Wernicke's encephalopathy). - **Relative**: Anuria (risk of fluid overload without sufficient kidney function). ### Common Adverse Effects - **Very Common (>10%)**: Hyperglycemia, glucosuria - **Common (1-10%)**: Fluid overload, peripheral edema, local pain or irritation at injection site (especially with higher concentrations) - **Serious but Rare**: Rebound hypoglycemia (with abrupt cessation of high-rate infusions), hypokalemia, hypophosphatemia, hyponatremia (dilutional), hyperosmolar hyperglycemic state. ### Key Drug Interactions - **Insulin**: Dextrose acts antagonistically to insulin's hypoglycemic effect; often co-administered for controlled glucose management. - **Corticosteroids**: May increase blood glucose levels, potentially requiring higher dextrose doses or more frequent monitoring. - **Diuretics**: Thiazide diuretics can cause hyperglycemia, potentially altering dextrose requirements. ## Monitoring & Follow-up - **Before Treatment**: Baseline blood glucose, electrolytes (Na, K, Mg, Phos). - **During Treatment**: - Blood glucose: Every 15-60 minutes initially, then every 1-4 hours (or more frequently) as indicated. - Electrolytes: Daily or as clinically indicated (especially K, Phos, Mg with significant glucose metabolism). - Fluid balance: Intake/output, vital signs, signs of fluid overload/dehydration. - **Clinical Signs**: Watch for symptoms of hypo/hyperglycemia, phlebitis at infusion site, fluid retention (edema, crackles). ## Clinical Pearls - 💡 **Tip 1**: Always verify blood glucose before and after dextrose administration for hypoglycemia. - 💡 **Tip 2**: Dextrose concentrations >D10% should ideally be administered via a central venous catheter to reduce risk of phlebitis and vein damage. - 💡 **Tip 3**: In patients with suspected alcohol abuse or malnutrition, administer thiamine **before** or concurrently with dextrose to prevent Wernicke-Korsakoff syndrome. - 💡 **Tip 4**: Rapid cessation of high-rate dextrose infusions can cause rebound hypoglycemia due to sustained insulin secretion. Taper infusions slowly if possible. > **⚠️ Important**: This information is for educational purposes only. Always consult current prescribing information, local guidelines, and clinical judgment before prescribing.