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Carbohydrate IV Solutions and Additives, 10% or lessGlucose Products for HypoglycemiaGlucose/Dextrose Products for GTTSolutions with One Carbohydrate
Dextrose (also known as glucose) is available in many various dosage formsUsed orally or parenterally to treat hypoglycemia (e.g., diabetic patients) and orally for glucose tolerance testsAlso used parenterally as a carbohydrate source in intravenous fluids and total parenteral nutrition (TPN) and as adjunctive treatment for hyperkalemia
Advocate Glucose SOS, Dex4 Glucose, Glutol, Glutose 15, Glutose 45, Glutose 5
Advocate Glucose SOS Oral Pwd: 15gDex4 Glucose/Dextrose/Glucose/Glutose 15/Glutose 45/Glutose 5 Oral Gel: 15g, 24g, 40%Dex4 Glucose/Dextrose/Glutol Oral Sol: 15g, 100g, 180mLDex4 Glucose/Glucose Oral Tab Chew: 4g, 15gDextrose Intracardiac Inj Sol: 5%Dextrose Intravenous Inj Sol: 5%, 10%, 20%, 25%, 30%, 50%, 70%Dextrose Intravenous Sol: 40%
15 to 20 grams glucose PO. If after 15 minutes the blood glucose is still below 70 mg/dL, ingest another 15 to 20 grams of glucose. Once blood glucose returns to normal, consume a meal or snack to prevent recurrence of hypoglycemia. If symptoms of hypoglycemia persist, contact a physician. Glucose is the preferred treatment for hypoglycemia in patients who are conscious and able to take oral replacement. Intravenous dextrose can be used in conscious or unconscious patients receiving medical care. Glucagon should be prescribed for all patients at significant risk of severe hypoglycemia.
10 to 25 grams/dose (20 to 50 mL of a 50% solution) IV to restore blood glucose concentrations. In severe cases, repeat doses may be needed. Subsequent continuous IV infusion of dextrose 10% injection may be necessary to stabilize serum glucose concentrations in some individuals.
0.5 to 1 g/kg/dose (5 to 10 mL/kg/dose of a 10% solution, 2 to 4 mL/kg/dose of a 25% solution, or 1 to 2 mL/kg/dose of a 50% solution) IV (Max: 25 g/dose). Follow bolus with continuous infusion if continued therapy is indicated.
200 mg/kg/dose IV of a 10% solution. Follow bolus with continuous infusion if continued therapy is indicated.
25 g (50 mL of 50% solution) IV over 5 minutes in conjunction with regular insulin. 100 g (1,000 mL of 10% solution) IV administered over 1 to 2 hours also may be used. Dextrose increases insulin release, aids in redistribution of potassium into the cells, and prevents hypoglycemia when given with insulin.
0.5 g/kg (5 mL/kg of a 10% solution) IV over 30 minutes in conjunction with regular insulin.
Doses are determined on individual patient needs based on weight, age, and clinical condition. Clinical practice guidelines recommend the carbohydrate content of parenteral nutrition should not exceed 7 g/kg/day IV. A minimum of 2 g/kg/day IV is recommended for critically ill patients.
100 grams PO of anhydrous glucose dissolved in water (or a commercially available glucose testing drink containing similar content). The beverage should be consumed in 5 minutes or less. The maximum glucose concentration in the beverage is 25 g/100 mL. The 1-step test takes a fasting sample, followed by 3 blood samples in the 3 hours following glucose ingestion. In pregnancy, in the absence of criteria that meet the traditional diagnosis of diabetes, gestational diabetes is diagnosed when 2 or more values meet or exceed the following: Fasting: 95 mg/dL; 1 hour: 180 mg/dL; 2 hours: 155 mg/dL; and 3 hours: 140 mg/dL.
A modified screen may be performed using 50 grams PO of anhydrous glucose dissolved in water (or a commercially available glucose testing drink containing similar content). The beverage should be consumed in 5 minutes or less. The maximum glucose concentration in the beverage is 25 grams/100 mL. A sample is taken 1 hour after the 50-grams glucose challenge; the normal response is plasma glucose less than 140 mg/dL. Perform the usual gestational 100 grams oral GTT on those patients with a plasma glucose level that exceeds this threshold value.
75 grams PO of anhydrous glucose dissolved in water (or a commercially available glucose testing drink containing similar content). The beverage should be consumed in 5 minutes or less. The maximum glucose concentration in the beverage is 25 grams/100 mL. Diagnostic criteria following the oral GTT are as follows: Prediabetes (impaired glucose tolerance): 2-hour plasma glucose 140 to 199 mg/dL. Diabetes: 2-hour plasma glucose 200 mg/dL or more. Per the ADA, a fasting blood glucose (FPG) is the recommended screening test for most individuals. The oral GTT may be necessary for the diagnosis of diabetes when the FPG is normal. The FPG is preferred for screenings because it is faster and easier to perform, more convenient, acceptable to patients, and less expensive.
1.75 grams/kg (not to exceed 75 grams) PO of anhydrous glucose dissolved in water (or a commercially available glucose testing drink containing similar content). The beverage should be consumed in 5 minutes or less. The maximum glucose concentration in the beverage is 25 grams/100 mL. Diagnostic criteria are the same as for adults for 2-hour sample following the test.
Dosage for dextrose is individualized to the patient's individual requirements.
No specific maximum dosage information is available.
Specific guidelines for dosage adjustments in hepatic impairment are not available; it appears that no dosage adjustments are needed.
Specific guidelines for dosage adjustments in renal impairment are not available; it appears that no dosage adjustments are needed.
Do not administer oral glucose products to anyone who is unconscious or unable to swallow.
Glucose tablets: Chew tablets thoroughly before swallowing.Glucose powder: Place powder in directly into mouth or into a small glass of water and let it dissolve.Repeat dose if after 15 minutes glucose concentrations still test low (less than 70 mg/dL).Once blood glucose returns to normal, consume a meal or snack to prevent recurrence of hypoglycemia. If symptoms of hypoglycemia persist, contact a physician.
Glucose (dextrose) oral gel or liquid oral solutionTake as directed on product label.Repeat dose if after 15 minutes glucose concentrations still test low (less than 70 mg/dL).Once blood glucose returns to normal, consume a meal or snack to prevent recurrence of hypoglycemia.If symptoms of hypoglycemia persist, contact a physician. Glucose (dextrose) oral solutions for diagnostic use (glucose tolerance test, GTT)See Dosage/Indications for more information on the GTT test and administration.
Visually inspect parenteral products for particulate matter and discoloration prior to administration whenever solution and container permit.
DilutionConcentrated dextrose solutions (i.e., 20% to 70%) MUST be diluted with compatible IV solutions or used as an admixture. They are NOT for direct IV infusion.Check for specific IV compatibilities. When introducing additives to commercially prepared dextrose solutions, use aseptic technique, mix thoroughly, and do not store. IV InfusionDextrose solutions are administered by slow IV infusion.Solutions containing more than 5% dextrose or parenteral nutrition solutions with an osmolarity of 900 mOsm/L or more should be infused via a central vein. Infusion into a peripheral vein may result in vein irritation, vein damage, thrombosis, and venous thrombophlebitis.Do not administer dextrose injection without electrolytes simultaneously with blood through the same infusion set because of the possibility that pseudo-agglutination of red cells may occur.When a concentrated dextrose infusion is abruptly withdrawn, it is advisable to follow with the administration of 5% Dextrose Injection or 10% Dextrose Injection to avoid rebound hypoglycemia.The maximum rate of infusion to avoid glycosuria is 0.5 g/kg/hour. Approximately 95% of the dextrose is retained when infused at a rate of 0.8 g/kg/hour. Directions for use of flexible pharmacy bulk packages (e.g., as for parenteral nutrition admixtures)Slight opacity of the plastic due to moisture absorption during the sterilization process may be observed in the 2,000 mL flexible pharmacy bulk packages of 50% Dextrose Injection and 70% Dextrose Injection. The opacity will gradually diminish.During use, container must be stored, and all manipulations performed, an appropriate laminar flow hood.When ready for compounding, insert piercing pin of transfer set into outlet port at bottom of container and suspend unit in laminar flow hood. Insertion of pin should only be performed once. Once the outlet has been entered, withdraw contents promptly and in 1 continuous operation. If this is not possible, a maximum time of 4 hours from pin placement is permitted to complete fluid transfer. Discard container no later than 4 hours after pin placement.Compounded admixtures utilizing 2,000 mL flexible pharmacy bulk packages of 50% Dextrose Injection and 70% Dextrose Injection may be stored under refrigeration for up to 24 hours. Complete administration of admixtures within 24 hours after removal from refrigeration.
Generic:- Avoid excessive heat (above 104 degrees F)- Avoid exposure to heat- Discard product if it contains particulate matter, is cloudy, or discolored- Discard unused portion. Do not store for later use.- Protect from freezing- Store at controlled room temperature (between 68 and 77 degrees F)Advocate Glucose SOS:- Storage information not provided in labelingDex4 Glucose:- Avoid excessive heat (above 104 degrees F)- Do not freeze- Do not refrigerate- Protect from moisture- Store at room temperatureGlutol :- Avoid exposure to heat- Protect from freezing- Store in a cool, dry placeGlutose 15 :- Store at room temperature (between 59 to 86 degrees F)Glutose 45 :- Store at room temperature (between 59 to 86 degrees F)Glutose 5:- Store at room temperature (between 59 to 86 degrees F)
Intravenous glucose (dextrose) should be given to a pregnant woman only if clearly needed, and doses should be individualized to the patient's needs to meet fluid and nutritional requirements. Frequent monitoring of serum glucose concentrations is required. Animal reproduction studies have not been conducted; it is not known whether dextrose can cause fetal harm when administered to a pregnant woman or can affect reproduction capacity. However, when used appropriately, there appears to be minimal risk to the clinical use of dextrose products during pregnancy when necessary. Oral glucose supplement products have not been assigned a pregnancy category by the FDA, but are not harmful when used as directed in the recommended doses to treat episodes of hypoglycemia in the conscious pregnant individual as per guideline recommendations. Oral glucose (15 to 20 grams) is the preferred treatment for the conscious patient, although any form of carbohydrate that contains glucose may be used.
Glucose and dextrose administration pose no particular risks during breast-feeding. Lactose is the major carbohydrate of human milk and is also the major osmotic constituent of human milk. Synthesis of lactose is the major determinant of the volume of milk produced by the lactating human mammary gland. Lactose is synthesized from free glucose and UDP-galactose. Thus, proper carbohydrate consumption by the mother during lactation is essential to milk production.
Dextrose injection solutions are contraindicated in patients with a dextrose hypersensitivity. Hypersensitivity and infusion reactions, including anaphylaxis, have been reported with dextrose injection solutions. Use dextrose injection solutions with caution in patients with severe corn hypersensitivity. Some intravenous solution manufacturers caution that the dextrose in the solutions may be derived from corn.
Concentrated intravenous dextrose solutions are contraindicated in patients with severe dehydration as hypertonic dextrose solutions can worsen the patient's hyperosmolar state. A concentrated parenteral dextrose solution should not be used when intraspinal or intracranial bleeding is present nor in the presence of delirium tremens if dehydration is present.
Concentrated dextrose solutions used as part of a parenteral nutrition regimen may lead to refeeding syndrome and electrolyte imbalance (i.e., hypokalemia, hypophosphatemia, hypomagnesemia) in patients with severe malnutrition or critically ill patients when parenteral nutrition is initiated. Refeeding syndrome is characterized by the intracellular shift of potassium, phosphorus, and magnesium as the patient becomes anabolic. The intravenous administration of dextrose solutions can also cause fluid and/or solute overload resulting in dilution of serum electrolyte concentrations, including hypoosmotic hyponatremia, overhydration, congested states (congestive heart failure) or pulmonary edema. Patients at high risk for developing hyponatremic encephalopathy include pediatric patients, geriatric patients, premenopausal women, patients with hypoxemia, and patients with underlying CNS disease. In high-risk patients, parenteral nutrition should be initiated gradually to minimize the potential for refeeding syndrome. Monitor electrolytes; fluid and electrolyte imbalances should be corrected. Essential vitamins and minerals also should be provided as needed.
Do not give parenteral dextrose via subcutaneous administration or intramuscular administration. Administer dextrose intravenously, taking care to insure that the needle (or catheter) is well within the lumen of the vein and that extravasation does not occur.
Administer concentrated parenteral dextrose solutions only after suitable dilution. They are not for direct IV infusion. Solutions containing more than 5% dextrose or with an osmolality of 900 mOsm/L or greater should be infused via a central vein. Infusion into a peripheral vein may result in vein irritation, vein damage, thrombosis, and venous thrombophlebitis, which manifests as pain, erythema, tenderness or a palpable cord. Remove the catheter as soon as possible if thrombophlebitis develops. Hypertonic parenteral dextrose solutions should also be given slowly. Significant hyperglycemia and possible hyperosmolar hyperglycemic state (HHS) may result from too rapid administration. The physician should be aware of the symptoms of HHS, such as mental confusion and loss of consciousness, especially in patients with chronic uremia and those with known carbohydrate intolerance.
Use caution when administering intravenous dextrose solutions to patients with renal impairment and particularly neonates, low birth weight infants, and premature neonates since dextrose solution contains aluminum, which may be toxic. Aluminum may reach toxic levels with prolonged parenteral administration in patients with renal impairment. Premature neonates are particularly at risk because their kidneys are immature, and they require large amounts of calcium and phosphate solutions, which contain aluminum. Research indicates that patients with renal impairment, including premature neonates, who receive parenteral levels of aluminum at greater than 4 to 5 mcg/kg/day accumulate aluminum at levels associated with CNS and bone toxicity. Tissue loading may occur at even lower rates of administration. In addition, caution should be exercised with low birth weight premature neonates, who are receiving dextrose concentrations of 10% or greater, as they are most susceptible to glucose intolerance, hyperglycemia, and parenteral nutrition-associated liver disease [PNALD]. Frequent monitoring of serum glucose concentrations, electrolytes, and organ function is required. In at-risk infants, excessive or rapid administration of dextrose injection may result in increased serum osmolality and possible intracerebral hemorrhage.
Intravenous solutions containing dextrose should be used with caution in patients with known hyperglycemia or subclinical or overt diabetes mellitus. Patients may require insulin or other measures to maintain desired serum glucose concentrations.
Concentrated dextrose solutions used as part of a parenteral nutrition regimen should be used with caution in patients with hepatic disease. Hepatobiliary disorders, including cholestasis, hepatic steatosis, steatohepatitis, hepatic fibrosis, and cirrhosis (parenteral nutrition-associated liver disease [PNALD]), potentially leading to hepatic failure, may occur in patients with or without preexisting hepatic disease who receive parenteral nutrition. Cholecystitis and cholelithiasis have also been observed. Premature infants may be at particular risk for PNALD. Monitor liver function tests closely in patients receiving parenteral nutrition. If liver function test abnormalities develop, consider discontinuation or dose reduction of the parenteral nutrition solution.
Concentrated parenteral dextrose solutions used as part of a parenteral nutrition regimen may lead to infection and related infectious complications. The risk of infection is increased in patients with malnutrition-associated immunosuppression, patients using parenteral nutrition long-term or with poor maintenance of intravenous catheters, and patients with concomitant conditions or receiving drugs associated with immunosuppression. To decrease the risk of infection, ensure adherence to aseptic techniques in catheter placement, catheter maintenance, and preparation and administration of the parenteral nutrition solution. Monitor for signs and symptoms of early infections (fever and chills), including laboratory tests that may indicate infection (leukocytosis and hyperglycemia). Frequently assess the parenteral access device and insertion site for edema, redness, and discharge.
anaphylactoid reactions / Rapid / 0-0.1bronchospasm / Rapid / Incidence not knownangioedema / Rapid / Incidence not knowncyanosis / Early / Incidence not knownrefeeding syndrome / Delayed / Incidence not knownpulmonary edema / Early / Incidence not knownaluminum toxicity / Delayed / Incidence not knowncholecystitis / Delayed / Incidence not knownpulmonary embolism / Delayed / Incidence not known
hyperglycemia / Delayed / 1.0-10.0confusion / Early / 0-1.0dehydration / Delayed / 0-1.0glycosuria / Early / 0-1.0dyspnea / Early / Incidence not knownhypotension / Rapid / Incidence not knownhypophosphatemia / Delayed / Incidence not knownhypokalemia / Delayed / Incidence not knownhypomagnesemia / Delayed / Incidence not knownhyponatremia / Delayed / Incidence not knownhepatitis / Delayed / Incidence not knownjaundice / Delayed / Incidence not knownparenteral nutrition-associated liver disease / Delayed / Incidence not knowncholestasis / Delayed / Incidence not knownelevated hepatic enzymes / Delayed / Incidence not knownsteatosis / Delayed / Incidence not knowncholelithiasis / Delayed / Incidence not knownhepatomegaly / Delayed / Incidence not known
rash / Early / 0-0.1urticaria / Rapid / 0-0.1pruritus / Rapid / 0-0.1chills / Rapid / Incidence not knownfever / Early / Incidence not known
There are no drug interactions associated with Dextrose, Glucose products.
Glucose is also known as dextrose. Glucose is a monosaccharide, also known as a simple sugar. As a carbohydrate, glucose supplies energy to cells, organs, and tissues. Some tissues can also use fat or protein as an energy source but others, such as the brain and red blood cells, only use glucose. Dextrose in intravenous fluids undergoes oxidation to carbon dioxide and water, and quickly provides fluid and calories. Oral glucose also works quickly (usually within 15 minutes) by raising blood glucose concentrations to alleviate symptoms of hypoglycemia.
Dextrose (glucose) is administered orally and intravenously. As a carbohydrate, glucose supplies energy to cells, organs, and tissues. Some tissues can also use fat or protein as an energy source but others, such as the brain and red blood cells, only use glucose. Glucose can be stored in the body as glycogen and the liver is the primary site of glycogen storage. Glycogen is mobilized from the liver and converted to glucose by gluconeogenesis when the blood glucose concentration is low. Gluconeogenesis is stimulated in response to the release of glucagon by the alpha cells of the pancreas when low blood glucose concentrations occur. Glucose may also be produced from non-carbohydrate precursors, such as pyruvate, amino acids and glycerol, by gluconeogenesis. It is gluconeogenesis that maintains blood glucose concentrations, for example during starvation or intense exercise. Cellular uptake of glucose occurs in response to insulin, and glucose is subsequently broken down through glycolysis, lowering blood sugar levels. Glycolysis is the metabolic pathway that converts glucose into pyruvate. The free energy released in this process is used to form the molecules ATP and NADH which are needed for many cellular functions/reactions. Affected Cytochrome P450 (CYP) 450 enzymes and drug transporters: None
Orally administered glucose is absorbed rapidly via transport from the intestinal lumen, across the epithelium and into blood. Onset of action usually occurs in 15 minutes.