Dextrose Dynamics: An Overview

Overview

Dextrose (hydrous dextrose) injection is used as a source of nourishment with water and calories, replenishing fluids and providing energy. It can be found in generic form. When a patient is unable to take in enough liquids or needs more fluids, this sterile solution gives the body extra water and carbohydrates (calories from sugar). The United States Food and Drug Administration (USFDA) approved Dextrose injection on November 23, 1998.

Drug Group:

Dextrose injection belongs to the glucose-elevating agents' drug class.

Indications:

Dextrose is combined with amino acids or other well-coordinating fluids and injected intravenously. This combination gives patients energy when they are unable to consume enough food or liquids for various reasons, such as dysphagia (difficulty swallowing), inadequate nutrients from food, or contraindications to eating or drinking.

Contraindications:

It is not recommended to use Dextrose injection in some patients because:

• Excessive concentration can exacerbate the symptoms of severe dehydration.

• One should not take Dextrose if they have a known allergy to it or an adverse reaction to it.

Dosage Forms and Available Strengths: There are several strengths of Dextrose injection available: 20 percent, 30 percent, 40 percent, 50 percent, and 70 percent. These are solutions that have different concentrations of dissolved sugar, or Dextrose, in water. They have therapeutic use.

They are supplied in flexible, one-dose, partially filled containers that are pliable and designed for single usage.

• In a 1000 mL (milliliters) flexible container with 500 mL containers:

  • 20 percent solution indicates that there are 20 grams of sugar for every 100 mL of solution.

  • 30 percent solution indicates that for every 100 mL of solution, there are 30 grams of sugar.

  • 40 percent solution contains 40 grams of sugar for every 100 mL.

  • 50 percent solution contains 50 grams of sugar for every 100 mL of solution.

  • 70 percent solution contains 70 grams of sugar for every 100 mL.

• Regarding the 2000 mL flexible container holding the 1000 mL containers.

  • 50 percent solution contains 50 grams of sugar for every 100 milliliters of solution.

These solutions are stronger than typical bodily fluids, sterile (free of microorganisms), and do not cause fever.

For Patients

What Is Hypoglycemia?

When the blood glucose level falls below a safe range, it is referred to as low blood glucose or hypoglycemia. This corresponds to blood glucose levels of less than 70 milligrams per deciliter (mg/dL). To find out the precise low blood glucose level, it is important to speak with the physician or healthcare team, as the result may vary.

What Are the Clinical Uses of Dextrose?

People with diabetes are frequently treated with Dextrose when their blood sugar is extremely low. To prevent insulin shock, which happens when insulin lowers blood sugar levels excessively due to insufficient food intake, Dextrose is administered through injection. Blood glucose is quickly raised by Dextrose. All bodily cells and organs require glucose, which is present in carbohydrate-rich foods like bread and fruit, to function properly.

It is also used to supply calories to people who are unable to eat because of disease, accident, or other medical issues. It is sometimes given to people who are sick from drinking too much alcohol. Dextrose can also be used to treat hyperkalemia or elevated blood potassium levels.

How Should Dextrose Be Used?

This medication is to be injected or infused into a vein by a medical practitioner in a clinic or hospital environment. Talk to the pediatrician regarding the usage of this medication in young patients. Precautions do apply even if this medication may be recommended for specific illnesses.

What Are the Side Effects of Dextrose?

Side effects should be notified by the patient to a doctor or other healthcare practitioner right away:

• Allergic responses, including a rash on the skin, itching, or facial swelling.

• Confusion.

• Signs of hyperglycemia, such as lightheadedness, dry lips or skin, fruity breath, nausea (vomiting sensation), increased thirst or hunger, or frequent urination.

• Dry mouth.

Usually, there are no life-threatening side effects; however, one should notify the doctor if they are still concerned.

What Are the Things to Inform the Doctor Before Taking Dextrose?

If one has any of the following conditions, a doctor should be informed:

• Brain or spinal cord bleeding.

• Diabetes.

• Regular alcohol intake.

• Diabetic kidney disease.

• Any unexpected or adverse reactions to preservatives, dyes, corn, meals, pharmaceuticals, or other ingredients.

• Being pregnant or intending to get pregnant.

• Breastfeeding.

For Doctors

Description: Dextrose injection is a sterile, nonpyrogenic solution of water and Dextrose, a form of sugar, intended for intravenous administration. It is available in strengths of 20 percent, 30 percent, 40 percent, 50 percent, and 70 percent. These solutions, which come in flexible plastic vials, need to be mixed or diluted before being injected intravenously. The intentional partial filling of the containers makes it easier to combine for the correct concentration. However, because they lack any antibacterial agents, they should only be combined or diluted for single injections. The plastic packing is permeable to water, although this does not affect the outcome. The calorie value of each intensity is determined by matching it to a particular quantity of Dextrose per container. Corn is the source of Dextrose, commonly referred to as D-glucose, which dissolves easily in water. Each liter of aluminum in the Dextrose injection is limited to a maximum of 25 micrograms, ensuring that these solutions consist of sterile water that meets the USP criteria for Water for Injection.

Pharmacodynamics: The amount given and the patient's clinical state can both affect the initiation of diuresis.

Mechanism of Action: By injecting glucose straight into the bloodstream, Dextrose injection gives the body an extra energy boost. In the body, glucose is transformed into carbon dioxide and water to produce energy.

Pharmacokinetics: As Dextrose is easily digested, it can stimulate the deposition of glycogen, reduce or avoid ketosis (a metabolic condition wherein the body burns fat rather than glucose to produce energy), and lessen losses of protein and nitrogen from the body when given in appropriate amounts. Water makes up roughly 70 percent of the total weight of the body and is a necessary component of all bodily tissues.

What Is the Prescribed Dosage and Method of Administration For Dextrose?

The crucial guidelines for setting up and administering Dextrose injections are mentioned below:

• Before Administration:

  • There are many strengths of Dextrose injection available.

  • It must be combined with other IV fluids or amino acids before use. It cannot be used directly.

  • Make sure the additions being made are appropriate. If in doubt, consult a pharmacist for guidance.

  • Examine the solution to determine how accurate it is. If any irregularities are noticed, proceed with caution.

  • Use it immediately after mixing; do not reuse it.

• Key Methods for Administration:

  • Close off the IV (intravenous) line's vent to avoid air bubbles.

  • If one wants to avoid air bubbles, use a separate IV line that is disconnected.

  • Verify that the solution is clear and free of fragments before providing it.

  • The strength of the solution may require it to enter a large vein rather than a little one.

• Dosage Information:

  • Dextrose injection must be combined with other fluids before being injected directly into the vein.

  • The patient's condition, weight, and nutritional requirements all affect the dosage.

  • Depending on how the patient is responding, start carefully and raise the dosage gradually.

• Stopping Dextrose Infusion:

  • Reduce the dosage as the infusion comes to an end to prevent low blood sugar.

Overdosage: Administering Dextrose injection too rapidly or with an extremely potent Dextrose solution might result in elevated blood sugar, heightened osmolality (blood particle concentration), and issues with electrolyte and water balance. This might be harmful.

Severe dilutional hyponatremia (low sodium levels from consuming too much fluid) or hyperglycemia (high blood sugar) can have life-threatening effects.

Immediately stop the infusion if there is an excess of fluid or solutes during treatment, such as overhydration or solute overload. It is necessary to adopt corrective measures, with a primary focus on the cardiovascular and respiratory systems.

Clinical Studies:

Research conducted in the California Contra Costa County EMS (emergency medical services) system examined the use of D10, which is a 10 percent dextrose solution, as an alternative to the standard D50, which is an intravenous bolus of 50 milliliters of 50 percent dextrose solution, for treating hypoglycemia in the field. They discovered that employing D10 was practical, secure, and efficient. They examined 164 individuals with low blood sugar; the majority of them were elderly. Their blood sugar levels decreased without any negative side effects after taking D10. A little over 18 percent of patients required an additional D10 dose due to persistently low blood sugar.

Since D50 is frequently in short supply, using D10 instead of D50 is easier and less expensive. D10 also carries fewer dangers, such as the possibility of damage from solution seeping out of the vein or negative consequences from elevated blood sugar.

Overall, the research indicates that D10 is a useful stand-in for treating hypoglycemia and that treatment-associated blood sugar levels appear to be stable.

Storage and Handling: Dextrose injection is available in flexible, single-dose, partially-filled containers with USP strengths of 20 percent, 30 percent, 40 percent, 50 percent, and 70 percent. Until it is time to use it, keep the container wrapped tightly. After mixing, use right away; do not freeze. Keep in storage at 20 to 25 degrees Celsius (68 to 77 degrees Fahrenheit).

Warnings and Precautions:

• Hyperglycemia and Hyperosmolar Hyperglycemic State: Patients with diabetes or glucose-related problems may become worse if they receive Dextrose infusions. Giving Dextrose too quickly might result in a coma, extremely high blood sugar, or even death. Individuals with renal problems and disorientation are more vulnerable. While utilizing Dextrose injection, it is critical to monitor blood sugar levels frequently and treat elevated readings. It may also be necessary to use Insulin to control blood sugar levels.

• Hypersensitivity Reactions: Dextrose infusions may cause allergic reactions in certain individuals, including potentially fatal ones like anaphylaxis. Stop the infusion right away and treat the reaction if any symptoms of an allergic reaction, such as rash, fast heartbeat, or breathing difficulties, show up.

• Risk of Infections: Since the solution can encourage the growth of bacteria, patients requiring Dextrose infusions are more vulnerable to infections. Patients who have inadequate nutrition, prolonged catheter use, high blood sugar from Dextrose infusions, or other immune-suppressive diseases are more susceptible to this risk. Always utilize sterile techniques while inserting or removing catheters, as well as when preparing and administering infusions, to lower the risk of infection. Keep an eye out for infection symptoms, such as fever, and examine the catheter site frequently.

• Refeeding Syndrome: When patients with severe malnutrition get Dextrose, the body may transfer minerals like potassium and phosphorus, which can result in problems like fluid retention and thiamine shortage. Keep a careful eye on these people and gradually increase their food intake to avoid this.

• Vein Damage and Thrombosis: Dextrose injection should be combined with other fluids before being injected straight into veins. Blood clots or vein damage may result from injecting extremely concentrated Dextrose solutions into peripheral veins. Remove the catheter right away if one experiences vein irritation or thrombosis.

• Aluminum Toxicity: The small amount of aluminum found in Dextrose injection can accumulate in patients with kidney issues, particularly premature babies. Elevated aluminum levels can damage the bones and nervous system. To prevent aluminum poisoning, patients with kidney problems should be continuously monitored.

• Chance of Parenteral Nutrition-Associated Liver Disease: Prolonged parenteral nutrition use, particularly in premature babies, may result in liver issues. Consider stopping or lowering the dosage if patients receiving Dextrose injections are found to have abnormal liver function.

• Fluid Overload and Electrolyte Imbalance: Extended usage of intense Dextrose solutions may result in fluid overload and low potassium and phosphate levels. Regularly check electrolyte levels, address imbalances, keep an eye out for symptoms of fluid excess, and modify treatment as necessary.

Use in Specific Populations:

• Pregnancy: No research has been done on the use of Dextrose injection in pregnant women, and no studies have been done on animals. Major birth abnormalities occur in about two percent to four percent of the general U.S. population, while miscarriages occur in about 15 to 20 percent of cases. Doctors may think about administering parenteral nutrition to pregnant women who are very malnourished and unable to consume enough food to avoid hazards to the unborn child, including low birth weight, early birth, growth issues, birth deformities, and even death.

• Lactation: No information is available regarding the presence of Dextrose in breast milk or its potential effects on milk supply or breastfed infants. Physicians should assess the advantages of nursing versus the requirement for Dextrose injection, as well as any possible hazards to the infant from the injection or the mother's health.

• Pediatric Use: When receiving intravenous glucose infusions, newborns, particularly those who are premature or have low birth weights, need to be closely observed to make sure their blood sugar levels are appropriate to avoid long-term issues. While hyperglycemia (high blood sugar) can result in infections and even death, hypoglycemia (low blood sugar) in neonates can cause major complications like convulsions and brain damage. Additionally, electrolyte levels need to be regularly monitored, particularly in very young infants who may not be able to balance their fluid and electrolyte intake properly. Dextrose injection in neonates could result in excessive blood osmolality and possibly brain hemorrhage. Aluminum poisoning is another danger for preterm infants getting Dextrose injections over an extended period.

• Geriatric Use: Not enough elderly adults were included in studies on Dextrose injection to determine whether their responses differed from those of younger adults. There have not been any reports on significant variations in the medicinal reaction between older and younger populations.