Pronunciation:

(DEKS trose)

U.S. Brand Names:

Synonyms:

Generic Available:

Use:

Oral: Treatment of hypoglycemia

5% and 10% solutions: Peripheral infusion to provide calories and fluid replacement

25% (hypertonic) solution: Treatment of acute symptomatic episodes of hypoglycemia in infants and children to restore depressed blood glucose levels; adjunctive treatment of hyperkalemia when combined with insulin

50% (hypertonic) solution: Treatment of insulin-induced hypoglycemia (hyperinsulinemia or insulin shock) and adjunctive treatment of hyperkalemia in adolescents and adults

10% solutions: Infusion after admixture with amino acids for nutritional support

Pregnancy Risk Factor:

Contraindications:

Warnings/Precautions:

Use with caution in patients with diabetes. Hyperglycemia and glycosuria may be functions of the rate of administration of dextrose; to minimize these effects, reduce the rate of infusion; addition of insulin may be necessary. Administration of potassium free I.V. dextrose solutions may result in significant hypokalemia, particularly if highly concentrated dextrose solutions are used; monitor closely and/or add potassium to dextrose solutions for patients with adequate renal function. Abrupt withdrawal of dextrose solution may be associated with rebound hypoglycemia. An unexpected rise in blood glucose level in an otherwise stable patient may be an early symptom of infection. Do not use oral forms in unconscious patients

Parenteral dextrose solutions contain aluminum which may accumulate to toxic levels with prolonged administration particularly in patients with impaired renal function. Patients with impaired renal function including premature neonates who receive aluminum at >4-5 mcg/kg/day accumulate aluminum at levels associated with CNS and bone toxicity.

Adverse Reactions:

Cardiovascular: Venous thrombosis, phlebitis, hypovolemia, hypervolemia, dehydration, edema

Central nervous system: Fever, mental confusion, unconsciousness, hyperosmolar syndrome

Endocrine & metabolic: Hyperglycemia, hypokalemia, acidosis, hypophosphatemia, hypomagnesemia

Genitourinary: Polyuria, glycosuria, ketonuria

Gastrointestinal: Polydipsia, nausea, diarrhea (oral)

Local: Pain, vein irritation, tissue necrosis

Respiratory: Tachypnea, pulmonary edema

Drug Interactions:

Stability:

Mechanism of Action:

Pharmacodynamics/Kinetics:

Onset of action: Treatment of hypoglycemia: Oral: 10 minutes

Maximum effect: Treatment of hyperkalemia: I.V.: 30 minutes

Absorption: Rapidly from the small intestine by an active mechanism

Metabolism: Metabolized to carbon dioxide and water

Time to peak, serum: Oral: 40 minutes

Dosage:

Hypoglycemia: Doses may be repeated in severe cases

I.V.:

Infants 6 months: 0.25-0.5 g/kg/dose (1-2 mL/kg/dose of 25% solution); maximum: 25 g/dose

Infants >6 months and Children: 0.5-1 g/kg/dose (2-4 mL/kg/dose of 25% solution); maximum: 25 g/dose

Adolescents and Adults: 10-25 g (40-100 mL of 25% solution or 20-50 mL of 50% solution)

Oral: Children >2 years and Adults: 10-20 g as single dose; repeat in 10 minutes if necessary

Treatment of Hyperkalemia: I.V. (in combination with insulin):

Infants and Children: 0.5-1 g/kg (using 25% or 50% solution) combined with regular insulin 1 unit for every 4-5 g dextrose given; infuse over 2 hours (infusions as short as 30 minutes have been recommended); repeat as needed

Adolescents and Adults: 25-50 g dextrose (250-500 mL D10W) combined with 10 units regular insulin administered over 30-60 minutes; repeat as needed or as an alternative 25 g dextrose (50 mL D50W) combined with 5-10 units regular insulin infused over 5 minutes; repeat as needed

Note: More rapid infusions (<30 minutes) may be associated with hyperglycemia and hyperosmolality and will exacerbate hyperkalemia; avoid use in patients who are already hyperglycemic

Administration:

Oral: Must be swallowed to be absorbed (see Warnings)

Parenteral: Not for SubQ or I.M. administration; dilute concentrated dextrose solutions for peripheral venous administration to a maximum concentration of 12.5%; in emergency situations, 25% dextrose has been used peripherally; for direct I.V. infusion, infuse at a maximum rate of 200 mg/kg over 1 minute; continuous infusion rates very with tolerance and range from 4.5-15 mg/kg/minute; hyperinsulinemic neonates may require up to 15-25 mg/kg/minute infusion rates

Monitoring Parameters:

Reference Range:

Children 0-2 years: 60-105 mg/dL

Children >2 years and Adults: 70-110 mg/dL

Additional Information:

Dental Health: Effects on Dental Treatment:

Dental Health: Vasoconstrictor/Local Anesthetic Precautions:

Mental Health: Effects on Mental Status:

Mental Health: Effects on Psychiatric Treatment:

Dosage Forms:

Gel, as 40% dextrose:

Glutose™: 40% (15 g, 45 g)

Insta-Glucose®: 40% (30 g)

Infusion, as 2.5% dextrose: 1000 mL

Infusion, as 5% dextrose: 25 mL, 50 mL, 100 mL, 150 mL, 250 mL, 500 mL, 1000 mL

Infusion, as 10% dextrose: 3 mL, 5 mL, 250 mL, 500 mL, 1000 mL

Infusion, as 20% dextrose: 500 mL, 1000 mL

Infusion, as 25% dextrose: 10 mL

Infusion, as 30% dextrose: 500 mL, 1000 mL

Infusion, as 40% dextrose: 500 mL, 1000 mL

Infusion, as 50% dextrose: 50 mL, 500 mL, 1000 mL, 2000 mL

Infusion, as 60% dextrose: 500 mL, 1000 mL

Infusion, as 70% dextrose: 70 mL, 500 mL, 1000 mL, 2000 mL

Solution, oral:

Enfamil® Glucose: 5% (90 mL) [5 g dextrose/100 mL]; 10% (90 mL) [10 g dextrose/100 mL]

Glutol™: 55% (180 mL) [100 g dextrose/180 mL]

Tablet, chewable:

B-D™ Glucose: 5 g

Dex4 Glucose: 4 g

International Brand Names: