ALCOHOL 5% AND DEXTROSE 5%
Clinical safety rating: caution
Comprehensive clinical and safety monograph for ALCOHOL 5% AND DEXTROSE 5% (ALCOHOL 5% AND DEXTROSE 5%).
Alcohol (ethanol) enhances GABA-A receptor activity and inhibits NMDA receptors, producing CNS depression. Dextrose provides a source of glucose for cellular metabolism.
| Metabolism | Alcohol: Primarily hepatic via alcohol dehydrogenase (ADH) to acetaldehyde, then aldehyde dehydrogenase (ALDH) to acetate. Dextrose: Metabolized via glycolysis and oxidative phosphorylation. |
| Excretion | Alcohol (ethanol): ~90-98% metabolized in liver via alcohol dehydrogenase and CYP2E1; ~2-10% excreted unchanged in urine (primarily), breath, and sweat. Dextrose is completely metabolized by glycolysis and oxidative phosphorylation; negligible renal excretion. |
| Half-life | Alcohol: terminal elimination half-life 4-5 hours (range 1-7 hours depending on liver function, chronic use, and genetic factors). Dextrose: half-life not applicable as it is rapidly cleared from circulation by insulin-dependent uptake; glucose t1/2 ~1-2 hours in fasting state without glucose load. |
| Protein binding | Alcohol: negligible (<5%, not significantly bound to plasma proteins). Dextrose: no protein binding. |
| Volume of Distribution | Alcohol: Vd ~0.6 L/kg (approximates total body water). Dextrose: Vd ~0.2 L/kg (extracellular fluid expansion with IV infusion). |
| Bioavailability | Alcohol (IV): 100% (intravenous administration). Dextrose (IV): 100% (intravenous administration; oral dextrose is rapidly absorbed but not relevant here). |
| Onset of Action | Intravenous administration: alcohol effects begin within minutes (central nervous system depression within 15-30 minutes depending on infusion rate and concurrent glucose metabolism). Dextrose: no pharmacodynamic effect; used for caloric supplementation. |
| Duration of Action | Alcohol: effects last 4-6 hours depending on dose and metabolism; clinical intoxication resolves over several hours. Dextrose: immediate metabolic utilization, no discrete duration. |
Intravenous infusion: 5% dextrose and 5% alcohol in water, administered as a continuous IV infusion at a rate of 0.5-1.5 mL/kg/hour (approximately 0.025-0.075 g alcohol/kg/hour). Typical adult dose: 500-1000 mL infused over 2-6 hours, not to exceed 1.5 mL/kg/hour to avoid alcohol toxicity.
| Dosage form | INJECTABLE |
| Renal impairment | No specific dose adjustment required for renal impairment. However, monitor fluid and electrolyte balance, especially in patients with severe renal impairment (GFR <30 mL/min), due to risk of fluid overload and hyperosmolarity. |
| Liver impairment | Contraindicated in patients with severe hepatic impairment (Child-Pugh class C). In mild to moderate impairment (Child-Pugh class A or B), use with caution and reduce infusion rate to 0.5 mL/kg/hour; monitor for signs of alcohol intoxication and hepatotoxicity. |
| Pediatric use | Not recommended for use in pediatric patients due to risk of alcohol toxicity. If used, dose based on weight: 0.5-1 mL/kg/hour of 5% alcohol/5% dextrose solution, with maximum rate of 1 mL/kg/hour. Monitor blood alcohol levels and blood glucose closely. |
| Geriatric use | Elderly patients are more sensitive to alcohol and may have reduced hepatic metabolism. Initiate infusion at 0.5 mL/kg/hour and titrate slowly; monitor for CNS depression, hypoglycemia, and fluid overload. Maximum rate should not exceed 1 mL/kg/hour. |
| 1st trimester | Consult provider |
| 2nd trimester | Consult provider |
| 3rd trimester | Consult provider |
Clinical note
Comprehensive clinical and safety monograph for ALCOHOL 5% AND DEXTROSE 5% (ALCOHOL 5% AND DEXTROSE 5%).
| Breastfeeding | Alcohol passes into breast milk; M/P ratio approximately 1.0; may impair infant motor development and reduce milk intake. Avoid use during breastfeeding; if unavoidable, delay nursing 2-3 hours per drink. Dextrose 5% is compatible but monitor for infant hyperglycemia. |
| Teratogenic Risk | Alcohol is a known teratogen; first trimester exposure increases risk of fetal alcohol spectrum disorders (FASD) including craniofacial anomalies, growth retardation, and neurodevelopmental deficits. Second and third trimester exposure may cause growth restriction and CNS effects. Dextrose 5% is generally safe but hyperglycemia may occur. Use contraindicated in pregnancy unless no alternative. |
■ FDA Black Box Warning
None.
| Serious Effects |
["Hypersensitivity to ethanol","Severe hepatic impairment","Ketoacidosis or hyperglycemia","History of alcohol abuse or dependence (relative)"]
| Precautions | ["Avoid extravasation due to hypertonicity","Use with caution in patients with hepatic impairment or alcoholism","Monitor blood glucose, electrolyte, and fluid status","Risk of acute alcohol intoxication-related events"] |
| Food/Dietary | No specific food interactions, but alcohol content may interact with disulfiram or metronidazole causing severe nausea and vomiting. Avoid concomitant use of other CNS depressants (e.g., sedatives, opioids). |
Loading safety data…
| Fetal Monitoring | Monitor maternal blood glucose, ethanol level (if prolonged infusion), and fluid/electrolyte status. Fetal assessment: growth ultrasound in third trimester, fetal movement counting. For high ethanol doses (intoxication), monitor fetal heart rate and consider toxicology screen. |
| Fertility Effects | Alcohol impairs female fertility via menstrual irregularities and anovulation; in males, reduces sperm quality and testosterone. Dextrose 5% has no known adverse fertility effects. |
| Clinical Pearls |
| Use cautiously in patients with hepatic impairment, alcoholism, or head trauma due to potential for increased intoxication or CNS depression. Monitor serum ethanol levels if prolonged infusion or high doses are used; ethanol is metabolized via alcohol dehydrogenase and can cause hypoglycemia in children. Always confirm compatibility when co-administering with other IV fluids, as ethanol can precipitate with certain drugs. |
| Patient Advice | This solution contains alcohol (5% ethanol) and may cause a temporary feeling of intoxication or dizziness. · Do not operate heavy machinery or drive while receiving this infusion. · Avoid consuming additional alcoholic beverages during treatment due to additive effects. · Report any signs of allergy, such as rash, itching, or difficulty breathing, to your healthcare provider. · Inform your doctor if you have a history of alcohol abuse, liver disease, or diabetes. |