DELFLEX W/ DEXTROSE 1.5% LOW MAGNESIUM LOW CALCIUM IN PLASTIC CONTAINER
Clinical safety rating: caution
Comprehensive clinical and safety monograph for DELFLEX W/ DEXTROSE 1.5% LOW MAGNESIUM LOW CALCIUM IN PLASTIC CONTAINER (DELFLEX W/ DEXTROSE 1.5% LOW MAGNESIUM LOW CALCIUM IN PLASTIC CONTAINER).
Peritoneal dialysis solution; dextrose provides osmotic gradient for ultrafiltration; electrolytes correct imbalances; low magnesium and calcium adjust levels in renal failure.
| Metabolism | Dextrose is metabolized via glycolysis and oxidative phosphorylation; electrolytes are renally excreted or metabolically utilized. |
| Excretion | Primarily eliminated via peritoneal drainage during continuous ambulatory peritoneal dialysis (CAPD). Approximately 60-80% of glucose is absorbed across the peritoneum and metabolized systemically; non-metabolized glucose and other solutes are removed in dialysate effluent. Renal excretion is negligible (<5%) in patients with end-stage renal disease on CAPD. |
| Half-life | Not applicable as a terminal half-life for the solution itself; glucose absorption half-life from peritoneal cavity is approximately 2-4 hours, reflecting peritoneal clearance. There is no systemic accumulation of the solution's components beyond expected glucose metabolism. |
| Protein binding | Calcium and magnesium are partially bound to serum proteins (albumin): calcium ~40-50% bound, magnesium ~30% bound. Glucose and dextrose degradation products are not significantly protein bound. |
| Volume of Distribution | Not applicable as a conventional drug; the solution distributes within the peritoneal cavity (approximately 2-3 L in adults). Glucose distributes into total body water (Vd ~0.5-0.7 L/kg). |
| Bioavailability | Intraperitoneal administration: glucose absorption is 60-80% across the peritoneum over a dwell. Electrolytes (calcium, magnesium) are partially absorbed to maintain homeostasis; bioavailability is not a standard parameter for dialysis solutions. |
| Onset of Action | Upon intraperitoneal instillation (IP): ultrafiltration and solute transfer begin immediately, with peak glucose absorption occurring within 1-2 hours of dwell. |
| Duration of Action | Dwell times of 4-8 hours for CAPD; longer dwells (8-12 hours) used for overnight exchanges. Ultrafiltration efficacy declines as glucose is absorbed and concentration gradient diminishes. |
Intraperitoneal administration: 2 liters per exchange, 4 exchanges per day, or 8-10 liters over 10-12 hours for overnight cycler, with dextrose concentration selected based on ultrafiltration needs.
| Dosage form | SOLUTION |
| Renal impairment | No dose adjustment required as drug is used for peritoneal dialysis; however, monitor ultrafiltration and electrolyte levels. GFR <15 mL/min: consider adjusting exchange volume or frequency based on clinical response. |
| Liver impairment | No dose adjustment recommended; use with caution in severe hepatic impairment due to potential lactate metabolism issues. |
| Pediatric use | Intraperitoneal: 800-1100 mL/m² per exchange, 4-5 exchanges per day; volume adjusted based on body size, tolerance, and ultrafiltration needs. |
| Geriatric use | No specific dose adjustment; initiate with lower exchange volumes (1.5-2 liters) and monitor for fluid overload and electrolyte imbalances. |
| 1st trimester | Consult provider |
| 2nd trimester | Consult provider |
| 3rd trimester | Consult provider |
Clinical note
Comprehensive clinical and safety monograph for DELFLEX W/ DEXTROSE 1.5% LOW MAGNESIUM LOW CALCIUM IN PLASTIC CONTAINER (DELFLEX W/ DEXTROSE 1.5% LOW MAGNESIUM LOW CALCIUM IN PLASTIC CONTAINER).
| Breastfeeding | Not systemically absorbed; negligible excretion in breast milk. Compatible with breastfeeding. |
| Teratogenic Risk | No evidence of teratogenic risk in any trimester; not systemically absorbed. Dialysate use considered safe during pregnancy. |
| Fetal Monitoring |
■ FDA Black Box Warning
Not for intravenous use; peritoneal dialysis solutions are for intraperitoneal administration only.
| Serious Effects |
["Pre-existing severe hyperglycemia","Hypersensitivity to any component","Documented peritoneal membrane failure","Abdominal conditions preventing effective dialysis (e.g., recent abdominal surgery, adhesions, hernias)","Severe lactic acidosis"]
| Precautions | ["Peritonitis risk due to catheter infection","Fluid and electrolyte imbalances (hyper/hypoglycemia, hypernatremia, hypokalemia)","Abdominal compartment syndrome","Catheter malfunction or obstruction","Peritoneal membrane failure with long-term use"] |
| Food/Dietary | No specific food interactions. However, patients should follow a renal diet as prescribed, typically low in potassium, phosphorus, and sodium. The low magnesium and calcium content of this solution may require dietary adjustments to avoid deficiency. Avoid excessive intake of magnesium-rich foods (e.g., nuts, seeds, whole grains) and calcium-rich foods (e.g., dairy, leafy greens) if levels are high, or increase intake if low. Diabetic patients should manage carbohydrate intake and adjust insulin in response to dextrose absorption. |
Loading safety data…
| Monitor fluid and electrolyte balance, renal function, and peritoneal dialysis adequacy. Assess for signs of infection (peritonitis) and glucose control due to dextrose. |
| Fertility Effects | No known effects on fertility; not systemically absorbed. |
| Clinical Pearls | Delflex with Dextrose 1.5% Low Magnesium Low Calcium is a peritoneal dialysis solution with reduced magnesium (0.25 mEq/L) and calcium (2.5 mEq/L) to correct hypermagnesemia and hypercalcemia in patients with end-stage renal disease. Monitor serum magnesium and calcium levels regularly, especially in patients on diuretics or with cardiac arrhythmias. The low calcium content may exacerbate hypocalcemia; consider concurrent use of calcium supplements or vitamin D analogs. The solution contains dextrose as an osmotic agent; hyperglycemia may occur in diabetic patients, requiring insulin adjustment. Do not use if solution is discolored or contains particulates. Warm solution to body temperature before use. Use a non-PVC transfer set to reduce DEHP exposure. |
| Patient Advice | Use this solution exactly as prescribed by your doctor. Do not change the type or amount of solution. · Store the bags at room temperature (15-30°C) away from direct sunlight and heat. Do not freeze. · Inspect the bag before use. Do not use if the solution is cloudy, contains particles, or the bag is damaged. · Warm the solution to near body temperature (37°C) using a dry heat warmer or heating pad. Do not microwave or immerse in water. · Wash hands thoroughly before handling the solution and performing exchanges to prevent infection. · Follow sterile technique during exchange to avoid peritonitis. Clean the catheter exit site as directed. · Report any signs of infection such as fever, abdominal pain, cloudy effluent, or redness at the catheter site immediately. · Monitor your blood sugar if you have diabetes, as the dextrose may increase glucose levels. Report high blood sugar to your doctor. · Do not skip exchanges or alter the schedule without consulting your healthcare provider. · Keep a record of your weight, blood pressure, and dialysis fluid balance as instructed. |