DELFLEX W/ DEXTROSE 4.25% IN PLASTIC CONTAINER
Clinical safety rating: caution
Comprehensive clinical and safety monograph for DELFLEX W/ DEXTROSE 4.25% IN PLASTIC CONTAINER (DELFLEX W/ DEXTROSE 4.25% IN PLASTIC CONTAINER).
Peritoneal dialysis solution with dextrose as osmotic agent; removes solutes and water across peritoneal membrane via diffusion and ultrafiltration.
| Metabolism | Dextrose absorbed systemically and metabolized via glycolysis; lactate buffer converted to bicarbonate in liver. |
| Excretion | Peritoneal dialysis; effectively removed via peritoneal membrane during dialysis exchanges; systemic absorption of dextrose minimal; elimination primarily through dialysate outflow; renal excretion negligible in anuria. |
| Half-life | Not applicable as a drug; dextrose is rapidly metabolized; plasma half-life of glucose ~1.5-2 hours; continuous reabsorption in dialysis prevents accumulation. |
| Protein binding | Not applicable; dextrose does not bind to plasma proteins. |
| Volume of Distribution | Not applicable; dextrose distributes throughout total body water (~0.55 L/kg); dialysate instilled volume is ~2 L per exchange. |
| Bioavailability | 100% via intraperitoneal route as dialysate; dextrose absorbed systemically at ~10-20 g per exchange depending on dwell time and concentration. |
| Onset of Action | Immediate upon instillation into peritoneal cavity; ultrafiltration and solute removal begin within minutes. |
| Duration of Action | Duration determined by dwell time (typically 4-6 hours for CAPD); longer dwells may lead to decreased ultrafiltration due to glucose absorption. |
Intraperitoneal administration: 2 L per exchange, typically 4 exchanges daily (continuous ambulatory peritoneal dialysis). Dextrose 4.25% solution used for ultrafiltration. Dose adjusted based on body size and fluid status.
| Dosage form | SOLUTION |
| Renal impairment | No dose adjustment needed for impaired kidney function as drug is administered intraperitoneally for dialysis; however, monitor serum electrolytes and fluid balance. |
| Liver impairment | No specific dose adjustment recommended. Caution in severe hepatic impairment due to potential lactic acidosis with dextrose-containing solutions. |
| Pediatric use | Intraperitoneal: 30-40 mL/kg per exchange, up to 1 L per exchange depending on body size; frequency as needed for dialysis. Dextrose concentration tailored to ultrafiltration needs. |
| Geriatric use | Start with lower volumes (e.g., 1.5-2 L per exchange) and monitor for fluid overload and glucose intolerance. Use lowest effective dextrose concentration to minimize hyperglycemia. |
| 1st trimester | Consult provider |
| 2nd trimester | Consult provider |
| 3rd trimester | Consult provider |
Clinical note
Comprehensive clinical and safety monograph for DELFLEX W/ DEXTROSE 4.25% IN PLASTIC CONTAINER (DELFLEX W/ DEXTROSE 4.25% IN PLASTIC CONTAINER).
| Breastfeeding | Dextrose and electrolytes from the solution may equilibrate with maternal plasma. Excretion into breast milk is likely minimal and not clinically significant. The M/P ratio is not established; however, the risk to the nursing infant is considered low. Monitoring infant for signs of electrolyte imbalance or hyperglycemia is prudent if maternal serum concentrations are elevated. |
| Teratogenic Risk | Delflex w/ Dextrose 4.25% is a peritoneal dialysis solution. No direct fetal risks are expected from the solution itself; however, maternal metabolic disturbances (e.g., hyperglycemia, electrolyte imbalances) could affect the fetus. In the first trimester, uncontrolled diabetes may increase the risk of congenital anomalies. In the second and third trimesters, maternal hyperglycemia may lead to fetal macrosomia, neonatal hypoglycemia, and polyhydramnios. |
■ FDA Black Box Warning
Not for intravenous use.
| Serious Effects |
["Pre-existing severe hyperglycemia","Hypersensitivity to any component","Documented loss of peritoneal function","Abdominal conditions compromising dialysis (e.g., recent surgery, adhesions)"]
| Precautions | ["Monitor serum electrolytes, glucose, and fluid balance","Risk of peritonitis with catheter use","Hypokalemia or hyperglycemia possible","Not for IV administration"] |
| Food/Dietary | No specific food interactions. However, dietary restrictions typically include limiting sodium, potassium, phosphorus, and fluid intake as recommended by the nephrologist. Avoid high-potassium foods (e.g., bananas, oranges, tomatoes) and high-phosphorus foods (e.g., dairy, nuts, colas) to prevent electrolyte imbalances. Consult a renal dietitian for personalized meal planning. |
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| Fetal Monitoring | Monitor maternal blood glucose, serum electrolytes (sodium, potassium, chloride, bicarbonate), and fluid balance. Assess fetal growth and amniotic fluid volume via ultrasound. Perform nonstress test or biophysical profile as indicated for gestational age and maternal condition. |
| Fertility Effects | No known direct effects on fertility. End-stage renal disease and its metabolic disturbances may impair fertility, but the solution itself is not associated with reproductive toxicity. |
| Clinical Pearls | DELFLEX W/ DEXTROSE 4.25% is a peritoneal dialysis solution used in continuous ambulatory peritoneal dialysis (CAPD) or automated peritoneal dialysis (APD). Monitor for signs of peritonitis, such as cloudy effluent, abdominal pain, and fever. Ensure strict aseptic technique during exchange to prevent infection. The 4.25% dextrose concentration is hypertonic and used for ultrafiltration in fluid overload. Check electrolyte levels regularly, especially potassium and magnesium, as dialysis can alter serum levels. Warm the solution to body temperature before use to improve comfort and dialysis efficiency. |
| Patient Advice | Wash hands thoroughly before handling the dialysis solution or performing exchanges. · Use a clean, dry area for all exchanges and keep the catheter site clean and dry. · Inspect the solution bag for cloudiness, leaks, or particulate matter before use; do not use if any are present. · Do not reuse or refrigerate the solution; store at room temperature and protect from light. · Report any signs of infection such as redness, swelling, or drainage at the catheter site, or cloudy effluent immediately. · Follow your prescribed exchange schedule exactly to maintain proper fluid and waste removal. |