DEXTROSE 20% IN PLASTIC CONTAINER
Clinical safety rating: caution
Comprehensive clinical and safety monograph for DEXTROSE 20% IN PLASTIC CONTAINER (DEXTROSE 20% IN PLASTIC CONTAINER).
Dextrose is a monosaccharide that serves as a source of calories and water for parenteral nutrition. It is oxidized to carbon dioxide and water, providing energy. Administration of hypertonic dextrose solutions increases blood glucose levels, which can stimulate insulin secretion and promote cellular glucose uptake.
| Metabolism | Dextrose is metabolized via glycolysis to pyruvate, which enters the Krebs cycle for energy production. Excess glucose is stored as glycogen in the liver and skeletal muscle or converted to triglycerides in adipose tissue. Enzymes involved include hexokinase, phosphofructokinase, and pyruvate kinase. |
| Excretion | Dextrose is completely metabolized to carbon dioxide and water via glycolysis and the citric acid cycle; negligible renal excretion of unchanged drug. <1% excreted unchanged in urine. |
| Half-life | Plasma half-life is approximately 2-5 minutes under normal conditions due to rapid cellular uptake and metabolism; prolonged in hyperglycemic states or renal impairment. |
| Protein binding | Negligible; <1% bound to plasma proteins. |
| Volume of Distribution | Approximately 0.2 L/kg; primarily distributes in extracellular fluid, expands rapidly after IV administration. |
| Bioavailability | Intravenous: 100% (complete bioavailability). Oral: Not relevant for 20% solution; dextrose monohydrate is orally absorbed but parenteral use is IV only. |
| Onset of Action | Intravenous: Immediate (within seconds) as dextrose is directly administered into the bloodstream. |
| Duration of Action | Intravenous: Duration varies depending on metabolic rate and insulin activity; typically 1-2 hours for blood glucose elevation, but rapidly redistributed and metabolized. |
Intravenous infusion; adult dose: 500-1000 mL of 20% dextrose solution (100-200 g dextrose) administered over 1-2 hours; maximum infusion rate: 0.5 g/kg/hour. Frequency: as needed for hypoglycemia or as part of parenteral nutrition.
| Dosage form | INJECTABLE |
| Renal impairment | For GFR <30 mL/min: reduce infusion rate to 0.25 g/kg/hour or less; monitor serum glucose and potassium closely. No specific dose adjustment for GFR 30-89 mL/min. |
| Liver impairment | Child-Pugh Class C: reduce total daily dextrose load by 50% and monitor glucose tolerance; Class A or B: no specific adjustment required. |
| Pediatric use | Intravenous infusion: 2-4 mL/kg of 20% dextrose (0.4-0.8 g/kg) over 30-60 minutes; maximum infusion rate 0.5 g/kg/hour. For neonates, use 10% dextrose instead unless severe hypoglycemia. |
| Geriatric use | Start at lower end of adult dosing; monitor glucose tolerance and volume status due to increased risk of hyperglycemia and fluid overload; maximum infusion rate 0.25 g/kg/hour. |
| 1st trimester | Consult provider |
| 2nd trimester | Consult provider |
| 3rd trimester | Consult provider |
Clinical note
Comprehensive clinical and safety monograph for DEXTROSE 20% IN PLASTIC CONTAINER (DEXTROSE 20% IN PLASTIC CONTAINER).
| Breastfeeding | Dextrose is compatible with breastfeeding. Intravenous administration increases maternal blood glucose, which is transferred to breast milk. The milk-to-plasma (M/P) ratio is approximately 1.0. No adverse effects in infants have been reported at therapeutic doses. Monitoring infant for signs of hyperglycemia is unnecessary unless maternal glucose is extremely elevated. |
| Teratogenic Risk | Dextrose 20% is not teratogenic. Glucose is an essential nutrient, and administration at standard rates does not increase fetal risk. However, severe maternal hyperglycemia (e.g., from rapid infusion) may cause fetal hyperglycemia and stimulate fetal insulin secretion, leading to neonatal hypoglycemia. No trimester-specific risks; indicated for maternal hypoglycemia or as caloric source. |
■ FDA Black Box Warning
Hypertonic dextrose solutions (≥10%) are contraindicated in patients with intracranial or intraspinal hemorrhage, delirium tremens, or severe dehydration. Do not administer via peripheral veins due to risk of thrombophlebitis; use central venous access for concentrations >10%.
| Serious Effects |
["Hypersensitivity to dextrose or corn products","Intracranial or intraspinal hemorrhage","Delirium tremens","Severe dehydration","Hyperglycemia with hyperosmolar coma"]
| Precautions | ["Use with caution in patients with diabetes mellitus or glucose intolerance","Monitor serum glucose and electrolytes during extended use","Risk of hyperglycemia and hyperosmolarity, especially in renal impairment","May cause fluid overload or electrolyte disturbances","Intravenous administration should be via central line if concentration >10%"] |
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| Fetal Monitoring | Monitoring includes maternal blood glucose levels (adjust infusion rate to maintain euglycemia, typically 70-110 mg/dL), serum electrolytes (especially potassium and phosphate due to intracellular shift), and fluid balance (avoid hyperglycemia-induced osmotic diuresis). Fetal monitoring is not routinely required unless maternal hyperglycemia is severe or prolonged, which could cause fetal hyperinsulinemia. |
| Fertility Effects | No adverse effects on fertility in animal studies. Dextrose 20% is a physiological solute; no known impact on gametogenesis or reproductive function. High glucose concentrations in vitro may impair oocyte maturation, but clinical relevance at therapeutic doses is negligible. |