DEXTROSE 25%
Clinical safety rating: caution
Comprehensive clinical and safety monograph for DEXTROSE 25% (DEXTROSE 25%).
Dextrose (D-glucose) is a monosaccharide that provides caloric support. It is transported into cells via glucose transporters (GLUTs) and undergoes glycolysis to produce ATP. It increases blood glucose levels, providing substrate for cellular metabolism.
| Metabolism | Dextrose undergoes glycolysis, entering the Krebs cycle. Metabolism is primarily via insulin-dependent pathways in most tissues, with hepatic gluconeogenesis and glycogenesis involved in regulation. |
| Excretion | Dextrose is completely metabolized to carbon dioxide and water. Excretion: Renal (0% unchanged), Biliary/Fecal (negligible). Essentially 100% metabolized. |
| Half-life | Terminal half-life is approximately 30-60 minutes due to rapid cellular uptake and metabolism. Clinical context: In hyperinsulinemic states or insulin therapy, half-life is shortened; in renal/hepatic impairment, half-life may be prolonged but glucose is quickly cleared. |
| Protein binding | Negligible (<1%). Dextrose does not bind significantly to plasma proteins. |
| Volume of Distribution | Vd: 0.15-0.25 L/kg (approximately 10-20 L in adults). Reflects distribution primarily in extracellular fluid. |
| Bioavailability | Oral: 100% bioavailable across intestinal mucosa. Intravenous: 100% (direct administration). |
| Onset of Action | Intravenous: Immediate (within seconds to minutes) as dextrose is directly infused into bloodstream. Oral: 10-15 minutes (intestinal absorption). |
| Duration of Action | Intravenous: 1-2 hours for hyperglycemic effect; duration depends on insulin secretion and metabolic rate. Oral: 2-3 hours for glucose elevation. |
Adults: 25 grams (100 mL of 25% solution) intravenously as a single dose for hypoglycemia. May repeat if needed based on blood glucose monitoring.
| Dosage form | INJECTABLE |
| Renal impairment | No specific dose adjustment required for dextrose; monitor fluid and electrolyte balance in severe renal impairment (GFR <30 mL/min) due to risk of hyperglycemia and volume overload. |
| Liver impairment | No specific adjustment based on Child-Pugh score; use with caution in severe hepatic impairment due to potential glucose intolerance. |
| Pediatric use | Infants and children: 0.25-0.5 g/kg (1-2 mL/kg of 25% dextrose) intravenously for hypoglycemia. Maximum rate: 0.5 g/kg/hour. Doses typically 2.5-5 mL/kg of 25% dextrose for neonates with hypoglycemia. |
| Geriatric use | Elderly patients: Use lower doses (e.g., 12.5 g as 50 mL of 25% solution) to avoid hyperglycemia and volume overload. Monitor blood glucose and volume status closely. |
| 1st trimester | Consult provider |
| 2nd trimester | Consult provider |
| 3rd trimester | Consult provider |
Clinical note
Comprehensive clinical and safety monograph for DEXTROSE 25% (DEXTROSE 25%).
| Breastfeeding | Dextrose is a normal constituent of breast milk. Intravenous administration of dextrose 25% results in increased maternal blood glucose, which may increase milk glucose concentration. The M/P ratio is not established, but glucose is considered compatible with breastfeeding. Use with caution in mothers with diabetes or glucose intolerance. |
| Teratogenic Risk | Dextrose 25% is a hypertonic glucose solution used for intravenous administration. It is not known to be teratogenic; glucose is an essential nutrient for fetal development. However, excessive administration may cause maternal hyperglycemia, which can lead to fetal hyperinsulinemia, macrosomia, and neonatal hypoglycemia. Risk in first trimester: no evidence of teratogenicity. Second and third trimesters: risk of maternal hyperglycemia and associated fetal effects if maternal glucose levels are not controlled. |
■ FDA Black Box Warning
None
| Serious Effects |
Absolute: Hypersensitivity to dextrose or corn products (rare). Relative: Hyperglycemia, diabetic ketoacidosis (unless used with insulin), severe metabolic acidosis, and conditions with increased intracranial pressure (IV administration). Avoid in patients with glucose-galactose malabsorption.
| Precautions | Intravenous administration of hypertonic dextrose solutions (≥10%) may cause phlebitis, thrombosis, or extravasation injury. Use with caution in patients with intracranial hemorrhage, hyperglycemia, or fluid overload. Monitor serum glucose and electrolytes; rapid administration can cause osmotic diuresis and hyperglycemia. |
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| Fetal Monitoring | Monitor maternal blood glucose levels closely during infusion to avoid hyperglycemia. Fetal monitoring may include ultrasound for fetal growth and amniotic fluid volume if maternal hyperglycemia is prolonged. In neonates, monitor blood glucose for hypoglycemia after delivery if significant maternal hyperglycemia occurred. |
| Fertility Effects | Decreased fertility or impaired spermatogenesis has not been reported with dextrose. Hyperglycemia from uncontrolled diabetes may impair fertility, but dextrose administration alone is not expected to affect fertility. |