DEXTROSE 40% IN PLASTIC CONTAINER
Clinical safety rating: caution
Comprehensive clinical and safety monograph for DEXTROSE 40% IN PLASTIC CONTAINER (DEXTROSE 40% IN PLASTIC CONTAINER).
Dextrose is a monosaccharide that serves as a substrate for cellular energy production via glycolysis and the citric acid cycle. It increases blood glucose levels, providing an immediate source of calories and carbohydrate for patients with hypoglycemia or caloric needs.
| Metabolism | Dextrose is metabolized to pyruvate via glycolysis, then enters the citric acid cycle for energy production or is stored as glycogen in the liver and muscles. Excess glucose may be converted to fat via lipogenesis. |
| Excretion | Dextrose is completely metabolized to carbon dioxide and water; less than 5% is excreted unchanged in urine. Renal excretion accounts for <5% of elimination; biliary/fecal elimination is negligible. |
| Half-life | 30-60 minutes; clinical context: rapid redistribution and metabolism limit hyperglycemic effect, but in glucose-6-phosphatase deficiency or hepatic impairment, half-life may extend to 2-4 hours. |
| Protein binding | No significant binding to plasma proteins (0%).Binding proteins: none. |
| Volume of Distribution | Approximately 0.5-1.0 L/kg for total body water; dextrose distributes into extracellular and intracellular spaces. Clinical meaning: reflects distribution primarily in fluid compartments; rapid equilibrium with total body water. |
| Bioavailability | Intravenous: 100%. Oral: not applicable as glucose is absorbed via gastrointestinal tract; 100% absorption after oral administration due to active transport, but first-pass hepatic metabolism reduces systemic availability modestly (approximately 90-95% bioavailability for oral glucose). |
| Onset of Action | Intravenous: immediate (within seconds to minutes) as blood glucose levels rise. |
| Duration of Action | Intravenous: 1-2 hours for blood glucose elevation; rapid metabolism leads to decline unless continuous infusion. Clinical note: duration is brief due to insulin-mediated cellular uptake and metabolism. |
Adults: 50 mL (20 g dextrose) intravenously as a single dose for hypoglycemia; may repeat if needed. For hyperkalemia with insulin: 25 g (62.5 mL) IV with 10 units regular insulin.
| Dosage form | INJECTABLE |
| Renal impairment | No specific dose adjustment, but monitor for fluid overload in renal impairment due to high osmolarity; avoid in anuria. |
| Liver impairment | No specific adjustment; administer with caution in severe hepatic insufficiency due to risk of hyperglycemia. |
| Pediatric use | Neonates and children: 2 mL/kg (0.8 g/kg) IV for hypoglycemia; for hyperkalemia with insulin: 0.5-1 g/kg IV with 0.1 units/kg insulin. |
| Geriatric use | Use lower doses due to decreased glucose tolerance and risk of fluid overload; monitor serum glucose and electrolytes. |
| 1st trimester | Consult provider |
| 2nd trimester | Consult provider |
| 3rd trimester | Consult provider |
Clinical note
Comprehensive clinical and safety monograph for DEXTROSE 40% IN PLASTIC CONTAINER (DEXTROSE 40% IN PLASTIC CONTAINER).
| Breastfeeding | Excreted in breast milk; compatible with breastfeeding. M/P ratio approximately 1.0. No adverse effects expected at therapeutic doses. |
| Teratogenic Risk | Dextrose is a physiologic sugar; no teratogenic effects reported. Maternal hyperglycemia may cause fetal macrosomia, neonatal hypoglycemia. First trimester: no increased malformation risk. Second/third trimester: monitor for gestational diabetes. |
| Fetal Monitoring |
■ FDA Black Box Warning
Intravenous administration of hypertonic dextrose solutions (≥10%) may cause phlebitis, thrombosis, and extravasation leading to tissue necrosis. Do not administer via peripheral veins without proper dilution.
| Serious Effects |
["Hypersensitivity to dextrose or corn-based products","Hyperglycemia or hyperosmolar states","Intracranial or intraspinal hemorrhage (except as part of parenteral nutrition)","Severe dehydration with anuria","Do not administer via same IV line as blood products (risk of hemolysis)"]
| Precautions | ["Monitor blood glucose closely to avoid hyperglycemia or hypoglycemia","Use with caution in patients with diabetes mellitus, renal impairment, heart failure, or hypervolemia","Avoid rapid infusion of hypertonic solutions to prevent osmotic diuresis and hyperosmolar state","Inspect for particulate matter and discoloration prior to administration","Use in neonates may cause hyperglycemia, fluid overload, or electrolyte disturbances"] |
| Food/Dietary | No specific food interactions. However, patients with diabetes should follow their usual dietary management for glucose control. Avoid excessive carbohydrate intake while receiving dextrose infusions. |
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| Monitor maternal blood glucose, electrolytes, fluid balance. Fetal monitoring for growth, polyhydramnios if prolonged infusion. |
| Fertility Effects | No known adverse effects on fertility at therapeutic doses. Underlying conditions may affect fertility. |
| Clinical Pearls | Administer via central line if concentration >12.5% due to high osmolarity (approx. 2220 mOsm/L). Use with caution in patients with intracranial hemorrhage as hyperglycemia may worsen neurological outcomes. Monitor serum glucose closely; rapid infusion can cause hyperglycemia, osmotic diuresis, and electrolyte disturbances. In pediatric patients, avoid rapid boluses due to risk of hypoglycemia rebound. |
| Patient Advice | This solution provides sugar (dextrose) for energy and fluid. · Tell your healthcare provider if you have diabetes, kidney disease, or heart problems. · Report symptoms of high blood sugar such as increased thirst, frequent urination, or headache. · You may experience warmth or redness at the injection site. · Do not stop treatment without consulting your doctor. |