DEXTROSE 5% AND ELECTROLYTE NO. 48 IN PLASTIC CONTAINER
Clinical safety rating: caution
Comprehensive clinical and safety monograph for DEXTROSE 5% AND ELECTROLYTE NO. 48 IN PLASTIC CONTAINER (DEXTROSE 5% AND ELECTROLYTE NO. 48 IN PLASTIC CONTAINER).
Dextrose provides caloric support and restores blood glucose levels, while electrolytes (such as sodium, potassium, magnesium, chloride, acetate, and phosphate) replace deficits and maintain acid-base balance. The specific electrolyte composition in No. 48 (e.g., sodium, potassium, magnesium, chloride, acetate, phosphate) aids in rehydration and correction of electrolyte disturbances.
| Metabolism | Dextrose is metabolized via glycolysis and the citric acid cycle to carbon dioxide and water, producing ATP. Electrolytes are not metabolized; they are excreted or reabsorbed by the kidneys, with acetate and lactate (if present) metabolized to bicarbonate. |
| Excretion | Dextrose is completely metabolized to carbon dioxide and water in the presence of insulin; minimal renal excretion (<5%) as unchanged glucose in normoglycemic individuals. Electrolytes (sodium, chloride, potassium, magnesium, acetate, gluconate) are primarily excreted renally; renal elimination accounts for >90% of sodium and chloride, ~80% of potassium, and ~70% of magnesium. Acetate is rapidly metabolized to bicarbonate. Gluconate is partially excreted renally and partially metabolized. |
| Half-life | Dextrose: terminal elimination half-life is approximately 2-3 hours in non-diabetic individuals, reflecting glucose utilization and storage; prolonged in renal impairment due to decreased clearance of metabolites. Electrolytes: half-life varies; sodium and chloride have elimination half-lives of 6-12 hours; potassium half-life is 12-24 hours; magnesium half-life is 24-48 hours; acetate half-life is minutes (rapid metabolism). |
| Protein binding | Dextrose: negligible; <5% bound to plasma proteins, primarily albumin (non-specific). Electrolytes: sodium and chloride are not significantly protein-bound (<1%); potassium is minimally bound (<5%); magnesium is approximately 30% bound to albumin and globulins; acetate and gluconate are not protein-bound. |
| Volume of Distribution | Dextrose: Vd approximately 0.2 L/kg (confined to extracellular fluid; expands after uptake). Sodium: Vd ~0.15-0.2 L/kg (primarily extracellular). Chloride: Vd ~0.15-0.2 L/kg. Potassium: Vd ~0.4-0.5 L/kg (distributes mainly intracellularly). Magnesium: Vd ~0.3-0.4 L/kg. Clinical meaning: Vd indicates distribution primarily in extracellular water for sodium/chloride; potassium and magnesium distribute more widely into cells. Acetate: Vd ~0.2 L/kg (extracellular). Gluconate: Vd ~0.2-0.3 L/kg. |
| Bioavailability | Intravenous: 100% bioavailability. Oral: not applicable; this product is for intravenous use only. No other routes are clinically relevant. |
| Onset of Action | Intravenous: immediate; hemodynamic effects (expansion of plasma volume) occur within minutes; glucose utilization begins immediately upon infusion. Onset of electrolyte effects depends on distribution: sodium and chloride effects are immediate; potassium and magnesium effects may require minutes to hours for cellular equilibration. |
| Duration of Action | Intravenous: glucose effect lasts 1-2 hours post-infusion, depending on insulin response and metabolic rate; volume expansion persists for 2-4 hours, influenced by renal function. Electrolyte effects: sodium and chloride effects persist for 6-12 hours; potassium effects persist for 12-24 hours; magnesium effects last 24-48 hours. Duration is prolonged in renal dysfunction. |
Intravenous administration; dosing is based on fluid and electrolyte requirements, typically 1-2 L per 24 hours for adults, infused at a rate of 100-200 mL/hour, adjusted according to clinical status and serum electrolyte levels.
| Dosage form | INJECTABLE |
| Renal impairment | In renal impairment, monitor serum potassium and adjust infusion rate to avoid fluid overload; no specific GFR-based dose modification is standard, but cautious use in oliguric patients. |
| Liver impairment | No specific Child-Pugh based dose adjustment recommended; monitor for signs of fluid overload and electrolyte imbalance. |
| Pediatric use | Weight-based dosing: 100-200 mL/kg per 24 hours for maintenance, infused at a rate adjusted for age and clinical condition; maximum infusion rate varies but typically 4-8 mg/kg/min of dextrose (equivalent to 0.4-0.8 mL/kg/h of D5W). |
| Geriatric use | Elderly patients may have reduced renal function; use lower initial infusion rates (e.g., 50-100 mL/hour) and monitor fluid status closely to avoid volume overload and electrolyte disturbances. |
| 1st trimester | Consult provider |
| 2nd trimester | Consult provider |
| 3rd trimester | Consult provider |
Clinical note
Comprehensive clinical and safety monograph for DEXTROSE 5% AND ELECTROLYTE NO. 48 IN PLASTIC CONTAINER (DEXTROSE 5% AND ELECTROLYTE NO. 48 IN PLASTIC CONTAINER).
| Breastfeeding | Dextrose and electrolytes are normal constituents of breast milk. Administration of this solution is unlikely to pose a risk to the nursing infant. No specific M/P ratio is available; dextrose equilibrates with endogenous glucose. |
| Teratogenic Risk | Dextrose and electrolyte solutions are generally considered safe in pregnancy when used as indicated. No teratogenic effects have been reported with dextrose 5% and electrolyte no. 48. However, intravenous fluids should be administered with caution to avoid fluid overload, electrolyte imbalances, or hyperglycemia, which could adversely affect the fetus. Trimester-specific risks are not established; clinical judgment is required. |
■ FDA Black Box Warning
None.
| Serious Effects |
["Hypersensitivity to any component","Hyperglycemia (if severe or uncontrolled)","Severe hypokalemia without potassium replacement","Severe hypernatremia or fluid overload","Anuria or severe renal impairment"]
| Precautions | ["Use with caution in patients with congestive heart failure, renal impairment, or conditions predisposing to hyperkalemia or fluid overload","Monitor serum glucose, electrolytes, and fluid balance closely","Avoid in patients with anuria or in those with increased lactate levels (e.g., lactic acidosis) if lactate-containing","Not for use in patients with known allergies to corn or corn products (dextrose derived from corn)"] |
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| Fetal Monitoring | Monitor maternal serum electrolytes, glucose, fluid balance, and vital signs. Fetal heart rate monitoring may be indicated in high-risk pregnancies or if maternal status changes. Assess for signs of fluid overload or electrolyte disturbances. |
| Fertility Effects | No known adverse effects on fertility. Dextrose and electrolyte solutions are basic physiological components and not expected to impair reproductive function. |