DEXTROSE 5% AND LACTATED RINGER'S
Clinical safety rating: caution
Comprehensive clinical and safety monograph for DEXTROSE 5% AND LACTATED RINGER'S (DEXTROSE 5% AND LACTATED RINGER'S).
Dextrose provides a source of calories and carbon for metabolism, increasing blood glucose concentration. Lactated Ringer's solution replenishes fluid and electrolytes (sodium, chloride, potassium, calcium, and lactate), where lactate is metabolized to bicarbonate in the liver to buffer acidosis.
| Metabolism | Dextrose is metabolized via glycolysis and the citric acid cycle to carbon dioxide and water, with insulin facilitating cellular uptake. Lactate is converted to glucose via gluconeogenesis or oxidized to CO2 and water, primarily in the liver (Cori cycle). |
| Excretion | Dextrose is completely metabolized to carbon dioxide and water, with no significant renal or biliary excretion. Lactated Ringer's components: lactate is metabolized to bicarbonate (primarily hepatic), water and electrolytes are excreted renally. >90% of infused water and electrolytes are eliminated via kidneys; <5% fecal. |
| Half-life | Dextrose: not applicable (immediate metabolism). Lactate: ~15-20 minutes (converted to bicarbonate, dose-dependent). Clinical context: effects of fluid resuscitation persist until distribution/elimination; electrolyte levels adjust rapidly. |
| Protein binding | Dextrose: not bound. Electrolytes (sodium, potassium, calcium, chloride) and lactate: negligible protein binding (<5%). |
| Volume of Distribution | Dextrose: distributes into total body water (approx 0.6 L/kg). Lactated Ringer's: electrolytes distribute proportional to body water; extracellular fluid volume ~0.2 L/kg. Combined: Vd approximates total body water (0.6 L/kg). Clinical meaning: rapid equilibration with extracellular and intracellular spaces. |
| Bioavailability | Intravenous: 100%. Not administered via other routes. |
| Onset of Action | Intravenous: immediate (seconds to minutes) for hemodynamic effects: increased intravascular volume, improved tissue perfusion. Metabolic effects (e.g., blood glucose elevation) occur within minutes. |
| Duration of Action | Intravenous: Hemodynamic effect lasts 1-2 hours per bolus; sustained with continuous infusion. Metabolic effect: glucose elevation lasts 1-2 hours post-infusion depending on metabolic demand. Lactate metabolism complete within 30-60 minutes. |
Intravenous infusion; rate determined by fluid and electrolyte requirements; typical adult maintenance: 100-200 mL/hour.
| Dosage form | INJECTABLE |
| Renal impairment | No specific dose adjustment for D5LR; monitor for fluid overload and electrolyte disturbances in renal impairment; contraindicated in anuria. |
| Liver impairment | No specific dose adjustment; use with caution in severe hepatic impairment due to risk of lactate accumulation. |
| Pediatric use | Intravenous infusion based on maintenance fluid calculations: 100 mL/kg/day for first 10 kg, 50 mL/kg/day for next 10 kg, 20 mL/kg/day for each additional kg; adjust for deficits and ongoing losses. |
| Geriatric use | Use with caution due to increased risk of fluid overload and electrolyte imbalances; consider lower infusion rates and monitor cardiac function, renal function, and serum electrolytes. |
| 1st trimester | Consult provider |
| 2nd trimester | Consult provider |
| 3rd trimester | Consult provider |
Clinical note
Comprehensive clinical and safety monograph for DEXTROSE 5% AND LACTATED RINGER'S (DEXTROSE 5% AND LACTATED RINGER'S).
| Breastfeeding | Dextrose and lactated Ringer's components are endogenous substances normally present in breast milk. No specific safety concerns; levels in milk are negligible compared to endogenous concentrations. M/P ratio not applicable as these are not xenobiotics. Compatible with breastfeeding. |
| Teratogenic Risk | Dextrose and lactated Ringer's solution are generally considered safe in pregnancy when used as clinically indicated. Dextrose is a physiological sugar; lactated Ringer's contains electrolytes and lactate, which is converted to bicarbonate. No specific teratogenic risks have been reported. However, excessive glucose administration may cause fetal hyperglycemia and hyperinsulinemia, potentially leading to neonatal hypoglycemia. Use with caution in gestational diabetes. First trimester: no known malformation risk. Second and third trimesters: monitor maternal glucose levels to avoid fetal hyperglycemia. |
■ FDA Black Box Warning
Not for use in newborns because of risk of aluminum toxicity from prolonged intravenous administration; also, solutions containing calcium should not be administered simultaneously with blood through the same infusion set because of risk of coagulation.
| Serious Effects |
["Hyperkalemia (Lactated Ringer's contains potassium)","Hypersensitivity to any component","Severe metabolic alkalosis (lactate may worsen alkalosis)","Patients with galactosemia or milk-alkali syndrome","Concurrent administration with blood (risk of clotting)"]
| Precautions | ["Monitor serum glucose and electrolytes; risk of hyperglycemia, especially in patients with diabetes mellitus or impaired glucose tolerance","Risk of fluid overload, particularly in patients with heart failure, renal impairment, or pulmonary edema","Avoid in patients with hypernatremia or hyperlactatemia","Use with caution in patients with liver disease (lactate metabolism impaired)","Do not administer if solution is discolored or contains precipitate"] |
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| Fetal Monitoring | Monitor maternal blood glucose, serum electrolytes (sodium, potassium, calcium, chloride, bicarbonate), fluid balance, and signs of fluid overload. In pregnancy, monitor for uterine activity and fetal heart rate if administering large volumes or in high-risk patients. Assess for signs of hyperglycemia or electrolyte imbalances. |
| Fertility Effects | No known adverse effects on fertility. Dextrose and lactated Ringer's are physiological solutions and do not impair reproductive function. |