DEXTROSE 5% AND RINGER'S IN PLASTIC CONTAINER
Clinical safety rating: caution
Comprehensive clinical and safety monograph for DEXTROSE 5% AND RINGER'S IN PLASTIC CONTAINER (DEXTROSE 5% AND RINGER'S IN PLASTIC CONTAINER).
Dextrose provides a source of calories and water for hydration, and Ringer's solution provides electrolytes to maintain fluid and electrolyte balance. The combination is used to restore intravascular volume and correct metabolic acidosis.
| Metabolism | Dextrose is metabolized via glycolysis and the Krebs cycle; Ringer's components (sodium, potassium, calcium, chloride, lactate) are excreted or metabolized by normal physiological pathways. |
| Excretion | Dextrose: primarily metabolized to CO2 and water; <5% excreted unchanged in urine. Ringer's solution: electrolytes (Na, K, Ca, Cl) excreted renally; water excreted via kidneys, lungs, and skin. |
| Half-life | Dextrose: not applicable as it is rapidly metabolized; clinical effect depends on glucose utilization. Ringer's components: distribution half-life ~20-30 minutes; elimination half-life determined by renal function, typically 2-4 hours for electrolyte adjustments. |
| Protein binding | Dextrose: negligible. Electrolytes: minimal protein binding (e.g., calcium ~40% bound to albumin; others <10%). |
| Volume of Distribution | Dextrose: ~0.2 L/kg (confined to extracellular fluid). Ringer's: distributes primarily in extracellular fluid; Vd ~0.15-0.2 L/kg for electrolytes. |
| Bioavailability | Intravenous: 100%. |
| Onset of Action | Intravenous: immediate (within minutes) for fluid and electrolyte replacement; dextrose effect on blood glucose within 5-10 minutes. |
| Duration of Action | Duration varies by infusion rate and patient status; typically 1-2 hours after infusion for volume expansion; glucose effect lasts 1-2 hours post-infusion. |
Intravenous administration at a rate determined by fluid and electrolyte needs; typical adult rate is 100-200 mL/hour, not to exceed 25 g dextrose per hour (500 mL/hour of D5LR).
| Dosage form | INJECTABLE |
| Renal impairment | For GFR 30-50 mL/min: no dose adjustment needed, but monitor fluid and electrolyte status; for GFR <30 mL/min: restrict volume to avoid fluid overload and adjust potassium content based on serum levels. |
| Liver impairment | Child-Pugh Class A: no adjustment; Class B: monitor glucose and electrolytes, reduce infusion rate if ascites present; Class C: use with caution, avoid in severe hepatic impairment due to risk of lactic acidosis and fluid overload. |
| Pediatric use | Weight-based infusion: 2-6 mL/kg/hour of D5LR for maintenance; maximum dextrose infusion rate: 12 mg/kg/min in neonates, 15 mg/kg/min in older children; adjust volume based on deficit and ongoing losses. |
| Geriatric use | Lower initial infusion rates (50-100 mL/hour) due to decreased renal function and higher risk of fluid overload; monitor serum glucose and electrolytes closely. |
| 1st trimester | Consult provider |
| 2nd trimester | Consult provider |
| 3rd trimester | Consult provider |
Clinical note
Comprehensive clinical and safety monograph for DEXTROSE 5% AND RINGER'S IN PLASTIC CONTAINER (DEXTROSE 5% AND RINGER'S IN PLASTIC CONTAINER).
| Breastfeeding | Dextrose and Ringer's components are normal plasma constituents and are excreted into breast milk in small amounts. No adverse effects reported. M/P ratio not established but expected to be low. Considered compatible with breastfeeding. |
| Teratogenic Risk | Dextrose 5% and Ringer's solution is generally considered safe in pregnancy when used appropriately. Dextrose is a normal constituent of blood and does not cross the placenta in excess amounts; Ringer's solution provides electrolytes similar to plasma. No known teratogenic effects at standard doses. However, hyperglycemia from excessive dextrose may be associated with fetal macrosomia and neonatal hypoglycemia. During first trimester, no evidence of structural anomalies. Second and third trimesters: risk of fetal hyperglycemia and metabolic disturbances if maternal glucose levels are not controlled. |
■ FDA Black Box Warning
None
| Serious Effects |
["Hyperglycemia with or without hyperosmolar nonketotic coma","Severe renal impairment with oliguria or anuria","Intracranial or intraspinal hemorrhage","Delirium tremens with dehydration"]
| Precautions | ["Risk of hyperglycemia in patients with diabetes mellitus","Potential for fluid overload in patients with renal impairment","Avoid in patients with hypersensitivity to corn products (dextrose source)","Do not administer if solution is discolored or contains precipitate"] |
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| Fetal Monitoring | Monitor maternal blood glucose levels, especially in diabetic patients or when large volumes infused. Assess fluid balance, serum electrolytes, and renal function. Fetal monitoring as clinically indicated for hydration status and glucose control. |
| Fertility Effects | No known adverse effects on fertility. Dextrose and Ringer's solution are used for fluid and electrolyte replacement and do not impact reproductive function at standard doses. |