DEXTROSE 5% IN ACETATED RINGER'S IN PLASTIC CONTAINER
Clinical safety rating: caution
Comprehensive clinical and safety monograph for DEXTROSE 5% IN ACETATED RINGER'S IN PLASTIC CONTAINER (DEXTROSE 5% IN ACETATED RINGER'S IN PLASTIC CONTAINER).
Dextrose is a monosaccharide that provides caloric supplementation and serves as a source of glucose for cellular metabolism. Acetate in Ringer's solution is metabolized to bicarbonate, acting as an alkalinizing agent to correct acidosis. The electrolyte composition (sodium, potassium, calcium, chloride, magnesium, acetate) maintains fluid and electrolyte balance.
| Metabolism | Dextrose is rapidly metabolized via glycolysis and the citric acid cycle; insulin facilitates cellular uptake. Acetate is metabolized in the liver and peripheral tissues to bicarbonate via acetyl-CoA. |
| Excretion | Renal: >95% as water; acetate and electrolytes are metabolized or excreted renally. |
| Half-life | Not applicable; dextrose is rapidly metabolized and cleared; functional half-life of infused fluid is about 15–30 minutes via redistribution and renal excretion. |
| Protein binding | Dextrose: negligible (<5%); does not significantly bind to plasma proteins. |
| Volume of Distribution | 0.2–0.25 L/kg (dextrose distributes mainly in extracellular fluid); total body water for water component. |
| Bioavailability | 100% for intravenous administration; not applicable for oral or other routes. |
| Onset of Action | Immediate upon IV infusion; plasma volume expansion occurs rapidly within minutes. |
| Duration of Action | Short-lived; effects on plasma volume last 1–2 hours post-infusion depending on renal function. |
Intravenous infusion, typically 1000-2000 mL per 24 hours, rate adjusted based on fluid and electrolyte needs.
| Dosage form | INJECTABLE |
| Renal impairment | No specific dose adjustment; use with caution in renal impairment (GFR <30 mL/min) due to risk of volume overload and electrolyte disturbances. Monitor serum potassium and consider acetate content. |
| Liver impairment | No specific dose adjustment; use with caution in severe hepatic impairment (Child-Pugh class C) due to potential impaired lactate metabolism and risk of metabolic alkalosis. |
| Pediatric use | Weight-based dosing: 20-100 mL/kg per 24 hours, rate adjusted based on age, weight, and clinical condition. For neonates, use with caution due to renal immaturity. |
| Geriatric use | Elderly patients may require reduced infusion rates and careful monitoring for fluid overload, electrolyte imbalances, and cardiac function due to age-related decreased renal and cardiovascular reserve. |
| 1st trimester | Consult provider |
| 2nd trimester | Consult provider |
| 3rd trimester | Consult provider |
Clinical note
Comprehensive clinical and safety monograph for DEXTROSE 5% IN ACETATED RINGER'S IN PLASTIC CONTAINER (DEXTROSE 5% IN ACETATED RINGER'S IN PLASTIC CONTAINER).
| Breastfeeding | Dextrose and acetate are endogenous substances present in human milk. Infusion of dextrose 5% in acetated Ringer's is unlikely to significantly alter milk composition. M/P ratio not applicable as these are normal metabolites. Considered compatible with breastfeeding; however, monitor for maternal fluid and electrolyte status. |
| Teratogenic Risk | Dextrose and acetated Ringer's solution are standard crystalloid fluids. Dextrose is a physiological sugar; acetate is a bicarbonate precursor. No specific teratogenic risk is identified at standard infusion rates. However, hyperglycemia from excessive dextrose infusion may be associated with fetal macrosomia and neonatal hypoglycemia. Trimester-specific risks: First trimester: No known increased risk of malformations. Second and third trimesters: Risk of fetal hyperinsulinemia and related complications if maternal glucose is poorly controlled. No data on acetate-specific fetal effects. |
■ FDA Black Box Warning
Not for use in patients with hyperglycemia or glucose intolerance. Avoid in patients with known hypersensitivity to corn or corn products. Do not administer simultaneously with blood products through the same IV line due to risk of hemolysis and agglutination.
| Serious Effects |
["Hyperglycemia (blood glucose > 200 mg/dL)","Glucose intolerance (e.g., diabetes mellitus, stress-induced hyperglycemia)","Known allergy to corn or corn products","Severe metabolic acidosis (unless specifically indicated for acetate therapy)","Hypersensitivity to any component of the solution"]
| Precautions | ["Monitor serum glucose, electrolytes, and acid-base balance during prolonged infusion","Use with caution in patients with renal impairment, heart failure, or conditions predisposing to fluid overload","Risk of hyperglycemia, especially in diabetic patients; may require insulin","Avoid extravasation due to risk of tissue necrosis","Not recommended for resuscitation due to potential for hyperglycemia and osmotic diuresis"] |
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| Fetal Monitoring | Monitor maternal blood glucose, serum electrolytes (sodium, potassium, chloride, bicarbonate/acetate), acid-base status, and fluid balance. Fetal monitoring by ultrasound for growth and amniotic fluid volume in prolonged use. In diabetic patients, frequent glucose monitoring and fetal surveillance (e.g., nonstress test) as indicated. |
| Fertility Effects | No known effects on fertility. Dextrose and acetate are physiological components and do not impair reproductive function at standard doses. |