DEXTROSE 5% IN LACTATED RINGER'S IN PLASTIC CONTAINER
Clinical safety rating
cautionComprehensive clinical and safety monograph for DEXTROSE 5% IN LACTATED RINGER'S IN PLASTIC CONTAINER (DEXTROSE 5% IN LACTATED RINGER'S IN PLASTIC CONTAINER).
Dextrose provides caloric support and increases serum glucose levels, while lactated Ringer's solution restores fluid and electrolyte balance. Lactate is metabolized to bicarbonate, buffering acidosis.
| Metabolism | Dextrose undergoes glycolysis and oxidative phosphorylation. Lactate is converted to pyruvate via lactate dehydrogenase (LDH) and then enters the citric acid cycle, primarily in the liver. |
| Excretion | Renal: water and electrolytes are excreted renally; dextrose is metabolized to CO2 and water, with CO2 exhaled and water excreted renally. Biliary/fecal: negligible. |
| Half-life | Approximately 5-10 minutes for dextrose; lactated Ringer's components have variable half-lives: lactate 5-20 minutes, electrolytes follow renal clearance. |
| Protein binding | Dextrose: negligible; electrolytes: minimal binding; lactate: not significantly protein-bound. |
| Volume of Distribution | 0.2-0.3 L/kg for dextrose (total body water); electrolytes distribute according to body water compartments (Na+ primarily extracellular, K+ intracellular), lactate distributes in total body water. |
| Bioavailability | Intravenous: 100% by definition. |
| Onset of Action | Intravenous: immediate (seconds to minutes) for fluid expansion and dextrose metabolism. |
| Duration of Action | Intravenous: 30-60 minutes for fluid volume effect; dextrose effect lasts until metabolized (minutes to hours depending on glucose utilization). |
| Molecular Weight | 180.16 |
Intravenous infusion. Dose depends on patient's fluid and electrolyte needs. Typical adult infusion rate: 100-200 mL/hour. Maximum rate of dextrose infusion: 0.5 g/kg/hour to avoid hyperglycemia.
| Dosage form | INJECTABLE |
| Renal impairment | GFR < 50 mL/min: Monitor for fluid overload and electrolyte disturbances. Dose reduction may be necessary to avoid hyperkalemia due to potassium content (approximately 20 mEq/L). GFR < 30 mL/min: Use with caution; consider alternative fluids. Anuria: Contraindicated. |
| Liver impairment | Child-Pugh Class B or C: Caution due to impaired lactate metabolism. Monitor lactate levels. May require alternative fluids in severe hepatic impairment to avoid lactic acidosis. |
| Pediatric use | Intravenous infusion. Dose based on weight and clinical condition. Typical maintenance: 100 mL/kg/day for first 10 kg, 50 mL/kg/day for next 10 kg, 20 mL/kg/day for each kg over 20 kg. Dextrose infusion rate should not exceed 0.5 g/kg/hour. |
| Geriatric use | Start at lower infusion rates (e.g., 50-100 mL/hour) due to decreased renal function and increased risk of fluid overload. Monitor electrolytes and glucose closely. Adjust rate based on volume status and comorbidities. |
| 1st trimester | Dextrose and lactated Ringer's are generally considered safe during pregnancy when used as indicated. Dextrose provides calories and lactated Ringer's provides electrolyte and fluid replacement. No known teratogenic effects from components. |
| 2nd trimester | Safe for use as indicated. Monitor for fluid overload and electrolyte disturbances, especially in preeclampsia. |
| 3rd trimester | Safe but use with caution in patients with gestational diabetes due to dextrose content. Avoid excess fluid to prevent pulmonary edema. |
Clinical note
Comprehensive clinical and safety monograph for DEXTROSE 5% IN LACTATED RINGER'S IN PLASTIC CONTAINER (DEXTROSE 5% IN LACTATED RINGER'S IN PLASTIC CONTAINER).
| Placental transfer | Dextrose and electrolytes readily cross the placenta. Lactate is metabolized to bicarbonate and crosses. |
| Breastfeeding | Dextrose and lactated Ringer's components are normal constituents of breast milk and are considered safe during breastfeeding. No special precautions needed. |
| Lactation Rating | L1: Safest |
| Teratogenic Risk | No evidence of teratogenicity. Dextrose and lactated Ringer's are physiologic solutions; at therapeutic doses, no increased risk of fetal malformations in any trimester. However, electrolyte imbalances or hyperglycemia from misuse may pose indirect fetal risks. |
| Fetal Monitoring | Monitor maternal serum electrolytes, glucose, and fluid balance. Fetal heart rate monitoring if administered during labor. Assess for signs of fluid overload or electrolyte disturbances. |
| Fertility Effects | No known effects on fertility. Dextrose and lactated Ringer's are physiologic solutions and do not impair reproductive function at standard doses. |
■ FDA Black Box Warning
None.
| Serious Effects |
Hyperglycemia (severe)Lactic acidosisHyperkalemiaAddison's diseaseRenal failure with anuria
| Precautions | Use with caution in patients with congestive heart failure, renal impairment, or conditions causing fluid overload, Monitor serum glucose, especially in diabetics or patients with glucose intolerance, Risk of electrolyte imbalances, Not for use in patients with lactic acidosis or severe hepatic impairment, Avoid in patients with known hypersensitivity to corn-derived products |
| Food/Dietary | No significant food interactions, as this is an intravenous solution. However, oral intake of high-potassium foods (bananas, oranges, spinach, potatoes) should be monitored in patients with hyperkalemia or renal impairment due to the potassium content of LR. |
| Clinical Pearls | D5LR is isotonic after infusion (osmolality ~525 mOsm/L initially, but rapidly equilibrates). Not for use in patients with lactic acidosis or known hyperlactatemia. Avoid in patients with galactosemia. Contains calcium; do not administer through same IV line as ceftriaxone (precipitation risk). Use with caution in renal impairment—risk of hyperkalemia from LR component. Blood transfusions via LR can cause citrate anticoagulant toxicity; prefer NS. In DKA, LR may worsen lactic acidosis—use NS initially. For hypovolemic patients, D5LR provides free water after dextrose metabolism; monitor for hyperglycemia. |
| Patient Advice | This IV solution contains sugar (dextrose) and electrolytes, including potassium. Report any pain, redness, or swelling at the IV site immediately. · You may experience increased thirst or urination while receiving this fluid. Notify your nurse if you feel short of breath or have leg swelling. · This solution may increase your blood sugar; if you have diabetes, we will monitor your glucose levels. Do not adjust your diabetes medications without talking to your doctor. · Inform your healthcare team if you are allergic to any ingredients or if you have a history of kidney problems, high potassium, or galactosemia (a rare metabolic disorder). · This product contains no preservatives; any unused portion will be discarded. |
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