DEXTROSE 5% IN LACTATED RINGER'S IN PLASTIC CONTAINER
Clinical safety rating: caution
Comprehensive 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). |
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 | Consult provider |
| 2nd trimester | Consult provider |
| 3rd trimester | Consult provider |
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).
| Breastfeeding | Excreted in breast milk in negligible amounts. Dextrose and electrolytes are normal milk constituents. No adverse effects expected. M/P ratio not determined as it is not pharmacologically active. |
| 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. |
■ FDA Black Box Warning
None.
| Serious Effects |
["Hyperglycemia or hyperlactatemia","Patients with severe metabolic acidosis (except when caused by dehydration)","Severe renal failure (oliguria or anuria)","Addison's disease","Administration of blood products through same IV line (due to risk of precipitation)"]
| 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"] |
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| 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. |