DEXTROSE 5%
Clinical safety rating: caution
Comprehensive clinical and safety monograph for DEXTROSE 5% (DEXTROSE 5%).
Dextrose 5% provides a source of calories and water for intravenous administration. It is metabolized to carbon dioxide and water, yielding energy. Dextrose solutions exert osmotic effects and can increase blood glucose levels.
| Metabolism | Dextrose is metabolized via glycolysis, the citric acid cycle, and oxidative phosphorylation to produce ATP, carbon dioxide, and water. Insulin facilitates cellular uptake and metabolism. |
| Excretion | Renal: 100% (D-glucose and its metabolites, including CO2 and water); less than 1% excreted unchanged in urine under normal conditions; fecal excretion negligible. |
| Half-life | 0.5-1 hour (endogenous glucose); intravenous infusion half-life is variable due to continuous cellular uptake and metabolism; clinical context: rapid clearance via insulin-mediated cellular uptake and glycolysis. |
| Protein binding | Negligible (<1%); no specific binding proteins; D-glucose is freely soluble in plasma. |
| Volume of Distribution | 0.15-0.25 L/kg (approximates total body water); clinical meaning: distributes primarily into extracellular fluid and intracellular compartments via glucose transporters. |
| Bioavailability | Intravenous: 100% (complete). Oral: not applicable (dextrose is administered intravenously; oral administration is for nutritional support but undergoes first-pass metabolism; not typically used for systemic effect). |
| Onset of Action | Intravenous: immediate (within 1 minute) for increasing blood glucose levels. |
| Duration of Action | Intravenous: 1-2 hours (depending on infusion rate and individual metabolic state); clinical notes: continuous infusion required to maintain effect; duration limited by rapid cellular utilization and renal reabsorption. |
Intravenous infusion; 5% dextrose in water (D5W) is typically administered at a rate of 100-200 mL/hour to provide 50-100 g of glucose per day for maintenance hydration and minimal caloric support in adults.
| Dosage form | INJECTABLE |
| Renal impairment | No specific GFR-based dose adjustment required as dextrose is a simple sugar that is metabolized to water and CO2; however, monitor for fluid overload in oliguric or anuric patients. |
| Liver impairment | No Child-Pugh based adjustments; use with caution in severe hepatic impairment due to risk of hyperglycemia and fluid overload; monitor glucose and volume status. |
| Pediatric use | Dosing based on glucose requirements: neonates and infants: 5-10 mg/kg/min as continuous IV infusion; children: 2-6 mg/kg/min to maintain normoglycemia; typically administered as D5W or D10W depending on age and needs. |
| Geriatric use | Lower infusion rates (50-100 mL/hour) recommended due to decreased renal function and risk of volume 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% (DEXTROSE 5%).
| Breastfeeding | Dextrose 5% is considered safe during breastfeeding. Glucose is a normal constituent of breast milk; intravenous administration of dextrose will increase maternal blood glucose and subsequently milk glucose levels transiently. No adverse effects on the breastfed infant are anticipated. The M/P ratio for glucose is approximately 0.5-1.0, reflecting passive diffusion and active transport. |
| Teratogenic Risk | Dextrose 5% is a source of glucose and water; glucose is essential for fetal development. No teratogenic effects are attributed to dextrose itself at therapeutic doses. However, maternal hyperglycemia (which can occur with excessive or too rapid administration) is associated with fetal macrosomia, neonatal hypoglycemia, and congenital anomalies if occurring during first trimester organogenesis. Intravenous dextrose should be administered with caution, especially in women with gestational or preexisting diabetes, with close glucose monitoring to avoid hyperglycemia. |
■ FDA Black Box Warning
None
| Serious Effects |
["Hyperglycemia (blood glucose > 200 mg/dL)","Hyperosmolar coma","Severe dehydration with hypernatremia","Known allergy to corn or corn products (since dextrose is derived from corn)","Concurrent use of certain drugs that may cause hyperglycemia"]
| Precautions | ["Hyperglycemia and hyperosmolar syndrome in patients with impaired glucose tolerance or diabetes mellitus","Intravenous administration may cause fluid overload, particularly in patients with renal or cardiac impairment","Electrolyte imbalances (e.g., hypokalemia, hypophosphatemia) due to intracellular shift with glucose administration","Thrombophlebitis or infection at the injection site","Use with caution in patients with intracranial hemorrhage or severe dehydration","Monitor serum glucose and electrolyte levels regularly during prolonged use"] |
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| Fetal Monitoring | Monitor maternal blood glucose levels frequently during infusion, especially in patients with diabetes or gestational diabetes. Assess for signs of fluid overload (e.g., edema, pulmonary congestion) and electrolyte imbalances, particularly if large volumes are administered. Fetal monitoring (nonstress test or biophysical profile) may be indicated in cases of maternal hyperglycemia or underlying high-risk pregnancy. Monitor for signs of hypoglycemia in the neonate after delivery if maternal hyperglycemia occurred. |
| Fertility Effects | There is no evidence that dextrose 5% adversely affects fertility in males or females. Glucose is a physiological substrate, and its administration at therapeutic doses does not impair reproductive function. However, uncontrolled hyperglycemia in diabetic patients may negatively impact fertility; dextrose infusion should be adjusted to maintain euglycemia. |