DEXTROSE 50% IN PLASTIC CONTAINER
Clinical safety rating: caution
Comprehensive clinical and safety monograph for DEXTROSE 50% IN PLASTIC CONTAINER (DEXTROSE 50% IN PLASTIC CONTAINER).
Dextrose is a monosaccharide that serves as a source of energy for the body. It is rapidly metabolized to produce glucose, which is essential for cellular metabolism. Intravenous administration increases blood glucose levels, providing calories and correcting hypoglycemia.
| Metabolism | Metabolized via glycolysis and the citric acid cycle to produce ATP; primarily in the liver and peripheral tissues. |
| Excretion | Excreted primarily via renal routes: ~10% unchanged in urine; remainder metabolized to carbon dioxide and water, exhaled via lungs. Fecal elimination negligible. |
| Half-life | Terminal elimination half-life of glucose is approximately 1.5-2 hours in normoglycemic individuals; prolonged in renal or hepatic impairment or hyperglycemic states. |
| Protein binding | Glucose exhibits minimal to no protein binding (<5%); not bound to albumin or other plasma proteins. |
| Volume of Distribution | Volume of distribution (Vd) approximates total body water: ~0.2 L/kg; expands slightly in hyperglycemia due to osmotic fluid shifts. |
| Bioavailability | Intravenous: 100% (complete bioavailability). Oral: 100% (dextrose is fully absorbed as glucose via intestinal transporters). |
| Onset of Action | Intravenous: immediate (within 1-2 minutes) due to direct delivery into bloodstream. |
| Duration of Action | Duration of action for blood glucose elevation is short, approximately 1-2 hours, depending on dose and patient metabolic state; continuous infusion required for sustained effect. |
Intravenous administration of 25 g (50 mL of 50% solution) for hypoglycemia; may repeat as needed. For hyperkalemia, administer 25 g (50 mL) with 10 units of regular insulin intravenously. Continuous infusion for parenteral nutrition is 5-25 g per liter of total nutrient admixture, rate based on glucose tolerance.
| Dosage form | INJECTABLE |
| Renal impairment | In severe renal impairment (GFR <30 mL/min/1.73 m²), use with caution due to risk of volume overload and hyperglycemia. No specific dose adjustment; monitor glucose and electrolytes frequently. |
| Liver impairment | No specific Child-Pugh based adjustments; use cautiously in severe hepatic impairment due to impaired gluconeogenesis and risk of hyperglycemia. |
| Pediatric use | For hypoglycemia: intravenous dose of 0.5-1 g/kg (1-2 mL/kg of 50% dextrose, diluted to ≤12.5% concentration for peripheral IV). Maximum 25 g per dose. Continuous infusion for parenteral nutrition: 5-20 mg/kg/min, adjusted based on glucose tolerance. |
| Geriatric use | Use lower initial doses (e.g., 12.5 g) for hypoglycemia due to increased sensitivity and risk of hyperglycemia. Monitor glucose and fluid status closely; avoid rapid administration to prevent osmotic diuresis. |
| 1st trimester | Consult provider |
| 2nd trimester | Consult provider |
| 3rd trimester | Consult provider |
Clinical note
Comprehensive clinical and safety monograph for DEXTROSE 50% IN PLASTIC CONTAINER (DEXTROSE 50% IN PLASTIC CONTAINER).
| Breastfeeding | Dextrose is endogenous and normally present in breast milk; intravenous administration increases maternal glucose, leading to elevated breast milk glucose levels. The milk-to-plasma ratio (M/P) is approximately 0.5–1.0. Use with caution; monitor infant for gastrointestinal disturbances. Generally considered compatible with breastfeeding. |
| Teratogenic Risk | Dextrose 50% is a hypertonic glucose solution. No direct teratogenic effects are known; however, maternal hyperglycemia may increase risk of fetal macrosomia, neonatal hypoglycemia, and congenital anomalies (especially neural tube defects) if sustained during organogenesis (first trimester). In second and third trimesters, excess glucose can cause fetal hyperinsulinemia, leading to macrosomia and neonatal hypoglycemia. Use only when clearly needed and monitor maternal blood glucose. |
■ FDA Black Box Warning
No FDA black box warning.
| Serious Effects |
["Hyperglycemia (including diabetic coma)","Hypersensitivity to dextrose","Intracranial or intraspinal hemorrhage","Anuria or severe renal impairment with oliguria"]
| Precautions | ["Hyperglycemia and hyperosmolarity risk","Fluid overload in patients with cardiac or renal impairment","Hypokalemia due to intracellular shift","Phlebitis or infection at injection site","Not for use in patients with intracranial or intraspinal hemorrhage","Use with caution in diabetes mellitus"] |
| Food/Dietary | No specific food interactions. However, oral intake is typically withheld during parenteral dextrose therapy to control blood glucose and avoid aspiration. In diabetic patients, coordinate dietary carbohydrate intake with dextrose infusion. |
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| Fetal Monitoring | Monitor maternal blood glucose levels frequently to avoid hyperglycemia or hypoglycemia after infusion. Assess fluid and electrolyte status. Fetal monitoring (heart rate, growth) recommended if used in gestational diabetes or prolonged infusion. Watch for signs of fluid overload in mother. |
| Fertility Effects | No direct effects on fertility reported. Short-term use for hypoglycemia does not impair fertility. However, uncontrolled hyperglycemia may disrupt menstrual cycles and ovulation; glucose control is important for reproductive function. |
| Clinical Pearls | Administer via large-bore IV or central line due to high osmolarity (~2525 mOsm/L). Avoid extravasation as it can cause severe tissue necrosis. Monitor serum glucose closely in diabetic patients; insulin may be required. Do not administer subcutaneously or intramuscularly. For neonatal use, dilute to ≤12.5% concentration to reduce risk of vascular injury. |
| Patient Advice | This solution provides sugar (calories) and fluids directly into your bloodstream. · Inform your healthcare provider if you have diabetes or any history of head injury or stroke. · Report any signs of allergic reaction such as rash, itching, or difficulty breathing. · Notify your nurse immediately if you experience pain, burning, or swelling at the IV site. · Do not eat or drink anything unless instructed by your doctor, as this may affect your blood sugar. |