DEXTROSE 50%
Clinical safety rating: caution
Comprehensive clinical and safety monograph for DEXTROSE 50% (DEXTROSE 50%).
Intravenous administration of 50% dextrose solution rapidly elevates blood glucose levels by providing exogenous glucose, which is taken up by cells via glucose transporters and metabolized to produce adenosine triphosphate (ATP), thereby correcting hypoglycemia.
| Metabolism | Glucose undergoes glycolysis, tricarboxylic acid cycle, and oxidative phosphorylation. Excess glucose may be stored as glycogen in the liver and muscle or converted to fatty acids via lipogenesis. |
| Excretion | Primarily eliminated by cellular metabolism to carbon dioxide and water; renal excretion of unchanged glucose occurs when plasma concentration exceeds renal threshold (approximately 180 mg/dL), accounting for <5% of elimination under normoglycemic conditions. |
| Half-life | 2-4 hours (exogenous glucose); in critically ill patients or hyperglycemic states, half-life may be prolonged due to impaired glucose utilization. |
| Protein binding | Negligible (<1%); glucose does not significantly bind to plasma proteins. |
| Volume of Distribution | Approximately 0.15-0.25 L/kg (glucose distributes primarily in extracellular fluid; apparent volume increases in hyperglycemia due to osmotic diuresis). |
| Bioavailability | IV: 100%; oral: 100% (glucose is completely absorbed from gastrointestinal tract when administered enterally). |
| Onset of Action | IV: Immediate (seconds to minutes) for hypertonic solution effects; oral: 10-30 minutes for glucose absorption. |
| Duration of Action | IV: 1-2 hours for blood glucose elevation; oral: 2-4 hours depending on dose and metabolic state. |
For hypoglycemia: 25 grams (50 mL of 50% solution) intravenous bolus, may repeat once if needed. For insulin-induced hypoglycemia: 25-50 grams intravenously.
| Dosage form | INJECTABLE |
| Renal impairment | No specific adjustment required; monitor for fluid overload in patients with severe renal impairment (GFR <30 mL/min). Use with caution and consider lower volume if fluid restriction is necessary. |
| Liver impairment | No dosage adjustment required; monitor for hyperglycemia in patients with hepatic insufficiency. |
| Pediatric use | Neonates and infants: 0.5-1 g/kg (1-2 mL/kg of 50% solution) intravenous, diluted to 12.5-25% concentration to minimize venous irritation. For older children: 0.5-1 g/kg intravenous; maximum 25 grams per dose. |
| Geriatric use | Use with caution due to higher risk of fluid overload and hyperglycemia. Start with lower doses (12.5-25 grams) and monitor blood glucose and volume status closely. |
| 1st trimester | Consult provider |
| 2nd trimester | Consult provider |
| 3rd trimester | Consult provider |
Clinical note
Comprehensive clinical and safety monograph for DEXTROSE 50% (DEXTROSE 50%).
| Breastfeeding | Dextrose is a normal constituent of breast milk. Intravenous administration results in increased maternal blood glucose, which may transiently elevate milk glucose levels. M/P ratio is not applicable as dextrose is endogenous. No adverse effects on nursing infants have been reported. |
| Teratogenic Risk | Dextrose 50% is not teratogenic. In all trimesters, administration is generally considered safe when indicated for maternal hypoglycemia or fluid management. No increased risk of fetal anomalies has been documented. |
■ FDA Black Box Warning
None.
| Serious Effects |
["Hypersensitivity to dextrose or corn products","Severe hyperglycemia or diabetes mellitus with ketoacidosis (unless specific treatment protocols)","Intracranial hemorrhage (in neonates)","Do not administer via same IV line as blood products due to risk of hemolysis"]
| Precautions | ["Risk of hyperglycemia, hyperosmolarity, and fluid overload, especially in patients with renal impairment or heart failure","Potential for phlebitis and extravasation; avoid extravasation due to risk of tissue necrosis","Use with caution in patients with diabetes mellitus, intracranial hypertension, or thiamine deficiency","Monitor serum glucose and electrolytes during prolonged administration"] |
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| Fetal Monitoring |
| Monitor maternal blood glucose levels frequently to avoid hyperglycemia or hypoglycemia. In pregnancy, monitor fetal heart rate and uterine activity if administered during labor. Assess maternal fluid and electrolyte status due to risk of fluid overload. |
| Fertility Effects | No known adverse effects on fertility. Dextrose 50% is a standard component of parenteral nutrition and fluid resuscitation and does not impair reproductive function. |