DEXTROSE 60%
Clinical safety rating: caution
Comprehensive clinical and safety monograph for DEXTROSE 60% (DEXTROSE 60%).
Dextrose is a monosaccharide that provides a source of calories and hydration. It increases blood glucose levels and is metabolized to carbon dioxide and water, yielding energy.
| Metabolism | Dextrose is metabolized via glycolysis and the citric acid cycle, ultimately producing ATP, carbon dioxide, and water. |
| Excretion | Renal: 100% (unchanged) if renal threshold not exceeded; otherwise, glucosuria. Biliary/fecal: negligible. |
| Half-life | 5–10 minutes (for glucose itself; dextrose is glucose). Clinically, rapid distribution and metabolism. |
| Protein binding | Negligible (<5%); not significantly bound to plasma proteins. |
| Volume of Distribution | Approximately 0.2 L/kg (total body water). Reflects distribution into extracellular and intracellular fluid. |
| Bioavailability | Intravenous: 100%. Oral: not applicable (not used orally for systemic glucose; absorbed but undergoes first-pass metabolism; enteral dextrose has complete absorption but no systemic bioavailability considered). |
| Onset of Action | Intravenous: immediate (seconds to minutes). Oral: 5–10 minutes. |
| Duration of Action | Intravenous: 1–2 hours depending on dose and metabolic state. Short due to rapid cellular uptake and metabolism. |
Intravenous: For hypoglycemia, 0.5-1 g/kg (10-25 g) as 50% solution; for hyperkalemia, 25 g dextrose with 10 units regular insulin IV. For parenteral nutrition, variable per metabolic needs. Infusion rate not to exceed 0.5 g/kg/h.
| Dosage form | INJECTABLE |
| Renal impairment | No dose adjustment required for dextrose 60%; monitor serum glucose and electrolytes in renal impairment. In renal failure, consider fluid and electrolyte balance when administering large volumes. |
| Liver impairment | No specific dose adjustment based on Child-Pugh score; monitor glucose levels closely in hepatic impairment due to risk of hyperglycemia or hypoglycemia. |
| Pediatric use | Neonates and children: For hypoglycemia, 0.5-1 g/kg IV (2-4 mL/kg of 25% dextrose or 1-2 mL/kg of 50% dextrose); for parenteral nutrition, start at 10-15 g/kg/day with gradual increase. Max infusion rate 0.5 g/kg/h. |
| Geriatric use | Caution in elderly due to high osmolality (60% solution is hypertonic); administer via central line. Monitor for fluid overload and hyperglycemia. Lower initial doses may be considered based on clinical response. |
| 1st trimester | Consult provider |
| 2nd trimester | Consult provider |
| 3rd trimester | Consult provider |
Clinical note
Comprehensive clinical and safety monograph for DEXTROSE 60% (DEXTROSE 60%).
| Breastfeeding | Dextrose is a normal constituent of breast milk. Intravenous administration may transiently increase maternal blood glucose and subsequently milk glucose levels, but no adverse effects on nursing infant are expected. M/P ratio not established; endogenous glucose M/P ratio approximates 1.0. Dextrose is considered compatible with breastfeeding. |
| Teratogenic Risk | Dextrose is a physiologic monosaccharide and does not have inherent teratogenicity at standard therapeutic doses. However, hyperglycemia from excessive administration may be associated with fetal macrosomia, neonatal hypoglycemia, and congenital anomalies if severe maternal hyperglycemia occurs. During first trimester, severe hyperglycemia may increase risk of neural tube defects and cardiac anomalies. Second and third trimester hyperglycemia risk includes fetal hyperinsulinism, macrosomia, and neonatal metabolic complications. Use with caution in gestational diabetes. |
■ FDA Black Box Warning
None
| Serious Effects |
["Hyperglycemia","Hypersensitivity to dextrose or any component","Intracranial or intraspinal hemorrhage","Patients with known allergy to corn or corn products (dextrose derived from corn)"]
| Precautions | ["Use with caution in patients with diabetes mellitus, hyperglycemia, or hypokalemia","Intravenous administration may cause hyperglycemia, hyperosmolarity, and fluid overload","Monitor serum glucose and electrolytes frequently during infusion","Avoid extravasation due to risk of tissue necrosis"] |
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| Fetal Monitoring | Monitor maternal blood glucose levels frequently, especially in patients with diabetes or gestational diabetes. Assess fluid balance and electrolyte status, particularly with prolonged administration. Fetal monitoring via ultrasound for growth and amniotic fluid volume if maternal hyperglycemia is present. Neonatal blood glucose monitoring after delivery if maternal hyperglycemia occurred. |
| Fertility Effects | No direct adverse effects on fertility reported at therapeutic doses. Hyperglycemia from excessive use may impair ovulatory function and endometrial receptivity. Controlled use does not alter fertility. |