DIANEAL LOW CALCIUM W/DEXTROSE 1.5% IN PLASTIC CONTAINER
Clinical safety rating: caution
Comprehensive clinical and safety monograph for DIANEAL LOW CALCIUM W/DEXTROSE 1.5% IN PLASTIC CONTAINER (DIANEAL LOW CALCIUM W/DEXTROSE 1.5% IN PLASTIC CONTAINER).
Dianeal Low Calcium with Dextrose 1.5% is a peritoneal dialysis solution that provides osmotic gradient for ultrafiltration and diffusion of solutes across the peritoneal membrane. Dextrose (1.5%) acts as the osmotic agent, creating a concentration gradient that drives water removal. The low calcium concentration (2.5 mEq/L) helps manage hypercalcemia in patients requiring calcium-based phosphate binders.
| Metabolism | Dextrose in the solution is absorbed into the systemic circulation and metabolized via normal glucose metabolic pathways, including glycolysis and the Krebs cycle. Calcium and other electrolytes are not metabolized but are handled by normal homeostatic mechanisms. |
| Excretion | Primarily removed via peritoneal dialysis itself; ~70% of absorbed glucose undergoes metabolism, with remaining glucose and lactate absorbed systemically and metabolized hepatically. Renal elimination of dextrose and lactate is negligible (<5%) due to low systemic absorption and endogenous metabolism. |
| Half-life | For intraperitoneal dextrose: not clinically applicable as elimination is via continuous peritoneal dialysis. Systemically absorbed dextrose has a half-life of 15-20 minutes due to rapid cellular uptake and metabolism. |
| Protein binding | Dextrose: negligible protein binding (<5%). |
| Volume of Distribution | Dextrose: Vd ~0.2 L/kg, approximating extracellular fluid volume; primarily distributes into extracellular space. |
| Bioavailability | Intraperitoneal: dextrose is 100% bioavailable systemically after absorption across the peritoneal membrane; lactate is also fully absorbed. |
| Onset of Action | Intraperitoneal: 30-60 minutes for ultrafiltration and solute removal; begins shortly after instillation of dialysate. |
| Duration of Action | Intraperitoneal: For a standard dwell time of 4-6 hours (CAPD) or 10-14 hours (APD cycler); ultrafiltration rate declines over time due to glucose absorption and osmotic gradient dissipation. |
Intraperitoneal administration: 2 L per exchange, 4 exchanges per day (2.5 L per exchange for larger patients if tolerated).
| Dosage form | SOLUTION |
| Renal impairment | No adjustment required as drug is used for peritoneal dialysis in end-stage renal disease; monitor ultrafiltration and electrolyte balance. |
| Liver impairment | No adjustment required; however, monitor for potential metabolic acidosis in severe hepatic impairment. |
| Pediatric use | Intraperitoneal: 30-40 mL/kg per exchange; adjust frequency based on clinical goals (typically 4-5 exchanges per day). |
| Geriatric use | Use same dosing as adults; monitor for fluid and electrolyte imbalances due to potential age-related comorbidities. |
| 1st trimester | Consult provider |
| 2nd trimester | Consult provider |
| 3rd trimester | Consult provider |
Clinical note
Comprehensive clinical and safety monograph for DIANEAL LOW CALCIUM W/DEXTROSE 1.5% IN PLASTIC CONTAINER (DIANEAL LOW CALCIUM W/DEXTROSE 1.5% IN PLASTIC CONTAINER).
| Breastfeeding | No data on excretion in breast milk. Dextrose is a normal blood constituent; peritoneal dialysis fluid components are unlikely to reach significant levels in milk. Caution recommended given lack of studies. |
| Teratogenic Risk | Insufficient human data; dextrose-based peritoneal dialysis solutions are not expected to increase risk of major birth defects. No known teratogenicity from intraperitoneal dextrose. However, uremia and metabolic disturbances in dialysis patients may pose risks. No first trimester-specific data. |
■ FDA Black Box Warning
None
| Serious Effects |
["Documented hypersensitivity to any component of the solution","Pre-existing severe hypercalcemia (serum calcium > 11.5 mg/dL)","Severe hypokalemia (serum potassium < 2.5 mEq/L)","Mechanical defects of the peritoneal cavity (e.g., diaphragmatic leak, pleuroperitoneal communication)","Severe peritoneal fibrosis or adhesions precluding effective dialysis","Untreated or uncontrolled peritonitis","Severe pancreatitis (acute episode)","Severe acute abdominal conditions (e.g., perforated viscus, recent abdominal surgery)"]
| Precautions | ["Monitor serum electrolytes, including calcium, magnesium, and potassium, frequently.","Risk of hyperglycemia, especially in diabetic patients; monitor blood glucose levels and adjust insulin as needed.","Peritonitis risk: aseptic technique required during catheter connection and solution exchange.","Do not use if solution is discolored, cloudy, or contains particulate matter.","Hypokalemia may occur; supplement potassium if necessary.","Monitor fluid balance for signs of overhydration or dehydration.","Use with caution in patients with significant electrolyte disturbances or severe metabolic disorders."] |
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| Fetal Monitoring | Monitor maternal serum electrolytes, blood glucose, renal function, and acid-base status. Assess for peritonitis. Fetal monitoring via ultrasound for growth and well-being. Monitor for maternal acidosis or hyperglycemia. |
| Fertility Effects | No specific studies on fertility with Dianeal Low Calcium. Uremic state from renal failure may impair fertility; peritoneal dialysis can stabilize metabolic status and potentially improve reproductive function. |