DIANEAL LOW CALCIUM W/DEXTROSE 4.25% IN PLASTIC CONTAINER
Clinical safety rating: caution
Comprehensive clinical and safety monograph for DIANEAL LOW CALCIUM W/DEXTROSE 4.25% IN PLASTIC CONTAINER (DIANEAL LOW CALCIUM W/DEXTROSE 4.25% IN PLASTIC CONTAINER).
Sterile, nonpyrogenic, hyperosmotic solution containing dextrose as osmotic agent; creates osmotic gradient across peritoneal membrane to remove excess fluid and waste products via diffusion and ultrafiltration.
| Metabolism | Dextrose is absorbed across peritoneum and metabolized via glycolysis and mitochondrial respiration; insulin may be required. |
| Excretion | Peritoneal elimination; glucose absorbed systemically is metabolized via glycolysis, with <5% excreted unchanged in urine. Dextrose removal relies on diffusion into dialysate; net ultrafiltrate exits via peritoneal catheter. |
| Half-life | Not applicable for intraperitoneal dextrose; systemic glucose half-life ~1.5-3 h in normal metabolic state. Peritoneal dialysis of dextrose reflects continuous absorption and metabolism. |
| Protein binding | Dextrose is not protein bound. |
| Volume of Distribution | Dextrose distributes into total body water, approximately 0.55-0.65 L/kg; clinical meaning: glucose rapidly equilibrates throughout extracellular and intracellular fluids. |
| Bioavailability | Intraperitoneal dextrose is absorbed systemically; absorption rate depends on dwell time, peritoneal transport characteristics, and concentration. Approximately 60-80% of dextrose is absorbed over a 4-hour dwell with 4.25% solution. |
| Onset of Action | Ultrafiltration begins immediately upon instillation; peak osmotic effect within 15-30 minutes. |
| Duration of Action | Dwell time of 4-6 hours for standard exchanges; ultrafiltration rate decreases as dextrose is absorbed and osmotic gradient dissipates. |
Intraperitoneal administration: 2 liters per exchange, 4 exchanges daily, with dwell times of 4-6 hours; dextrose concentration adjusted to achieve ultrafiltration goals.
| Dosage form | SOLUTION |
| Renal impairment | No dose adjustment required for renal impairment as drug is administered intraperitoneally; monitor serum potassium and calcium levels in patients with end-stage renal disease. |
| Liver impairment | No specific dose adjustment guidelines available for hepatic impairment. Use with caution in severe liver disease due to potential for metabolic acidosis. |
| Pediatric use | Intraperitoneal: 30-40 mL/kg per exchange, starting with 4 exchanges daily, volume and frequency adjusted based on body surface area and ultrafiltration needs. |
| Geriatric use | Use standard adult dosing; monitor for electrolyte imbalances (hypokalemia, hypocalcemia) and volume status more frequently due to age-related physiological changes. |
| 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 4.25% IN PLASTIC CONTAINER (DIANEAL LOW CALCIUM W/DEXTROSE 4.25% IN PLASTIC CONTAINER).
| Breastfeeding | No data on M/P ratio. Systemic absorption is minimal; dextrose and electrolytes are endogenous substances. Compatible with breastfeeding due to negligible transfer into milk. |
| Teratogenic Risk | No known teratogenic risk in any trimester. Dextrose and electrolytes are physiologic. High osmolality may cause fetal hyperglycemia if maternal glucose levels rise significantly, but risk is low with intraperitoneal administration. |
■ FDA Black Box Warning
Not for intravenous use. Strict aseptic technique required to prevent peritonitis.
| Serious Effects |
Hypersensitivity to any component; severe hyperglycemia; abdominal conditions that compromise peritoneal integrity (e.g., recent surgery, fistulas, hernias).
| Precautions | Monitor for electrolyte disturbances (hypokalemia, hypermagnesemia), volume overload, and hyperglycemia. Risk of peritonitis if aseptic technique compromised. |
Loading safety data…
| Fetal Monitoring |
| Monitor maternal blood glucose, electrolytes, and fluid balance. Fetal surveillance includes growth scans, amniotic fluid volume, and nonstress testing as clinically indicated. |
| Fertility Effects | No known adverse effects on fertility. Peritoneal dialysis may improve fertility in women with end-stage renal disease by correcting uremia. |