DIANEAL PD-2 W/ DEXTROSE 1.5% IN PLASTIC CONTAINER
Clinical safety rating: caution
Comprehensive clinical and safety monograph for DIANEAL PD-2 W/ DEXTROSE 1.5% IN PLASTIC CONTAINER (DIANEAL PD-2 W/ DEXTROSE 1.5% IN PLASTIC CONTAINER).
Dianeal PD-2 with Dextrose 1.5% is a peritoneal dialysis solution. Dextrose acts as an osmotic agent to create an osmotic gradient across the peritoneal membrane, facilitating the removal of waste products (urea, creatinine) and excess fluid from the blood into the peritoneal cavity, which is then drained out.
| Metabolism | Dextrose is metabolized primarily via glycolysis and the citric acid cycle in peripheral tissues, particularly in the liver and muscles. |
| Excretion | Dextrose is completely metabolized via glycolysis and the citric acid cycle to carbon dioxide and water; <1% excreted unchanged in urine. Osmotic agent effect terminated by peritoneal absorption and systemic metabolism. |
| Half-life | Not applicable; dextrose utilization is capacity-limited with half-life of ~1.5 hours in normal circulation. In peritoneal dialysis, the osmotic effect declines over dwell time (2-4 hours) as dextrose is absorbed. |
| Protein binding | None; dextrose does not bind to plasma proteins. |
| Volume of Distribution | Dextrose distributes into total body water (approximately 0.55-0.6 L/kg in adults). For peritoneal dialysis fluid, localized distribution is within peritoneal cavity and then absorbed into extracellular fluid. |
| Bioavailability | Not applicable for intravenous route; intraperitoneal: 100% of dextrose absorbed systemically over the dwell period (approximately 60-80% absorbed within 4 hours). |
| Onset of Action | Immediately upon instillation into peritoneal cavity; ultrafiltration begins within 15–30 minutes due to osmotic gradient. |
| Duration of Action | Ultrafiltration maximal at 1–2 hours; dwell time typically 4–6 hours for standard exchanges. Longer dwells may lead to net reabsorption of fluid. |
Intraperitoneal: 2-2.5 L per exchange, 4 exchanges per day (continuous ambulatory peritoneal dialysis).
| Dosage form | SOLUTION |
| Renal impairment | Not applicable; drug is used for renal replacement therapy. Dosing frequency and volume adjusted based on residual renal function and adequacy targets (Kt/V). |
| Liver impairment | No specific dose adjustment required; monitor peritoneal dialysis adequacy in severe hepatic impairment due to potential changes in protein binding. |
| Pediatric use | Intraperitoneal: 800-1100 mL/m² per exchange, 4-5 exchanges per day, adjusted based on body surface area and clinical response. |
| Geriatric use | No specific dose adjustment; consider reduced exchange volume if ultrafiltration or tolerance issues arise. Monitor for dehydration and electrolyte imbalances. |
| 1st trimester | Consult provider |
| 2nd trimester | Consult provider |
| 3rd trimester | Consult provider |
Clinical note
Comprehensive clinical and safety monograph for DIANEAL PD-2 W/ DEXTROSE 1.5% IN PLASTIC CONTAINER (DIANEAL PD-2 W/ DEXTROSE 1.5% IN PLASTIC CONTAINER).
| Breastfeeding | Dianeal PD-2 is not systemically absorbed; thus, transfer into breast milk is negligible. No M/P ratio is available. Lactation is considered safe during peritoneal dialysis. |
| Teratogenic Risk | Dianeal PD-2 with dextrose 1.5% is not systemically absorbed; therefore, no direct fetal exposure occurs. Intraperitoneal dextrose does not pose teratogenic risk. However, maternal metabolic alterations (e.g., hyperglycemia) secondary to peritoneal dialysis may impact fetal development if uncontrolled. No trimester-specific risks are known. |
■ FDA Black Box Warning
None
| Serious Effects |
["Pre-existing severe hyperglycemia (e.g., diabetic ketoacidosis)","Peritoneal fibrosis or adhesions that impair dialysis function","Recent abdominal surgery or trauma","Severe peripheral vascular disease","Uncorrectable mechanical defects (e.g., diaphragmatic hernia)"]
| Precautions | ["Peritonitis (infectious complication)","Catheter-related complications (e.g., leakage, obstruction)","Metabolic complications (e.g., hyperglycemia, especially in diabetic patients)","Fluid and electrolyte imbalances (e.g., hypernatremia, hypokalemia)","Encapsulating peritoneal sclerosis (rare, long-term use)"] |
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| Fetal Monitoring | Monitor maternal blood glucose, electrolytes, and acid-base status. Assess for peritonitis, catheter function, and ultrafiltration volume. Fetal monitoring includes serial ultrasound for growth and amniotic fluid volume assessment. |
| Fertility Effects | No direct effects on fertility are reported. Peritoneal dialysis may improve uremic conditions that impair fertility, but underlying renal disease and comorbidities may affect reproductive function. |