DIANEAL PD-2 W/ DEXTROSE 4.25% IN PLASTIC CONTAINER
Clinical safety rating: caution
Comprehensive clinical and safety monograph for DIANEAL PD-2 W/ DEXTROSE 4.25% IN PLASTIC CONTAINER (DIANEAL PD-2 W/ DEXTROSE 4.25% IN PLASTIC CONTAINER).
DIANEAL PD-2 with 4.25% dextrose is a peritoneal dialysis solution that creates an osmotic gradient across the peritoneal membrane, promoting diffusion and convection of solutes and ultrafiltration of fluid from the blood into the peritoneal cavity. Dextrose is absorbed systemically and metabolized, providing caloric load.
| Metabolism | Dextrose is metabolized via glycolysis and subsequent oxidative phosphorylation; insulin regulates its uptake. Lactate (buffer) is metabolized to bicarbonate in the liver via gluconeogenesis. |
| Excretion | Renal, peritoneal; ~80% removed via peritoneal dialysis, remainder metabolized to CO2 and water |
| Half-life | Not applicable as glucose is continuously absorbed; systemic half-life of absorbed dextrose ~1-2 hours |
| Protein binding | Minimal (<10%), primarily to albumin |
| Volume of Distribution | 0.2 L/kg (dextrose distributes in extracellular fluid) |
| Bioavailability | 100% via intraperitoneal route (direct absorption into bloodstream) |
| Onset of Action | Immediate upon instillation into peritoneal cavity |
| Duration of Action | 4-6 hours per dwell time; glucose absorption and ultrafiltration diminish over time |
Intraperitoneal administration: 2 to 2.5 L per exchange, 4 exchanges per day (continuous ambulatory peritoneal dialysis) or as prescribed for automated peritoneal dialysis. Dextrose 4.25% used for ultrafiltration. Dose adjusted based on patient's peritoneal membrane transport characteristics and fluid status.
| Dosage form | SOLUTION |
| Renal impairment | Not applicable; drug is used for renal replacement therapy in ESRD. Adjust dwell volume and exchange frequency based on residual renal function and clearance targets per KDOQI guidelines. |
| Liver impairment | No specific adjustments; monitor fluid and electrolyte balance as hepatic impairment may affect peritoneal clearance. |
| Pediatric use | Dose based on body weight: 800-1100 mL/m² per exchange for CAPD, with 4-5 exchanges per day; for APD, prescribe tidal or continuous cycling. Use 4.25% dextrose for required ultrafiltration. Adjust per BSA and membrane function. |
| Geriatric use | No specific dose adjustment; monitor for fluid overload, hypotension, and electrolyte disturbances due to age-related changes in cardiovascular and renal function. Consider lower dwell volumes and individualized exchange frequency. |
| 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 4.25% IN PLASTIC CONTAINER (DIANEAL PD-2 W/ DEXTROSE 4.25% IN PLASTIC CONTAINER).
| Breastfeeding | No data on excretion into breast milk. Systemic absorption is minimal; risk to infant likely low. Caution advised. |
| Teratogenic Risk | Dianeal PD-2 with dextrose 4.25% is a peritoneal dialysis solution. Dextrose at this concentration is not teratogenic. No human data exist; animal studies are inadequate. Risk cannot be excluded. Use only if clearly needed. |
| Fetal Monitoring |
■ FDA Black Box Warning
None.
| Serious Effects |
["Documented or suspected peritoneal membrane failure","Abdominal wall infections or skin infections at catheter site","Abdominal adhesions or fibrosis compromising dialysis","Uncorrectable mechanical defects (e.g., hernia, diaphragmatic leak)","Recent abdominal surgery with indwelling drains","Severe chronic obstructive pulmonary disease (may worsen respiratory status)","Severe hyperglycemia uncontrolled by insulin"]
| Precautions | ["Peritonitis","Catheter-related infections","Fluid and electrolyte imbalances (hyperglycemia, hypokalemia, hypomagnesemia, hypophosphatemia)","Metabolic acidosis or alkalosis depending on buffer","Ultrafiltration failure","Encapsulating peritoneal sclerosis","Hyperglycemia and hyperosmolar syndrome in diabetic patients"] |
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| Monitor fluid balance, electrolytes, renal function, and signs of peritonitis. Fetal ultrasound for growth and amniotic fluid volume. |
| Fertility Effects | No known effects on fertility. |