ISOLYTE H W/ DEXTROSE 5% IN PLASTIC CONTAINER
Clinical safety rating
cautionComprehensive clinical and safety monograph for ISOLYTE H W/ DEXTROSE 5% IN PLASTIC CONTAINER (ISOLYTE H W/ DEXTROSE 5% IN PLASTIC CONTAINER).
Intravenous solution providing electrolytes (sodium, potassium, magnesium, chloride, acetate, phosphate) and dextrose for caloric supply. Acetate and phosphate serve as bicarbonate precursors to buffer metabolic acids. Dextrose provides energy and protein-sparing effects.
| Metabolism | Dextrose is metabolized via glycolysis to pyruvate then enters the TCA cycle. Acetate is metabolized via TCA cycle to bicarbonate. Phosphate is excreted renally or incorporated into ATP and other compounds. |
| Excretion | Electrolytes are primarily excreted via renal pathways; dextrose is metabolized to CO2 and water, with negligible renal excretion. Specifically, sodium, potassium, magnesium, chloride, acetate, and gluconate are eliminated by the kidneys, with over 90% of infused electrolytes excreted renally. |
| Half-life | Dextrose has a half-life of approximately 1.5–3 hours in patients with normal glucose metabolism; in renal failure, electrolyte half-lives may be prolonged. The half-life of sodium is about 2–4 hours, and potassium 2–6 hours, depending on renal function. |
| Protein binding | Sodium, potassium, chloride, magnesium, and acetate have negligible protein binding (<5%); calcium is ~45% bound to albumin; gluconate binding is minimal. |
| Volume of Distribution | Electrolytes distribute into total body water, approximately 0.6 L/kg for adults; dextrose distributes into extracellular fluid (~0.2 L/kg) but is rapidly taken up by cells. |
| Bioavailability | Intravenous: 100% bioavailability. |
| Onset of Action | Intravenous administration: electrolyte effects occur within minutes; dextrose metabolism begins immediately upon infusion. |
| Duration of Action | Electrolyte effects persist for 1–2 hours post-infusion depending on renal function; dextrose levels normalize within 2–4 hours after infusion stops. |
| Molecular Weight | Dextrose: 180.16 Da; Electrolytes: variable (e.g., sodium 23 Da, potassium 39 Da, chloride 35.5 Da, acetate 59 Da). |
Intravenous infusion, rate determined by patient's fluid and electrolyte needs; typical adult dose: 1-2 L per 24 hours, adjusted based on clinical status.
| Dosage form | INJECTABLE |
| Renal impairment | Contraindicated in severe renal impairment (GFR <30 mL/min) due to risk of hyperkalemia and fluid overload; for GFR 30-50 mL/min, use with caution and monitor potassium and fluid status. |
| Liver impairment | No specific dose adjustment for Child-Pugh class; use with caution in severe hepatic impairment due to risk of fluid overload and electrolyte imbalances. |
| Pediatric use | Intravenous infusion at a rate of 100-150 mL/kg/day for maintenance, adjusted based on weight, clinical condition, and electrolyte requirements. |
| Geriatric use | Use with caution due to decreased renal function; start at lower infusion rates (e.g., 0.5-1 L per 24 hours) and monitor fluid and electrolyte status closely. |
| 1st trimester | Generally considered safe; used for fluid and electrolyte replacement. No known teratogenic effects. |
| 2nd trimester | Safe when used as directed for fluid and electrolyte maintenance. |
| 3rd trimester | Safe; monitor for fluid overload in preeclampsia or renal impairment. |
Clinical note
Comprehensive clinical and safety monograph for ISOLYTE H W/ DEXTROSE 5% IN PLASTIC CONTAINER (ISOLYTE H W/ DEXTROSE 5% IN PLASTIC CONTAINER).
| Placental transfer | Dextrose and electrolytes freely cross placenta; no known harm at therapeutic doses. |
| Breastfeeding | Excreted in breast milk in small amounts; considered compatible with breastfeeding. Monitor infant for electrolyte disturbances if high doses used. |
| Lactation Rating | L1 (Safe) |
| Teratogenic Risk | Dextrose and electrolyte solutions are generally considered safe in pregnancy. Dextrose is a physiologic nutrient; no teratogenic effects are expected. Electrolytes are essential ions and do not pose fetal risk when administered appropriately. Hyperglycemia from excessive dextrose may be associated with fetal macrosomia, neonatal hypoglycemia, and other metabolic disturbances, particularly in diabetic pregnancies. No specific trimester risks are identified for isotonic balanced solutions. |
| Fetal Monitoring | Monitor maternal serum electrolytes, glucose, fluid balance, and renal function, especially with prolonged infusion or in patients with preeclampsia, diabetes, or renal impairment. Fetal monitoring (heart rate, growth) as per standard obstetric care if maternal metabolic disturbances occur. |
| Fertility Effects | No known effects on fertility. Dextrose and electrolyte solutions are not associated with reproductive impairment. |
■ FDA Black Box Warning
Not for use in patients with intracranial or intraspinal hemorrhage, or in patients with known hypersensitivity to any component. Do not administer simultaneously with blood products through the same set due to risk of hemolysis.
| Serious Effects |
HyperglycemiaHypernatremiaSevere electrolyte disorders uncorrectedAnuriaPulmonary edema
| Precautions | Risk of fluid overload, electrolyte disturbances, and hyperglycemia in patients with impaired renal function, cardiac failure, or diabetes, Use with caution in patients with severe hepatic disease (risk of lactic acidosis from acetate), Monitoring of serum electrolytes, glucose, fluid balance, and acid-base status is required, Avoid extravasation: risk of tissue necrosis |
| Food/Dietary | No specific food interactions. Patients should maintain a balanced diet as tolerated, but sodium and potassium intake may need monitoring or adjustment based on electrolyte status. Avoid excessive ingestion of high-sodium or high-potassium foods unless directed by clinician. |
| Clinical Pearls | ISOLYTE H with Dextrose 5% is a hypertonic solution (approx. 480 mOsm/L) used for fluid and electrolyte replacement in patients with hypochloremic metabolic alkalosis and fluid losses. It should be administered through a central line due to its high osmolarity. Monitor serum electrolytes, glucose, and acid-base status. Do not administer if solution is discolored or contains particulate matter. |
| Patient Advice | This IV solution provides fluids, electrolytes, and calories to help correct imbalances caused by illness or surgery. · Tell your healthcare provider if you have a history of heart failure, kidney disease, or diabetes, as this solution may affect these conditions. · You may experience discomfort at the IV site; report any pain, redness, or swelling immediately. · Regular blood tests will be needed to monitor your electrolyte levels and kidney function. · Do not stop or adjust the infusion rate on your own. |
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