When administered intravenously this solution restores blood glucose levels in hypoglycemia and provides a source of carbohydrate calories. Carbohydrate in the form of dextrose may aid in minimizing liver or glycogen depletion and exerts a protein-sparing action. Dextrose injection undergoes oxidation to carbon dioxide and water.
Dextrose Injection USP is indicated in the treatment of insulin hypoglycemia (hyperinsulinism or insulin shock) to restore blood glucose levels. The solution is also indicated after dilution, for intravenous infusion as a source of carbohydrate calories in patients whose oral intake is restricted or inadequate to maintain nutritional requirements. Slow infusion of hypertonic solutions is essential to insure proper utilization of dextrose and avoid production of hyperglycemia.
Dextrose Injection, USP should not be administered simultaneously with blood through the same administration set because of the possibility of pseudo-agglutination or hemolysis. The intravenous administration of these solutions can cause fluid and/or solute overloading resulting in dilution of serum electrolyte concentrations, overhydration, congested states, or pulmonary edema. The risk of dilutive states is inversely proportional to the electrolyte concentrations of the injections. The risk of solute overload causing congested states with peripheral and pulmonary edema is directly proportional to the electrolyte concentrations of the injections.
Excessive administration of dextrose injections may result in significant hypokalemia. In very low birth weight infants, excessive or rapid administration of dextrose injection may result in increased serum osmolality and possible intracerebral hemorrhage. Clinical evaluation and periodic laboratory determinations are necessary to monitor changes in fluid balance, electrolyte concentrations, and acid base balance during prolonged parenteral therapy or whenever the condition of the patient warrants such evaluation.
Pregnancy Category C
There are no adequate and well controlled studies with Dextrose Injection, USP in pregnant women and animal reproduction studies have not been conducted with this drug. Therefore, it is not known whether Dextrose Injection, USP can cause fetal harm when administered to a pregnant woman. Dextrose Injection, USP should be given during pregnancy only if the potential benefit justifies the potential risk to the fetus.
Labor and Delivery
Intrapartum maternal intravenous infusion of glucose-containing solutions may produce maternal hyperglycemia with subsequent fetal hyperglycemia and fetal metabolic acidosis . Fetal hyperglycemia can result in increased fetal insulin levels which may result in neonatal hypoglycemia following delivery. Consider the potential risks and benefits for each specific patient before administering Dextrose Injection, USP.
It is not known whether this drug is present in human milk. Because many drugs are present in human milk, caution should be exercised when Dextrose Injection, USP is administered to a nursing woman.
Dosage and administration
Peripheral Vein Administration
Injection of the solution should be made slowly. The maximum rate at which dextrose can be infused without producing glycosuria is 0.5 g/kg of body weight/hour. About 95% of the dextrose is retained when infused at a rate of 0.8 g/kg/hr.
In insulin-induced hypoglycemia, intravenous injection of 10 to 25 g of dextrose (20 to 50 mL of 50% dextrose) is usually adequate. Repeated doses and supportive treatment may be required in severe cases. A specimen for blood glucose determination should be taken before injecting the dextrose. In such emergencies, dextrose should be administered promptly without awaiting pre-treatment test results.
Central Venous Administration
For total parenteral nutrition 50%, Dextrose Injection USP is administered by slow intravenous infusion: (a) after admixture with amino acid solutions via indwelling catheter with the tip positioned in a large central vein, preferably the superior vena cava, or (b) After dilution with sterile water for injection. Dosage should be adjusted to meet individual patient requirements.
Clinical evaluation and periodic laboratory determinations are necessary to monitor changes in fluid balance, electrolyte concentrations and acid-base balance during prolonged parenteral therapy or whenever the condition of the patient warrants such evaluation.