dextrose monohydrate: clinical use

Prescribing considerations

• Assess glucose and fluid requirements individually.
• Correct pre-existing thiamine deficiency and significant fluid or electrolyte deficits before infusion.
• Use caution with impaired glucose tolerance, renal or cardiac impairment, hypervolaemia, increased serum osmolarity, hypoxia or unstable metabolism.
• Consider refeeding syndrome in malnourished or depleted patients.
• Avoid administration through the same equipment immediately before, during or after blood products.

Contraindications and cautions

• Hypersensitivity to glucose; consider reported reactions in people allergic to corn products.
• Hyperglycaemia that remains uncontrolled despite insulin treatment.
• Dehydrated delirium tremens.
• Acute shock or circulatory collapse.
• Metabolic acidosis.
• Hyperhydration, pulmonary oedema or acute congestive heart failure.

Monitoring

• Blood glucose and signs of hypo- or hyperglycaemia.
• Serum sodium, potassium, phosphate, magnesium and other relevant electrolytes.
• Fluid input, output and evidence of fluid overload.
• Acid–base balance where clinically appropriate.
• Infusion site for irritation, thrombophlebitis or extravasation.
• Neonatal blood glucose where glucose is infused during labour.

Clinical pharmacology

Intravenous glucose has complete systemic availability. It first distributes within the vascular space and is then taken up by cells. Glycolysis produces pyruvate; aerobic metabolism yields carbon dioxide and water, while hypoxia favours lactate formation.

Formulation and product differences

• The selected product is a clear, colourless, hypertonic solution for infusion with water for injections as its only excipient.
• Although hypertonic in the container, it may become physiologically hypotonic after glucose is rapidly metabolised.
• Compatibility must be established before using it as a vehicle; its acidic pH can cause incompatibility with medicines or blood.

Solution for infusion

Route: Intravenous

Strengths: 10% w/v, 40% w/v