glucose, anhydrous + glucose monohydrate: clinical use

Prescribing considerations

• Select the product, dilution and venous access according to the indication, final osmolarity and individual metabolic and fluid requirements.
• Assess glucose tolerance, fluid status and electrolyte disturbances before treatment.
• Use particular caution in diabetes, renal or cardiac impairment, acute illness, severe malnutrition, thiamine deficiency, ischaemic stroke, traumatic brain injury and risk of SIADH.
• Neonates and children require specialist oversight and close glycaemic and electrolyte monitoring.
• Do not administer electrolyte-free glucose through the same equipment as whole blood.

Contraindications and cautions

• Clinically significant hyperglycaemia.
• Hypersensitivity to glucose or an excipient; consider potential reactions in patients allergic to corn products.

Monitoring

• Blood glucose before and during administration.
• Serum sodium and other electrolytes, particularly potassium, phosphate and magnesium.
• Fluid balance, hydration, osmolality and acid–base status where clinically indicated.
• Infusion site and venous catheter for irritation, phlebitis, infection or precipitates.
• Signs of refeeding syndrome in severely malnourished patients.

Clinical pharmacology

Glucose provides an immediately available carbohydrate substrate and raises circulating glucose. Its metabolism can leave electrolyte-free water, making glucose-containing fluids physiologically hypotonic and creating risks of hyponatraemia, fluid imbalance and hyperglycaemia.

Formulation and product differences

• Glucose Intravenous Infusion BP 20% w/v is a sterile hyperosmolar infusion with an osmolarity of approximately 1110 mOsmol/L. If undiluted, it is intended for central venous administration and should not enter peripheral veins.
• Glucose 40% w/v is a concentrate with an osmolarity of approximately 2220 mOsmol/L. It is not for direct intravenous infusion and must be diluted or incorporated into a parenteral-nutrition admixture.
• Glucose content may be expressed as anhydrous glucose or the equivalent amount of glucose monohydrate. Both selected formulations contain water for injections and may contain hydrochloric acid for pH adjustment.