glucose monohydrate + potassium chloride + sodium chloride: clinical use

Prescribing considerations

• Assess fluid, electrolyte and glucose requirements against cardiac, renal, hepatic and endocrine status.
• Ensure renal function and urine output are adequate before and during potassium administration.
• Consider acute hyponatraemia because glucose metabolism can leave a physiologically hypotonic fluid.
• Use particular caution in children, older people, diabetes or glucose intolerance, oedematous states and conditions associated with non-osmotic vasopressin release.
• Review additives for physical and chemical compatibility; do not co-administer with blood through the same set.

Contraindications and cautions

• Hyperkalaemia or clinically relevant hyperchloraemia
• Severe renal impairment with oliguria or anuria
• Hyperhydration, fluid or sodium retention, or severe uncompensated heart failure, depending on the selected product
• Acute ischaemic stroke or head trauma during the first 24 hours
• For the Baxter product: Addison's disease, uncontrolled diabetes, hyperglycaemia, hyperosmolar coma, hyperlactataemia and other known glucose intolerance
• Known hypersensitivity to the product

Monitoring

• Fluid balance and urine output
• Serum potassium, sodium, chloride and other relevant electrolytes
• Blood glucose
• Acid–base status where clinically indicated
• ECG in patients at increased cardiac risk or when clinically required
• Infusion site and signs of fluid overload, hypo- or hypernatraemia and hyperkalaemia

Clinical pharmacology

Intravenous administration provides immediate systemic availability of glucose, potassium, sodium and chloride. Potassium is predominantly intracellular; sodium and chloride distribute mainly extracellularly. Glucose is metabolised for energy, altering the solution's effective tonicity. Electrolytes are principally regulated and excreted through the kidneys.

Formulation and product differences

• Both selected products are clear aqueous solutions for intravenous infusion with water for injections as the excipient.
• One selected product identifies glucose derived from corn and advises caution in known corn allergy.
• One product's container contains significant air and must not be pressure-infused; the other is supplied in flexible infusion bags.
• Contraindications and incompatibilities are not identical, so the product-specific SmPC must be checked.