glucose monohydrate: clinical use

Prescribing considerations

• Assess total fluid, glucose and electrolyte requirements; glucose solution alone may not provide adequate electrolyte replacement.
• Correct pre-existing thiamine deficiency before glucose infusion because of the risks of lactic acidosis and Wernicke encephalopathy.
• Use caution in diabetes, impaired glucose metabolism, renal insufficiency, acute illness and conditions associated with non-osmotic vasopressin release.
• Avoid glucose-containing solution as an arterial-line flush because sample contamination can produce falsely high glucose readings and inappropriate insulin treatment.
• Confirm additive compatibility and consider the final mixture's osmolarity when selecting venous access.

Contraindications and cautions

• Hyperglycaemia that is not adequately controlled.
• Lactic acidosis for the selected B. Braun product.
• Water excess or hyperhydration states.
• Where substantial fluid loading is required: acute congestive heart failure or pulmonary oedema.
• Use as the sole fluid supply where electrolyte replacement is required.

Monitoring

• Fluid balance and urine output.
• Blood glucose.
• Serum sodium, potassium and other relevant electrolytes.
• Acid–base status where clinically indicated.
• Infusion site and signs of fluid overload or neurological deterioration.

Clinical pharmacology

Intravenous bioavailability is complete. Glucose distributes from the intravascular compartment into cells, where glycolysis produces pyruvate; aerobic metabolism ultimately yields carbon dioxide, water and energy. Glucose metabolism increases cellular potassium uptake and may increase potassium, phosphate and magnesium requirements.

Formulation and product differences

• Both selected products are aqueous glucose solutions for intravenous infusion containing glucose monohydrate and water for injections.
• The B. Braun product is licensed as a carbohydrate solution for intravenous liquid therapy and as a vehicle for compatible medicines; it specifically states that it must not be the entire fluid supply alone.
• The Aguettant product is licensed for fluid replacement, alone or with compatible electrolytes or additives, and as a vehicle for compatible intravenous medicines.
• Container systems, access ports, pH and measured osmolality differ between products; follow product-specific handling instructions.

Solution for infusion

Route: Intravenous

Strengths: 5%, 5% w/v, 10%, 10% w/v, 20% w/v, 30% w/v