glucose + sodium chloride: clinical use

Prescribing considerations

• Select the fluid according to clinical and metabolic status, concurrent therapy and the need for water, sodium chloride and carbohydrate.
• Use particular caution with impaired glucose tolerance, severe malnutrition or refeeding risk, thiamine deficiency, renal impairment, sodium-retaining states, acute ischaemic stroke, severe head injury and corn allergy.
• Children, people with increased vasopressin activity and those with reduced cerebral compliance are particularly vulnerable to acute hyponatraemic encephalopathy.
• Do not use glucose-containing solution as an arterial-line flush because contaminated samples can produce falsely high glucose readings and inappropriate insulin treatment.

Contraindications and cautions

• Hypersensitivity to the product.
• Extracellular hyperhydration, hypervolaemia, fluid and sodium retention, general oedema or ascitic cirrhosis.
• Severe renal insufficiency with oliguria or anuria, or uncompensated cardiac failure.
• Hyponatraemia or hypochloraemia.
• Clinically significant hyperglycaemia, uncompensated diabetes, other known glucose intolerance, hyperosmolar coma or hyperlactataemia.

Monitoring

• Assess fluid status, input and output, serum glucose, sodium and other electrolytes before and during administration.
• Consider acid-base balance and potassium, phosphate and magnesium, particularly during prolonged therapy or in malnutrition.
• Watch for hyperglycaemia, hyponatraemia, hypokalaemia, osmotic diuresis, fluid overload and infusion-site complications.
• Avoid rapid correction of abnormal sodium concentrations.

Clinical pharmacology

The solution supplies extracellular sodium and chloride with water, while glucose is metabolised under insulin regulation to provide energy. Although iso-osmolar in the container, glucose metabolism can leave a physiologically hypotonic fluid that increases free-water exposure.

Formulation and product differences

• The selected product is a clear solution for intravenous infusion; water for injections is its only excipient.
• It is supplied in single-use Viaflo bags and unused solution should be discarded.
• Compatibility must be established before adding another medicine.
• It must not be administered simultaneously with blood through the same administration set because pseudoagglutination or haemolysis may occur.