glucose: clinical use

Prescribing considerations

• Confirm the indication and assess glucose handling, fluid status, acid–base balance and electrolyte risks.
• Use caution in diabetes or carbohydrate intolerance, severe undernutrition, thiamine deficiency, hypophosphataemia, sepsis, trauma, shock, metabolic acidosis and severe dehydration.
• Consider the substantial risk of local injury from hypertonic solutions and ensure appropriate venous access.
• Do not use glucose-containing solution to maintain arterial-line patency because contamination can produce falsely high glucose readings and lead to inappropriate insulin administration.

Contraindications and cautions

• Hypersensitivity to the active substance or excipients, including known allergy to corn or corn products.
• Glucose–galactose malabsorption syndrome.
• Anuria; intraspinal or intracranial haemorrhage; ischaemic stroke; or dehydrated delirium tremens.
• Hyperglycaemic coma.

Monitoring

• Blood glucose and, where relevant, urine glucose.
• Fluid balance, acid–base status, serum sodium and other electrolytes.
• Neurological features suggesting acute hyponatraemia or hyperosmolar illness.
• Cannula site, venous patency and evidence of extravasation, phlebitis or thrombosis.
• Thiamine and refeeding-related risks in severe undernutrition.

Clinical pharmacology

A hypertonic carbohydrate solution that directly supplies circulating glucose. Glucose is rapidly taken up and metabolised as an energy substrate, with carbon dioxide and water as end products. After metabolism, glucose-containing fluid may become physiologically hypotonic.

Formulation and product differences

• The selected 20% solution is ready for intravenous infusion and is generally administered centrally except in emergency treatment of severe hypoglycaemia.
• The selected 50% formulation is more concentrated and ordinarily requires appropriate dilution for central administration; emergency peripheral use carries heightened extravasation and vein-injury risk.
• Both formulations contain hydrochloric acid and water for injections and must not be given intramuscularly or subcutaneously.

Solution for infusion

Route: Intravenous

Strengths: 20% w/v, 50% w/v