Dextrose

Pharmacologic Category

Antidote, Hypoglycemia; Intravenous Nutritional Therapy

Dosing: Adult

Calcium channel blocker or beta-blocker overdose/toxicity (adjunctive agent) (off-label use): Note: For use only as an adjuvant component of high-dose insulin therapy (HDIT). Optimal dosage regimen has not been determined; HDIT is used for patients who are refractory to initial therapies (eg, atropine, calcium, vasopressors). Monitor blood glucose and electrolytes frequently, especially at the initiation of therapy. Use of concentrated dextrose solutions may help to avoid fluid overload (Cole 2018; Engebretsen 2011; Krenz 2018).

Patients with existing hypoglycemia: Note: Correct relative hypoglycemia (baseline blood glucose <200 mg/dL) prior to initiation of HDIT (Cole 2018; Engebretsen 2011; Krenz 2018); some experts recommend a lower baseline blood glucose (<150 mg/dL) at which to correct hypoglycemia (Barrueto 2019).

IV: 25 g (50 mL D50W) as a single bolus dose followed by a continuous infusion of 0.5 g/kg/hour when HDIT is initiated; titrate dextrose to maintain blood glucose concentration >100 mg/dL. Hold dextrose for blood glucose concentration ≥200 mg/dL (Krenz 2018).

Patients without existing hypoglycemia: Initiate a continuous infusion of 0.5 g/kg/hour when HDIT is initiated; titrate dextrose infusion to maintain blood glucose concentration >100 mg/dL. Hold dextrose for blood glucose concentration ≥200 mg/dL (Krenz 2018).

Glucose tolerance test (diagnostic test for diabetes): Glutol: Oral:

One-step (ADA 2020): 75 g as single dose to a fasting patient; assess plasma glucose 2 hours after dose in nonpregnant adults or 1 and 2 hours after dose in pregnant women.

Two-step (ADA 2020): Pregnant women:

First step: 50 g as a single dose to a nonfasting patient; assess plasma glucose 1 hour after dose; if levels ≥130 mg/dL proceed to 100 g oral glucose tolerance test (Note: Cutoffs of ≥135 or ≥140 mg/dL have also been recommended; increased sensitivity and decreased specificity have been associated with use of a lower cutoff).

Second step: 100 g as a single dose to a fasting patient; assess plasma glucose at 1, 2, and 3 hours after dose.

Hypoglycemia:

IV: 10 to 25 g (40 to 100 mL of 25% solution or 20 to 50 mL of 50% solution); repeat as needed in severe cases.

Note: The Society of Critical Care Medicine suggests that blood glucose <70 mg/dL (or <100 mg/dL in neurologic injury patients) be treated immediately by discontinuing insulin therapy (if receiving) and administering 10 to 20 g (20 to 40 mL of 50% solution) IV; repeat blood glucose measurement in 15 minutes with repeat dextrose administration as necessary; avoid overcorrection (Jacobi 2012).

Oral: 15 to 20 g as a single dose; repeat in 15 minutes if self-monitoring of blood glucose (SMBG) shows continued hypoglycemia. Once the SMBG returns to normal, a meal or snack should be consumed to prevent recurrence of hypoglycemia (ADA 2020).

Hyperkalemia (adjunctive treatment) (off-label use): IV: 25 g dextrose (50 mL D50W) over 5 to 30 minutes; administer with regular insulin 10 units; repeat as needed (AHA [Vanden Hoek 2010]; Allon 1990).

* See Dosage and Administration in AHFS Essentials for additional information.

Dosing: Geriatric

Refer to adult dosing.

Dosing: Renal Impairment: Adult

There are no specific dosage adjustments provided in the manufacturer's labeling; however, dextrose is excreted by the kidney, and closer monitoring for adverse effects may be warranted in patients with renal impairment.

Dosing: Hepatic Impairment: Adult

There are no dosage adjustments provided in the manufacturer's labeling.

Dosing: Pediatric

Hypoglycemia: Note: Doses may be repeated in severe cases:

IV, Intraosseous:

Infants and Children: Dextrose 25% solution: 0.5 to 1 g/kg/dose (2 to 4 mL/kg/dose of 25% solution); maximum dose: 25 g/dose (AAP [Hegenbarth 2008]; PALS [Kleinman 2010])

Adolescents: Dextrose 50% solutions: 0.5 to 1 g/kg/dose (1 to 2 mL/kg/dose of 50% solution); maximum dose: 25 g/dose (AAP [Hegenbarth 2008]; PALS [Kleinman 2010])

Oral: Children and Adolescents: 10 to 20 g as a single dose; repeat in 10 to 15 minutes if hypoglycemia persists (ADA 2018; ISPAD [Abraham 2018])

Hyperkalemia, treatment: Infants, Children, and Adolescents: IV: 0.5 to 1 g/kg/dose (using 25% or 50% solution) combined with regular insulin over 15 to 30 minutes; dose may be repeated; in some cases, a continuous IV infusion may be necessary. Note: Usual ratio is 1 unit insulin for every 4 to 5 g dextrose. In adults, the usual dose is 10 units of insulin mixed with 25 g of dextrose (50 mL of D50W) administered over 15 to 30 minutes (AAP [Hegenbarth 2008]; ACLS [Vanden Hoek 2010]; Fuhrman 2011; Lehnhardt 2011; Masilamani 2012)

Parenteral nutrition: IV: Dextrose component (ASPEN 2002; ASPEN Pediatric Nutrition Support Core Curriculum [Corkins 2015]):

Infants <1 year: Initial: 6 to 8 mg/kg/minute; daily increase: 3.5 mg/kg/minute increments; usual goal: 10 to 14 mg/kg/minute; maximum daily rate: 18 mg/kg/minute

Children 1 to 10 years: Initial: 3 to 6 mg/kg/minute; daily increase: 2 to 3 mg/kg/minute; usual goal: 8 to 10 mg/kg/minute

Children >10 years and Adolescents: Initial: 2.5 to 3 mg/kg/minute; daily increase: 1 to 2 mg/kg/minute; usual goal: 5 to 6 mg/kg/minute

Glucose tolerance test (diagnostic test for diabetes): Oral liquid: Children and Adolescents: Oral: 1.75 g/kg as a single dose; maximum dose: 75 g/dose; assess plasma glucose 2 hours after dose (ADA [Chiang 2018]; ISPAD [Mayer-Davis 2018])

Use: Labeled Indications

Oral:

Hypoglycemia: Treatment of hypoglycemia

Glucose tolerance test (Glutol): Oral glucose tolerance test for diagnosis of diabetes mellitus

Intravenous:

5% and 10% solutions: Fluid replacement/calories: Provision of calories and/or fluid replacement

25% (hypertonic) solution: Hypoglycemia: Treatment of acute symptomatic episodes of hypoglycemia in infants and children to restore depressed blood glucose levels

50% (hypertonic) solution: Hyperinsulinemia, insulin shock: Treatment of insulin-induced hypoglycemia (hyperinsulinemia or insulin shock)

≥10% solutions: Nutritional support: Infusion after admixture with other intravenous nutrients (eg, amino acids, fat emulsion) for nutritional support

* See Uses in AHFS Essentials for additional information.

Use: Off-Label: Adult

​Calcium channel blocker or beta-blocker overdose/toxicity (adjunctive agent)Level of Evidence [C, G]

Data from observational studies, case series, and clinical experience suggest that dextrose, only as an adjuvant component of high-dose insulin therapy, may be beneficial for the treatment of severe bradycardia due to calcium channel blocker or beta-blocker overdose/toxicity Ref.

Based on the 2018 American College of Cardiology/American Heart Association/Heart Rhythm Society Guideline on the evaluation and management of patients with bradycardia and cardiac conduction delay, dextrose, only as an adjuvant component of high-dose insulin therapy, is recommended and effective for the treatment of bradycardia associated with symptoms of hemodynamic compromise due to calcium channel blocker or beta-blocker overdose/toxicity.

​Hyperkalemia

Intravenous: 25% and 50% hypertonic solutions: Hyperkalemia (adjunctive): Treatment of hyperkalemia when used with concomitant insulin.

Clinical Practice Guidelines

Advanced Cardiac Life Support (ACLS)/Emergency Cardiovascular Care (ECC):

AHA, “2015 American Heart Association Guidelines Update for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care,” October 2015.

AHA, "2010 Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care,” November 2010.

Diabetes:

AACE/ACE, “Consensus Statement on the Comprehensive Type 2 Diabetes Management Algorithm - 2019 Executive Summary,” January 2019

ADA, “Standards of Medical Care in Diabetes - 2020,” January 2020

Administration: IV

Injectable is not for SubQ or IM administration; concentrated dextrose solutions for peripheral venous administration must be diluted (maximum concentration: 12.5%); in emergency situations only, 25% and 50% dextrose have been used peripherally; for direct IV infusion, infuse at a maximum rate of 200 mg/kg over 1 minute; continuous infusion rates vary with tolerance and range from 4.5 to 15 mg/kg/minute. Refer to indication-specific infusion rates in dosing for detailed recommendations.

Dextrose 10% may be an irritant. Concentrated IV dextrose (>10%) may be an irritant or a vesicant; higher concentration (higher osmolarity) is associated with a higher risk. Ensure proper needle or catheter placement prior to and during IV infusion. Avoid extravasation.

Extravasation management: If extravasation occurs, stop infusion immediately and disconnect (leave needle/cannula in place); gently aspirate extravasated solution (do NOT flush the line); initiate hyaluronidase antidote; remove needle/cannula; apply dry cold compresses (Hurst 2004; Reynolds 2014); elevate extremity.

Hyaluronidase:

Dextrose 10%to <50%: Intradermal or SubQ: Inject a total of 1 to 1.7 mL (15 units/mL) as five separate 0.2 to 0.3 mL injections (using a 25-gauge needle) into area of extravasation at the leading edge in a clockwise manner (MacCara 1983; Reynolds 2014; Zenk 1981).

Dextrose 50%: Injection of a total of 1 mL (150 units/mL) as five separate 0.2 mL injections administered along the leading edge of erythema has been used successfully (Wiegand 2010).

Administration: Oral

Must be swallowed to be absorbed; buccal absorption has been shown to be minimal (Gunning 1978).

Administration: Pediatric

Oral: Must be swallowed to be absorbed

Parenteral: For IV administration only, not SubQ or IM. Maximum concentration for peripheral administration is 12.5% and for central administration is 25% (ASPEN [Corkins 2015]); in emergency situations, 25% dextrose has been used peripherally in infants and children and 50% dextrose in adolescents (PALS [Kleinman 2010]).

Neonates: Continuous infusion rates vary with tolerance and range from 4 to 14 mg/kg/minute (Fanaroff 2013); hyperinsulinemic neonates may require up to 15 to 20 mg/kg/minute infusion rates (LaFranchi 1987); a more rapid administration of 0.2 g/kg bolus of D10W over 1 minute for treatment of hypoglycemia has been described (Lilien 1980).

Vesicant (at concentrations ≥10%); ensure proper needle or catheter placement prior to and during IV infusion. Avoid extravasation. If extravasation occurs, stop infusion immediately and disconnect (leave needle/cannula in place); gently aspirate extravasated solution (do NOT flush the line); initiate hyaluronidase antidote (see Management of Drug Extravasations for more details); remove needle/cannula; apply dry cold compresses (Hurst 2004; Reynolds 2014); elevate extremity.

Buccal: Neonate: Dry mouth with gauze; massage gel into buccal mucosa (Harris 2013)

Vesicant/Extravasation Risk

Dextrose 10% may be an irritant; concentrated IV dextrose (>10%) may be an irritant or a vesicant; higher concentration (higher osmolarity) is associated with a higher risk.

Dietary Considerations

Some products may contain potassium and/or sodium.

Storage/Stability

Stable at room temperature; protect from freezing and extreme heat. Store oral dextrose in airtight containers.

Preparation for Administration: Adult

Parenteral: Dilute concentrated dextrose solutions for peripheral venous administration to a maximum concentration of 12.5%; in emergency situations only, 25% and 50% dextrose solutions have been used peripherally (AHA [Vanden Hoek 2010]).

Preparation for Administration: Pediatric

Parenteral: Dilute concentrated dextrose solutions for peripheral venous administration to a maximum concentration of 12.5% and for central administration to a maximum of 25% (ASPEN [Corkins 2015]); in emergency situations, 25% dextrose has been used peripherally in infants and children and 50% dextrose has been used for adolescents (PALS [Kleinman 2010]).

Medication Patient Education with HCAHPS Considerations

What is this drug used for?

All products:

• It is used to treat low blood sugar.

Injection:

• Some products are used to add fluid to the body after fluid loss, to mix with certain drugs that are given as an injection, or to add calories to a TPN.

All drugs may cause side effects. However, many people have no side effects or only have minor side effects. Call your doctor or get medical help if any of these side effects or any other side effects bother you or do not go away:

• Nausea

• Vomiting

• Diarrhea

WARNING/CAUTION: Even though it may be rare, some people may have very bad and sometimes deadly side effects when taking a drug. Tell your doctor or get medical help right away if you have any of the following signs or symptoms that may be related to a very bad side effect:

• Severe dizziness

• Passing out

• Fluid and electrolyte problems like mood changes, confusion, muscle pain or weakness, abnormal heartbeat, severe dizziness, passing out, fast heartbeat, increased thirst, seizures, loss of strength and energy, lack of appetite, unable to pass urine or change in amount of urine passed, dry mouth, dry eyes, or nausea or vomiting.

• Blue/gray skin discoloration

• Chills

• Shortness of breath

• Excessive weight gain

• Swelling of arms or legs

• Injection site pain or irritation

• Low blood sugar after medicine is stopped

• Signs of an allergic reaction, like rash; hives; itching; red, swollen, blistered, or peeling skin with or without fever; wheezing; tightness in the chest or throat; trouble breathing, swallowing, or talking; unusual hoarseness; or swelling of the mouth, face, lips, tongue, or throat.

Note: This is not a comprehensive list of all side effects. Talk to your doctor if you have questions.

Consumer Information Use and Disclaimer: This information should not be used to decide whether or not to take this medicine or any other medicine. Only the healthcare provider has the knowledge and training to decide which medicines are right for a specific patient. This information does not endorse any medicine as safe, effective, or approved for treating any patient or health condition. This is only a limited summary of general information about the medicine's uses from the patient education leaflet and is not intended to be comprehensive. This limited summary does NOT include all information available about the possible uses, directions, warnings, precautions, interactions, adverse effects, or risks that may apply to this medicine. This information is not intended to provide medical advice, diagnosis or treatment and does not replace information you receive from the healthcare provider. For a more detailed summary of information about the risks and benefits of using this medicine, please speak with your healthcare provider and review the entire patient education leaflet.

Medication Safety Issues

​Sound-alike/look-alike issues:

​High alert medication:

​Other safety concerns:

Contraindications

Injectable: Hypersensitivity to dextrose, corn or corn products, or any component of the formulation; hypertonic solutions in patients with intracranial or intraspinal hemorrhage; delirium tremens (if dehydrated); severe dehydration; clinically significant hyperglycemia; anuria; hepatic coma; dextrose solutions without electrolytes should not be administered simultaneously with blood through the same infusion set because of the possibility that pseudoagglutination of red cells may occur. Contraindications may vary by product (also refer to manufacturer's labeling).

Warnings/Precautions

Concerns related to adverse effects:

• Extravasation: Dextrose 10% may be an irritant. Concentrated IV dextrose (>10%) may be an irritant or a vesicant; higher concentration (higher osmolarity) is associated with a higher risk. Ensure proper catheter or needle position prior to and during infusion. Avoid extravasation.

• Hepatobiliary effects: Hepatobiliary disorders (eg, cholecystitis, cholelithiasis, cholestasis, cirrhosis, hepatic steatosis, fibrosis) may occur in patients without liver disease who receive parenteral nutrition and may lead to hepatic failure. Increase in blood ammonia levels and hyperammonemia may also occur. Monitor liver function and ammonia levels.

• Hyperglycemia or hyperosmolar hyperglycemic state: Use of dextrose infusions with impaired glucose intolerance may worsen hyperglycemia. Administration of dextrose at a rate exceeding the patient's utilization rate may lead to hyperglycemia, coma, and death. Patients with underlying CNS disease and renal impairment may be at greater risk of developing hyperosmolar hyperglycemic state. Monitor blood glucose levels.

• Hypersensitivity: Hypersensitivity/infusion reactions, including anaphylaxis, have been reported. Stop infusion immediately and treat patient accordingly if any signs or symptoms of a hypersensitivity reaction develop.

• Hypokalemia: Administration of potassium free IV dextrose solutions may result in significant hypokalemia, particularly if highly concentrated dextrose solutions are used; monitor closely and/or add potassium to dextrose solutions for patients with adequate renal function.

• Hyponatremia: Administration of low sodium or sodium-free IV dextrose solutions may result in significant hyponatremia or water intoxication; risk is increased in pediatric and elderly patients, postoperative patients, and those with psychogenic polydipsia. Avoid dextrose injection in patients with or at risk for hyponatremia; if used, monitor serum sodium concentration. Use high-volume infusion with caution in patients with cardiac or pulmonary failure and in patients with nonosmotic vasopressin release (ie, syndrome of inappropriate antidiuretic hormone secretion) due to the risk of hospital-acquired hyponatremia. Rapid correction of hyponatremia is potentially dangerous (ie, serious neurologic complications); monitor serum sodium/chloride, fluid status, acid-base balance, and signs of neurologic complications.

• Infection: Patients requiring parenteral nutrition may be at high risk of infection, including sepsis. Risk of infection is increased with malnutrition, hyperglycemia exacerbated by dextrose infusion, or catheters required for administration. Proper aseptic technique should be followed; monitor for signs of early infection. Diabetic patients are at a greater risk of developing catheter-related infections compared with nondiabetic patients (McMahon 1996).

• Parenteral nutrition-associated liver disease: Has been reported in patients receiving parenteral nutrition for extended periods of time, especially preterm infants, and can present as cholestasis or steatohepatitis. Consider discontinuation or dose reduction in patients who develop LFT abnormalities.

• Refeeding syndrome: Refeeding severely undernourished patients may result in refeeding syndrome (eg, intracellular shift of potassium, phosphorus, and magnesium as the patient becomes anabolic); thiamine deficiency and fluid retention may also develop. Carefully monitor severely undernourished patients and slowly increase dextrose and other nutrient intakes.

Disease-related concerns:

• Diabetes: Use with caution in patients with diabetes mellitus; hyperglycemia and glycosuria may be functions of the rate of administration of dextrose; to minimize these effects, reduce the rate of infusion; addition of insulin may be necessary.

• Hyperkalemia: The use of dextrose with insulin for the treatment of hyperkalemia achieves a rapid reduction in serum potassium concentrations by redistributing serum potassium intracellularly; however, this effect is transient (lasts up to 2 hours) and does not remove potassium body stores. Other therapies can be used to increase potassium elimination (eg, sodium polystyrene sulfonate, hemodialysis) (Elliott 2010; Khilnani 1992; Kraft 2005).

• Pulmonary edema: Use with caution in patients with pulmonary edema; these patients are susceptible to excessive fluid accumulation.

• Renal impairment: Use with caution in patients with renal impairment; may be at risk of electrolyte and fluid volume overload, and in developing hyperosmolar hyperglycemic state. May contain aluminum, which may accumulate following prolonged administration in patients with renal impairment.

Special populations:

• Very low birth weight infants: Excessive or rapid dextrose administration in very low birth weight infants has been associated with increased serum osmolality and possible intracerebral hemorrhage.

Dosage form specific issues:

• Aluminum: The parenteral product may contain aluminum; toxic aluminum concentrations may be seen with high doses, prolonged use, or renal dysfunction. Premature neonates are at higher risk due to immature renal function and aluminum intake from other parenteral sources. Parenteral aluminum exposure of >4 to 5 mcg/kg/day is associated with CNS and bone toxicity; tissue loading may occur at lower doses (Federal Register 2002). See manufacturer's labeling.

• Oral dosage forms: In patients with impaired consciousness, oral dextrose administration may increase the risk of aspiration; use only when no alternatives (eg, parenteral dextrose, glucagon) are available (Desimone 2018).

• Precipitates: Periodically inspect solution, infusion set, and catheter for precipitates. Pulmonary vascular precipitates causing pulmonary vascular emboli and pulmonary distress have been reported (some fatal). If signs of pulmonary distress occur, stop the infusion.

Other warnings/precautions:

• Abrupt withdrawal: Rebound hypoglycemia may occur when a concentrated dextrose infusion is abruptly withdrawn.

• Administration: Hypertonic solutions (>10%) may cause thrombosis if infused via peripheral veins; administer hypertonic solutions via a central venous catheter.

* See Cautions in AHFS Essentials for additional information.

Pregnancy Considerations

Appropriate use of dextrose injection would not be expected to cause adverse developmental outcomes to the fetus when used during pregnancy. Maternal hyperglycemia or malnutrition may be associated with adverse pregnancy outcomes.

In females with nausea and vomiting of pregnancy who cannot tolerate oral liquids for prolonged periods or who are clinically dehydrated, intravenous hydration that includes dextrose is recommended. Due to potential maternal complications, enteral therapy is preferred over parenteral if nutrition support is required. Total parenteral nutrition (which may include dextrose) should be reserved for use in females with severe nausea and vomiting not responsive to enteral therapy (ACOG 189 2018). Medications used for the treatment of cardiac arrest in pregnancy are the same as in the non-pregnant female. Doses and indications should follow current Advanced Cardiovascular Life Support guidelines. Appropriate medications should not be withheld due to concerns of fetal teratogenicity (Jeejeebhoy [AHA] 2015).

Oral dextrose is used for the screening and diagnosis of gestational diabetes mellitus in pregnant females not previously diagnosed with diabetes (ADA 2020).

Breast-Feeding Considerations

Glucose is endogenous to breast milk (IOM 2005).

According to the manufacturer, the decision to breastfeed during therapy should consider the risk of infant exposure, the benefits of breastfeeding to the infant, and benefits of treatment to the mother.

Adverse Reactions

Frequency not defined:

Cardiovascular: Localized phlebitis, phlebitis, venous thrombosis

Central nervous system: Confusion, loss of consciousness

Endocrine & metabolic: Dehydration, glycosuria, hyperglycemia, hyperosmolar syndrome, hypervolemia, hypokalemia

Local: Local pain

Respiratory: Pulmonary edema

<1%, postmarketing, and/or case reports: Hypersensitivity reaction (including anaphylaxis)

* See Cautions in AHFS Essentials for additional information.

Allergy and Idiosyncratic Reactions

• Dextrose Allergy

Metabolism/Transport Effects

None known.

Drug Interactions Open Interactions

There are no known significant interactions.

Monitoring Parameters

Blood glucose, serum electrolytes, I & O, caloric intake, acid-base balance (prolonged parenteral therapy). Monitor infusion site.

Calcium channel blocker or beta-blocker overdose/toxicity: Monitor blood glucose concentrations every 10 minutes at the initiation and titration of high-dose insulin therapy and adjunctive dextrose. Decrease frequency of monitoring to every 30 to 60 minutes once insulin dose is stable (Engebretsen 2011).

Reference Range

Classification of hypoglycemia (ADA 2020):

Level 1: ≥54 to ≤70 mg/dL; hypoglycemia alert value; initiate fast-acting carbohydrate (eg, glucose) treatment

Level 2: <54 mg/dL; threshold for neuroglycopenic symptoms; requires immediate action

Level 3: Hypoglycemia associated with a severe event characterized by altered mental and/or physical status requiring assistance

Glucose tolerance test (diagnostic test for diabetes) (ADA 2020):

One step (75 g dose [fasting]):

Non-pregnant adults: Plasma glucose ≥200 mg/dL at 2 hours postdose meets criteria for diagnosis of diabetes; in the absence of unequivocal hyperglycemia, diagnosis requires 2 abnormal test results from the same sample or in 2 separate test samples (if using 2 separate test samples it is recommended that the second test, which may be a repeat of the oral glucose tolerance test [OGTT] or a different test [eg, fasting plasma glucose, HbA1C], be performed without delay)

Pregnant women: Criteria for diagnosis of gestational diabetes is met when any of the following plasma glucose levels are met/exceeded: Fasting: 92 mg/dL; 1 hour postdose: ≥180 mg/dL; 2 hours postdose: ≥153 mg/dL

Two-step (first dose: 50 g [nonfasting]; second dose: 100 g [fasting]): Pregnant women:

Following 50 g dose: If levels ≥130 mg/dL at 1 hour postdose, proceed to 100 g oral glucose tolerance test (Note: Cutoffs of ≥135 or ≥140 mg/dL have also been recommended; increased sensitivity and decreased specificity have been associated with use of a lower cutoff).

Following 100 g dose, criteria for diagnosis of gestational diabetes is met if at least 2 of the following 4 plasma glucose levels are met/exceeded: Fasting ≥95 or 105 mg/dL; 1 hour postdose: ≥180 or 190 mg/dL; 2 hours postdose: ≥155 or 165 mg/dL; 3 hours postdose: ≥140 or 145 mg/dL

Advanced Practitioners Physical Assessment/Monitoring

Obtain serum electrolytes, blood glucose, and urine glucose. Monitor I & O and caloric intake. Refer patient for diabetes self-management education.

Nursing Physical Assessment/Monitoring

Check ordered labs and report abnormalities. Monitor I & O and caloric intake. Ensure proper IV catheter placement; avoid extravasation. Educate patient and family on signs/symptoms of hypoglycemia. If hypoglycemia occurs frequently patient may need increased diabetes self-management education.

Dosage Forms: US

Excipient information presented when available (limited, particularly for generics); consult specific product labeling. [DSC] = Discontinued product

Gel, Oral:

Insta-Glucose: 77.4% (31 g) [contains fd&c red #40, methylparaben, propylparaben, sodium benzoate]

Liquid, Oral:

Glutol: 100 g/180 mL (180 mL) [lemon flavor]

Solution, Intravenous:

Generic: 250 mg/mL (10 mL); 5% (25 mL, 50 mL, 100 mL, 150 mL, 250 mL, 500 mL, 1000 mL); 10% (250 mL, 500 mL, 1000 mL); 20% (500 mL [DSC]); 30% (500 mL); 70% (500 mL [DSC], 1000 mL [DSC], 2000 mL)

Solution, Intravenous [preservative free]:

Generic: 5% (100 mL, 150 mL, 250 mL, 500 mL, 1000 mL); 10% (250 mL, 500 mL, 1000 mL); 20% (500 mL); 40% (500 mL); 50% (50 mL, 500 mL); 70% (500 mL, 2000 mL)

Solution, Oral:

Glucose Nursette: 5% (59 mL)

Good Start 5% Glucose Water: 5% (88.7 mL)

Tablet Chewable, Oral:

Generic: 4 g

Dosage Forms: Canada

Excipient information presented when available (limited, particularly for generics); consult specific product labeling.

Liquid, Oral:

Glucodex: 250 mg/mL (300 mL)

Solution, Intravenous:

Dextroject: 25% (10 mL, 30 mL)

Generic: 5% (10 mL, 25 mL, 50 mL, 100 mL, 150 mL, 250 mL, 500 mL, 1000 mL); 10% (250 mL, 500 mL, 1000 mL); 20% (500 mL, 1000 mL); 33.3% (750 mL); 40% (500 mL, 1000 mL); 50% (50 mL, 500 mL, 1000 mL, 2000 mL); 70% (500 mL, 1000 mL, 2000 mL, 3000 mL)

Generic Available (US)

May be product dependent

Pricing: US

Chewable (Glucose Oral)

4 g (per each): $0.22

Gel (Glutose 15 Oral)

40% (per gram): $0.11

Gel (Insta-Glucose Oral)

77.4% (per gram): $0.10

Solution (Dextrose Intravenous)

5% (per mL): $0.02 - $0.09

10% (per mL): $0.01

20% (per mL): $0.03

30% (per mL): $0.03

40% (per mL): $0.03

50% (per mL): $0.07 - $0.32

70% (per mL): $0.01

Solution (Glucose Nursette Oral)

5% (per mL): $0.03

Solution (Good Start 5% Glucose Water Oral)

5% (per mL): $0.02

Disclaimer: A representative AWP (Average Wholesale Price) price or price range is provided as reference price only. A range is provided when more than one manufacturer's AWP price is available and uses the low and high price reported by the manufacturers to determine the range. The pricing data should be used for benchmarking purposes only, and as such should not be used alone to set or adjudicate any prices for reimbursement or purchasing functions or considered to be an exact price for a single product and/or manufacturer. Medi-Span expressly disclaims all warranties of any kind or nature, whether express or implied, and assumes no liability with respect to accuracy of price or price range data published in its solutions. In no event shall Medi-Span be liable for special, indirect, incidental, or consequential damages arising from use of price or price range data. Pricing data is updated monthly.

Mechanism of Action

Dextrose, a monosaccharide, is a source of calories and fluid for patients unable to obtain an adequate oral intake; may decrease body protein and nitrogen losses; promotes glycogen deposition in the liver. When used in the treatment of hyperkalemia (combined with insulin), dextrose stimulates the transient uptake of potassium by cells, especially in muscle tissue, lowering serum potassium.

Pharmacodynamics/Kinetics

Onset of action: Treatment of hypoglycemia: Oral: 10 minutes

Maximum effect: Treatment of hyperkalemia: IV: 30 minutes

Absorption: Oral: Rapidly from the small intestine by an active mechanism; Buccal: negligible (Gunning 1978)

Metabolism: Metabolized to carbon dioxide and water

Time to peak, serum: Oral: 40 minutes

Local Anesthetic/Vasoconstrictor Precautions

No information available to require special precautions

Effects on Dental Treatment

No significant effects or complications reported

Effects on Bleeding

No information available to require special precautions

Related Information

• Management of Drug Extravasations

Pharmacotherapy Pearls

Each g of dextrose supplies 3.4 kcal; glucose monohydrate 1 g is equal to 1 g anhydrous dextrose; osmolarity of 10% dextrose is 505 mOsm/L and 25% dextrose is 1330 mOsm/L. Normal body fluid osmolarity is 310 mOsm/L.

Index Terms

Anhydrous Glucose; D10W; D25W; D30W; D40W; D50; D50W; D5W; D60W; D70W; Dextrose Monohydrate; Glucose; Glucose Monohydrate; Glycosum

References

Abraham MB, Jones TW, Naranjo D, et al. ISPAD Clinical Practice Consensus Guidelines 2018: Assessment and management of hypoglycemia in children and adolescents with diabetes. Pediatr Diabetes. 2018;19 Suppl 27:178-192.[PubMed 29869358]

Adamkin DH and Committee on Fetus and Newborn, "Postnatal Glucose Homeostasis in Late-Preterm and Term Infants," Pediatrics, 2011, 127(3):575-9.[PubMed 21357346]

Allon M, Copkney C. Albuterol and insulin for treatment of hyperkalemia in hemodialysis patients. Kidney Int. 1990;38(5):869-872.[PubMed 2266671]

Aluminum in large and small volume parenterals used in total parenteral nutrition. Fed Regist. 2002;67(244):77792-77793. To be codified at 21 CFR §201.323.

American College of Obstetricians and Gynecologists (ACOG) Committee on Practice Bulletins—Obstetrics. ACOG Practice Bulletin No. 189: Nausea and Vomiting of Pregnancy. Obstet Gynecol. 2018;131(1):e15-e30. doi:10.1097/AOG.0000000000002456.[PubMed 29266076]

American Diabetes Association (ADA). Standards of medical care in diabetes - 2018. Diabetes Care. 2018;41(Suppl 1):S1-S159. http://care.diabetesjournals.org/content/41/Supplement_1.

American Diabetes Association (ADA). Standards of medical care in diabetes–2020. Diabetes Care. 2020;43(suppl 1):S1-S212. https://care.diabetesjournals.org/content/43/Supplement_1. Accessed January 22, 2020.

ASPEN Board of Directors and the Clinical Guidelines Task Force, "Guidelines for the Use of Parenteral and Enteral Nutrition in Adult and Pediatric Patients," JPEN J Parenter Enteral Nutr, 2002, 26(1 Suppl):1-138.

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Brand Names: International

Ardeanutrisol G (CZ); Dextrabbott (MX); Dextralpha (MX); Dextrevit (MX); Dextrogel (GB); Diasol 5 (KR); Fima D5 (IN); Fluidex-5 (QA); Glucocemin (ES); Glucolin (AR); Glucosada (PT); Glucosado (PT); Glucose Braun (PL); Glucosteril (DE, FI, RU); Glucosum (PL); Glucotem (AR); Glukoza (PL); Glukoza Braun (PL); Hluran CL (UA); Infusan D (IN); Infusol D10 (LK); Injectio Glucosi (PL); Isodex (HU); Kissimin (AR); Marivelle (PH); Nutrosa (AR); Rapilose (GB); Wida (IN)

Last Updated 10/9/20