Dextrose solution (GW).pdf

Intravenous dextrose (glucose water) available conc., doses, side effects, precautions & direction for adm.
presented at Al-Mahmoudiya General Hospital on 20/12/2022

1. Dextrose solution (GW)
Alaa F. Hassan (MSc. Pharmacology)
Drug Information Centre/ Al-Mahmoudiya G. Hospital
Doses equivalence & conversion
 75 g anhydrous glucose eq. to glucose BP 82.5g
(1)

 Oral liquid containing 250mg/ml & tablet containing glucose 4g/tab.
(1)

 Buccal gel tube of 40% oral gel containing 10g/tube
(1)

 IV solution available as (GW) 2.5%, 5% & 10%, (HT) 15%, 20%, 30 %, 40% 50% & 70%
(2, 4)
; note that

ref. 4 classify sol.>5% as HT.
Available in our Hosp. Anhydrous glucose conc.
5% 500ml 50mg/ml
10% 500ml 100mg/ml
20% 50ml 200mg/ml
50% 20ml 500mg/ml
pH value 3.5-6.5, stored at 20-25°C
(3)

Indication & doses-only parenteral

Indication
(3)
Concentrations
Energy source & fluid replacement (peripheral inf.) 2.5%, 5%, 10%
(3, 4)

Energy source (CV inf. As TPN) 10%-70%
(3, 4)

Insulin induced hypoglycaemia 25%, 50%
Neonates & infant acute symptomatic episodes of
hypoglycaemia
25%
Adj. management of hyperkalaemia 25% or 50%
As IV diluent for drugs adm. 2.5%-10%

Hypoglycaemia
 Preterm & term neonates’ 200mg/kg slow IV inj. Followed by 3-6mg/kg/min inf.
(2ml/kg GW 10%)
(2)

 Infant ≤6month 250-500mg/kg/dose (1-2ml HT 25%)
(3-4)

 Neonates 500mg/kg/hr as GW 10% IV inf., initial dose 250mg/kg/5min may be required
for severe hypoglycaemia (associated with loss of consciousness&/seizures)
(1)

 Children>1month (6months) 500mg-1g/kg IV inj./inf. (5-10ml/kg GW 10% or 2-4ml
HT 25%) into large vein through large gauge needle
(1-3)

 Adult 10000-25000mg (40-100ml HT 25% or 20-50ml HT 50%) repeated as needed
(3)

 children & adult 20-50ml

HT 50% at rate of 3ml/min , maintenance dose of GW 10% (4)

2. Hyperkalaemia
 500mg/kg (2ml HT 25%) with soluble insulin 0.1U/kg repeated as needed (unlabelled)
(3)

 Neonates 500mg-1g/kg (2.5-5ml/kg HT 20%) with soluble insulin 0.3-0.6U/kg/hr
(2)

 Children >1month 500mg-1g/kg (2.5-5ml/kg HT 20%) with soluble insulin 0.05-
0.2U/kg/hr
(2)

 Adult 25000mg (50ml HT 50%) with soluble insulin 10U/5min repeated as needed
(unlabelled)
(3)

Persistent cyanosis combined with propranolol & followed by morphine
If (blood glucose < 3mmol/l) Children 200mg/kg as GW 10% IV inf. /10 min
(1)

Energy source (nutritional support), carbohydrate/calorie &/fluid replacement
Mixed with amino acid &/ sterile water for inj. (SWFI) with dose adjustment for individual pt.
requirement
(1, 3)
Children & Adult 2.5%, 5% & 10% sol. via peripheral line or 10%-70% sol. Through large CV
line (typically mixed with TPN)
(4)

Diabetic ketoacidosis
(1)
Insulin secreting islet cell adenoma & varicose veins (off-label)
(4)


Common Side effects, contraindications, precautions
 Febrile reaction
(3, 4)
, fever&/chills
(1, 4)

 Electrolyte & fluid imbalances-dilution of serum electrolyte conc.,
overhydration/congested state, polyuria & pulmonary oedema
(1, 3, 4)

 Acidosis & alkalosis
(3)

 Rash & hypersensitivity (anaphylaxis, difficult breathing, periorbital/facial &/ laryngeal
oedema, pruritus, sneezing & urticaria)
(3, 4)
, local reaction & pain
(1, 4)

 Hypertension, heart failure
(4)
, venous thrombosis & phlebitis
(1-4)


 Delirium tremens with dehydration, anuria
(3, 4)

 Diabetic coma with excessive blood sugar while used in caution with pt. have
subclinical/overt diabetes or receiving corticosteroids, hepatic coma
(3, 4)

 Heart failure
(4)
, intracranial/intraspinal haemorrhage
(3, 4)

 Corn&/corns’ product allergy, drug hypersensitivity
(3, 4)


 Glycosuria is associated with rate of adm., while 0.5g/kg/hr not causes glycosuria; an inf.
at rate of 0.8g/kg/hr when 95% of the solution is retained will cause glycosuria
(3)

 Excessive&/rapid adm. Will result in hyperosmolar syndrome, (generally used with
extreme caution in new born/very low birth weight infant= hypo-/hyperglycaemia),
characterized with ↑ serum Osmolarity, mental confusion, loss of consciousness &
possible intracerebral haemorrhage
(3, 4)

3. Also fatty liver infiltration, acute respiratory failure & hypermetabolic pt. difficult
weaning from respirator
(3)
, besides resulting in sig. hypokalaemia & hypophosphatemia
(3)
.

While prolong administration of glucose without electrolyte is associated with
hyponatraemia & electrolyte imbalance
(1)

 Slow iv inf. /5min suggested for conc. not >25%
(2)
,

When higher conc. >5% to be given
via peripheral vein, adm. Slowly preferably through small bore needle into large vein to
minimize irritation
(3, 4)
, use umbilical/central venous catheter for sol. Conc.>10% after
appropriate dilution
(1, 2)
, > 12.5%
(5)
, or an inf. via CV line for conc. not >25% or 30%
(considered irritant to central vein)
(2)

 HT 50% sol. should be only administered in emergency; avoid sudden withdrawal, adm.
GW 5% or 10% infusion after the HT inj. To avoid rebound hypoglycaemia
(2-4)

 1 manufacturer state the use final filter during adm. Of all parenteral sol. When possible
(3)

 Causes pseudoagglutination of RBCs when adm. simultaneously with whole blood
(3, 4)

 Do not use plastic bags in series connection, pressurize bag to increase flow rate nor use
vented IV adm. Set (results in air embolism)
(3,4)

 Some sol. Contains Aluminium, in pt. with impaired renal fx. , toxicity is expected
(Premature neonates are at particular risk-their immature kidneys & requirement of
calcium + phosphate) (pt. with impaired renal fx. Receiving parenteral Al >4-5mcg/day
are at risk for CNS or bone toxicity)
(3)


Preparation of other conc. From GW 10% 500ml +HT 50%
(2)

Volume removed
from GW 10% (ml)
Volume of HT 50% to
be added (ml)
Final conc. Final vol. (ml)
31.25 31.25 12.5% 500
62.5 62.5 15% 500
93.75 93.75 17.5% 500
187.5 187.5 25% 500
Volume req. HT 50%= (% change [higher conc. – lower conc.] * final volume) /40
(5)

If you need to add NaCl 0.9% to the made 500ml bottle, remove 15ml prepared solution & add
15ml NaCl 30%
(2)

References
1. British National Formulary for Children. V3.1.6 updated 28
th
Sep. 2022 [Android apk]
2. Guy’s & St Thomas’ NHS Foundation Trust - Paediatric Formulary. First Ed. Updated 27
th

April 2020 [Android apk]
3. Elsevier’s 2032 Intravenous Medications, A handbook for nurses and health professionals.
Thirty-nine Ed. V3.6.14 [Android apk]
4. McGraw-Hill - I.V Drug Handbook. V3.0.82 2009-2010 [Android apk]
5. Neonatal Guidelines And Drug Doses 2015 [Android apk]