Dosing

Dosing: Adult
Treatment of hypoglycemia: Doses may be repeated in severe cases
I.V.: 10-25 g (40-100 mL of 25% solution or 20-50 mL of 50% solution)
Treatment of hyperkalemia: I.V. (in combination with insulin): 25-50 g dextrose (250-500 mL D10W) combined with 10 units regular insulin administered over 30-60 minutes; repeat as needed or as an alternative 25 g dextrose (50 mL D50W) combined with 5-10 units regular insulin infused over 5 minutes; repeat as needed
Note: More rapid infusions (<30 minutes) may be associated with hyperglycemia and hyperosmolality and will exacerbate hyperkalemia; avoid use in patients who are already hyperglycemic

Dosing: Pediatric
Treatment of hypoglycemia: Doses may be repeated in severe cases
I.V.:
Infants ≤6 months: 0.25-0.5 g/kg/dose (1-2 mL/kg/dose of 25% solution); maximum: 25 g/dose
Infants >6 months and Children: 0.5-1g/kg/dose (2-4 mL/kg/dose of 25% solution); maximum: 25 g/dose
Adolescents: Refer to adult dosing.
Treatment of hyperkalemia: I.V. (in combination with insulin):
Infants and Children: 0.5-1 g/kg (using 25% or 50% solution) combined with regular insulin 1 unit for every 4-5 g dextrose given; infuse over 2 hours (infusions as short as 30 minutes have been recommended); repeat as needed
Adolescents: Refer to adult dosing.

Dosing: Geriatric
Refer to adult dosing.

Use

5% and 10% solutions: Peripheral infusion to provide calories and fluid replacement
25% (hypertonic) solution: Treatment of acute symptomatic episodes of hypoglycemia in infants and children to restore depressed blood glucose levels; adjunctive treatment of hyperkalemia when combined with insulin
50% (hypertonic) solution: Treatment of insulin-induced hypoglycemia (hyperinsulinemia or insulin shock) and adjunctive treatment of hyperkalemia in adolescents and adults
≥10% solutions: Infusion after admixture with amino acids for nutritional support

Adverse Reactions

Frequency not defined. Note: Most adverse effects are associated with excessive dosage or rate of infusion.
Cardiovascular: Edema, dehydration, hyper-/hypovolemia, phlebitis, venous thrombosis
Central nervous system: Fever, hyperosmolar syndrome, mental confusion, unconsciousness
Endocrine & metabolic: Acidosis, hyperglycemia, hypokalemia, hypophosphatemia, hypomagnesemia
Genitourinary: Ketonuria, glycosuria, polyuria
Gastrointestinal: Diarrhea (oral), nausea, polydipsia
Local: Pain, tissue necrosis, vein irritation
Respiratory: Pulmonary edema, tachypnea

Contraindications

Hypersensitivity to corn or corn products; diabetic coma with hyperglycemia; hypertonic solutions in patients with intracranial or intraspinal hemorrhage; patients with delirium tremens and dehydration; patients with anuria, hepatic coma, or glucose-galactose malabsorption syndrome

Warnings / Precautions Drug

Concerns related to adverse effects:
• Hyperglycemia: An unexpected rise in blood glucose level in an otherwise stable patient may be an early symptom of infection. Rapid administration of hypertonic solutions may produce significant hyperglycemia, glycosuria, and shifts in electrolytes; this may result in dehydration, hyperosmolar syndrome, coma, and death especially in patients with chronic uremia or carbohydrate intolerance.
• Hypokalemia: Administration of potassium free I.V. 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 I.V. dextrose solutions may result in significant hyponatremia or water intoxication in pediatric patients; monitor serum sodium concentration.
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.
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.
Other warnings/precautions:
• Abrupt withdrawal: Rebound hypoglycemia may be associated with abrupt withdrawal.
• Administration: Hypertonic solutions (>10%) may cause thrombosis if infused via peripheral veins; administer hypertonic solutions via a central venous catheter.

Interactions

There are no known significant interactions.

Pregnancy

C/A (oral)

Monitoring Parameters

Blood and urine sugar, serum electrolytes, I & O, caloric intake
Reference Range
Normal blood sugar:
Children 0-2 years: 60-105 mg/dL
Children >2 years and Adults: 70-110 mg/dL

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 uptake of potassium by cells, especially in muscle tissue, lowering serum potassium.

Pharmacodynamics / Kinetics

Onset of action:
Maximum effect: Treatment of hyperkalemia: I.V.: 30 minutes
Metabolism: Metabolized to carbon dioxide and water