50% w/v DEXTROSE INJECTION USP Infusion/Solution for

What is 50% w/v DEXTROSE INJECTION USP

50% w/v Dextrose Injection USP is a hypertonic intravenous (IV) solution containing 500 grams of anhydrous dextrose per 1000ml of sterile water. It is typically administered via a large volume plastic infusion bag for rapid IV delivery in hospital settings.

• Active ingredient: Dextrose (anhydrous), which is chemically identical to glucose, the primary energy source for body cells.
• Concentration: 50% weight/volume (w/v), meaning 50 grams of dextrose are present in every 100 ml of solution.
• Form: Clear, colorless solution intended for IV infusion.
• Packaging: Supplied in 1000ml plastic infusion bags for clinical use.

This formulation is used for:

• Emergency treatment of severe hypoglycemia (very low blood sugar).
• Providing a concentrated source of glucose in patients unable to take food orally.
• As a part of parenteral nutrition in critically ill or malnourished patients.
• Treatment of hyperkalemia (high potassium levels), when combined with insulin.

It must only be administered under medical supervision, often in intensive care units or emergency departments. Due to its high concentration, this solution is not suitable for peripheral veins and is generally administered via central venous access.

How to use 50% w/v DEXTROSE INJECTION USP

Administration of 50% Dextrose Injection USP should always be carried out by trained healthcare professionals due to its hypertonic nature and the potential for vein irritation or glucose overload.

• Route of administration: Intravenous infusion, typically via central venous line.
• Infusion rate: Determined by patient condition, age, body weight, and blood glucose level.
• Preparation: Inspect visually before use. The solution should be clear, free from particulate matter and discoloration. Do not use if cloudy or if the seal is damaged.

Steps for clinical use:

1. Connect the IV set to the 1000ml plastic bag, ensuring sterile technique.
2. Prime the IV line to remove air before infusion.
3. Adjust the infusion rate based on the physician’s orders and patient’s needs.
4. Monitor the patient’s vital signs, blood glucose levels, and fluid status during administration.

Important precautions:

• Administer via central vein when possible due to high osmolality.
• Do not mix with blood or incompatible medications in the same line.
• Continuous blood glucose monitoring is essential, especially in diabetic or critically ill patients.

This solution is not intended for routine maintenance fluid therapy and is reserved for specific clinical indications.

Mode of Action 50% w/v DEXTROSE INJECTION USP

The pharmacological effect of 50% w/v Dextrose Injection USP is based on the role of glucose as an essential nutrient and metabolic substrate. Upon intravenous administration, dextrose (glucose) rapidly enters the bloodstream and is transported into cells for energy production.

• Cellular uptake: Glucose is transported into cells primarily via insulin-dependent glucose transporters (GLUT-4), especially in muscle and fat tissue.
• Energy production: Once inside the cell, glucose undergoes glycolysis, the citric acid cycle, and oxidative phosphorylation to generate ATP (adenosine triphosphate), the primary energy molecule in the body.
• Brain function: Glucose is the main fuel for the brain. Infusion of hypertonic glucose rapidly corrects neuroglycopenic symptoms in hypoglycemia.

Additional effects include:

• Hyperkalemia management: When combined with insulin, dextrose helps drive extracellular potassium back into cells, lowering serum potassium levels.
• Osmotic effects: Due to its high osmolarity, 50% dextrose draws water from intracellular to extracellular compartments, potentially affecting fluid balance.

Pharmacokinetics:

• Onset of action: Immediate (within minutes of IV administration).
• Metabolism: Metabolized by the liver and other tissues via normal glucose metabolic pathways.
• Excretion: Minimal unchanged glucose in urine unless renal threshold is exceeded.

50% w/v DEXTROSE INJECTION USP Interactions 50% w/v DEXTROSE INJECTION USP

While 50% Dextrose Injection USP itself does not interact with many medications, its metabolic effects—particularly on blood glucose—can indirectly impact the action of several drugs.

• Insulin and oral hypoglycemics: Antagonistic effect. Dextrose elevates blood glucose, reducing the efficacy of anti-diabetic drugs.
• Corticosteroids: May enhance hyperglycemia caused by dextrose infusion.
• Diuretics (e.g., furosemide, thiazides): May contribute to fluid and electrolyte imbalances when combined with high-glucose IV solutions.
• Digoxin: Hypokalemia induced by insulin-dextrose therapy may increase the risk of digoxin toxicity.
• Potassium supplements: Often co-administered during insulin-dextrose treatment to prevent hypokalemia.

Other considerations:

• Infusing hypertonic glucose with calcium-containing solutions may increase the risk of precipitation and should be avoided in the same IV line.
• Co-administration with blood products is contraindicated due to risk of red cell hemolysis.
• Interferes with certain lab tests—especially blood glucose assays, serum osmolality, and electrolyte panels.

Always inform your healthcare provider about all medications being used before initiating dextrose therapy, especially in critically ill or diabetic patients.

Dosage of 50% w/v DEXTROSE INJECTION USP

The dosage of 50% w/v Dextrose Injection USP is highly individualized and must be prescribed by a physician based on the clinical context. Overdose or inappropriate use can lead to serious metabolic complications.

• Adults (Hypoglycemia): A common dose is 25–50 ml IV bolus (equivalent to 12.5–25 grams of dextrose). This may be followed by maintenance infusions using less concentrated dextrose solutions.
• Adults (Hyperkalemia): Often used with 10 units of regular insulin, followed by 50ml of 50% dextrose to prevent hypoglycemia.
• Children: Dose based on body weight. Typically 0.5–1 g/kg of dextrose administered IV slowly. Must be diluted to 10%–25% to prevent vein irritation.
• Neonates: Avoid use of 50% dextrose unless in emergency situations; diluted solutions are preferred.

Maximum safe dose:

• There is no fixed upper limit, but infusion rates should not exceed the body’s capacity to metabolize glucose, generally not more than 0.5 g/kg/hour.

Monitoring:

• Blood glucose every 15–30 minutes after bolus administration.
• Serum potassium, sodium, and fluid balance if used over longer periods.

Use with extreme caution in patients with diabetes mellitus, renal impairment, or risk of intracranial hypertension.

Possible side effects of 50% w/v DEXTROSE INJECTION USP

Though life-saving in emergencies, 50% Dextrose Injection USP may cause a variety of side effects, especially if administered rapidly or in large volumes.

• Metabolic:
  • Hyperglycemia (high blood sugar)
  • Hypokalemia (low potassium), especially when combined with insulin
  • Hyperosmolar syndrome or dehydration
• Local effects:
  • Phlebitis (vein irritation or inflammation)
  • Thrombosis at the injection site
  • Extravasation injury if leakage occurs outside the vein
• Systemic effects:
  • Fluid overload, particularly in patients with renal or cardiac dysfunction
  • Seizures (rare, from sudden glucose spikes)
  • Confusion, anxiety, or mood changes from rapid blood sugar swings

Allergic reactions: Although rare, signs may include rash, itching, swelling (especially of the face/tongue/throat), severe dizziness, or difficulty breathing.

Precautions: Monitor closely in pediatric and elderly patients, those with impaired glucose tolerance, or receiving concomitant insulin therapy.

50% w/v DEXTROSE INJECTION USP Contraindications 50% w/v DEXTROSE INJECTION USP

There are several clinical scenarios where 50% Dextrose Injection USP is contraindicated due to the potential for serious harm:

• Hyperglycemia or diabetes mellitus (uncontrolled): High concentration of dextrose may worsen glycemic control.
• Intracranial or intraspinal hemorrhage: Elevated blood glucose can worsen neurological outcomes.
• Severe dehydration without electrolytes: This solution lacks sodium, potassium, and other electrolytes.
• Hypersensitivity to dextrose: Though rare, any known allergy to dextrose or glucose solutions contraindicates its use.
• Fluid overload states: Such as pulmonary edema or heart failure, due to the risk of circulatory overload.
• Peripheral vein administration: Not recommended due to high osmolality, which can cause vein damage or necrosis.

Use extreme caution or avoid use in:

• Renal failure (risk of volume overload)
• Liver failure (impaired glucose metabolism)
• Thiamine deficiency (can precipitate Wernicke’s encephalopathy in chronic alcoholics)

Storage of 50% w/v DEXTROSE INJECTION USP

Proper storage of 50% Dextrose Injection USP is essential to ensure sterility, potency, and safety.

• Temperature: Store at controlled room temperature between 15°C to 25°C (59°F to 77°F).
• Protection from light: While not highly light-sensitive, store away from direct sunlight to avoid degradation or discoloration.
• Do not freeze: Freezing can compromise the integrity of the plastic bag and potentially affect solution stability.
• Inspect before use: Ensure the solution is clear and the bag is intact. Do not use if there is turbidity, discoloration, or visible particles.

Shelf life: Refer to the manufacturer's label for expiry date. Once the bag is opened or the port punctured, use immediately or discard any unused portion to prevent contamination.

Handling precautions:

• Single-use container. Do not reuse.
• Keep out of reach of children.
• Avoid mixing with incompatible drugs unless compatibility is confirmed.

Proper disposal according to hospital waste management protocols is essential for used bags and partially used containers.