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 sterile, non-pyrogenic, hypertonic solution containing dextrose (anhydrous) in water for injection. It is supplied in a 250ml plastic infusion bag and is primarily used for intravenous administration in clinical settings. This preparation is commonly utilized for:

• Providing a source of carbohydrates (calories) in parenteral nutrition.
• Treating hypoglycemia (low blood sugar levels), especially in emergency settings.
• Managing hyperkalemia (high potassium levels) when used in combination with insulin.
• Serving as a diluent for various intravenous drugs.

Due to its high osmolarity, 50% Dextrose is typically administered via a central vein, especially when large volumes or repeated doses are required. The solution does not contain any antimicrobial agents and is intended for single-use only.

It must be used with caution and under the supervision of healthcare professionals, particularly in patients with diabetes mellitus, renal impairment, or other metabolic conditions.

How to use 50% w/v DEXTROSE INJECTION USP

50% Dextrose Injection USP must be administered intravenously by qualified healthcare professionals. It is a high-concentration dextrose solution and should be used with caution due to the risk of vein irritation and hyperglycemia.

• Administration Route: Intravenous (IV) injection or infusion, preferably via a central venous catheter due to hypertonicity.
• Dosage Form: 250ml plastic bag for single-use infusion.
• Technique: The solution should be inspected for clarity, absence of particles, and integrity of the container before use. Do not use if the solution is discolored or if the container is leaking.
• Use in Emergency: In cases of severe hypoglycemia, rapid IV push or infusion may be required to quickly elevate blood glucose levels.
• Monitoring: Blood glucose, serum electrolytes, and fluid balance should be monitored during administration to prevent complications such as hyperglycemia or fluid overload.

In pediatric or geriatric populations, dosage and rate of infusion must be carefully adjusted. The solution should not be mixed with other medications unless compatibility is established.

Mode of Action 50% w/v DEXTROSE INJECTION USP

The pharmacologic effect of 50% Dextrose is based on the role of dextrose (glucose) as the primary source of energy for the body. Here's how it works:

• Energy Supply: Dextrose is rapidly absorbed and metabolized in the body to provide energy. It enters cells via glucose transporters and is utilized in glycolysis and the Krebs cycle to produce ATP, the body's energy currency.
• Corrects Hypoglycemia: When administered intravenously, the dextrose quickly raises blood glucose levels, effectively reversing hypoglycemic symptoms such as dizziness, sweating, tremors, and unconsciousness.
• Osmotic Action: As a hypertonic solution, 50% Dextrose draws water from the intracellular space into the extracellular and intravascular compartments. This property may also influence fluid balance and cell hydration status.
• Potassium Regulation: When combined with insulin, dextrose helps drive potassium into cells, which is helpful in managing hyperkalemia.

Once administered, dextrose is metabolized in the liver and other tissues, and excess glucose may be stored as glycogen or converted to fat if energy requirements are met.

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

While 50% Dextrose is generally considered safe when used properly, it may interact with other medications and clinical conditions. Important interactions include:

• Insulin: Concomitant use can enhance the movement of potassium into cells, potentially leading to hypokalemia. Blood glucose levels must be carefully monitored.
• Diuretics (e.g., furosemide, thiazides): May alter fluid and electrolyte balance, necessitating close monitoring when high concentrations of dextrose are administered.
• Corticosteroids: Can increase blood glucose levels, potentially reducing the effectiveness of dextrose therapy in hypoglycemia.
• Phenytoin: High-concentration dextrose solutions may reduce phenytoin solubility, thus limiting its intravenous compatibility.
• Parenteral Nutrition: Dextrose is often combined with amino acids, electrolytes, and lipids in TPN solutions. Incompatibilities may occur if not properly formulated.

Always review the compatibility and clinical status of the patient before co-administering with other IV solutions or medications. Dextrose should not be infused through the same line as blood products due to risk of hemolysis and clot formation.

Dosage of 50% w/v DEXTROSE INJECTION USP

The appropriate dosage of 50% Dextrose Injection varies based on the clinical condition, age, and weight of the patient. The following are general guidelines:

• Adults (Hypoglycemia): 25–50ml IV bolus (i.e., 12.5g–25g of dextrose), repeated as necessary, followed by a maintenance infusion if required.
• Pediatrics: Use with extreme caution. Typically, more dilute dextrose solutions (e.g., D10 or D25) are used. In emergencies, 0.5–1g/kg may be administered IV slowly.
• Parenteral Nutrition: Dosage is individualized based on caloric needs. Continuous infusion is often preferred with dose adjustments based on metabolic parameters.
• Hyperkalemia Treatment: Typically, 50ml of 50% Dextrose is administered along with 10 units of regular insulin IV to promote cellular uptake of potassium.

Always monitor blood glucose, electrolytes, and fluid balance during administration. The infusion should not be rapid unless required to treat acute hypoglycemia.

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

Though generally safe when used appropriately, 50% Dextrose Injection can cause various side effects, especially with prolonged use or high doses:

• Hyperglycemia: Most common side effect. Signs include dry mouth, increased thirst, frequent urination, confusion, and fatigue.
• Local Irritation: Pain, redness, or inflammation at the injection site, especially with peripheral administration due to hypertonicity.
• Thrombophlebitis: Inflammation of veins may occur with peripheral infusion. Central venous access is preferred for repeated dosing.
• Fluid Overload: In patients with renal or cardiac dysfunction, excess fluid may lead to edema, pulmonary congestion, or heart failure.
• Electrolyte Imbalance: Hypokalemia or hyponatremia can develop, particularly when insulin is co-administered or when large volumes are infused.
• Rebound Hypoglycemia: Rapid glucose metabolism can occasionally lead to subsequent drops in blood sugar, particularly in insulin-sensitive individuals.

Serious side effects are rare but require immediate medical attention. Continuous monitoring during infusion minimizes risks.

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

Administration of 50% Dextrose Injection is contraindicated in certain conditions where the risks outweigh the benefits:

• Intracranial or Intraspinal Hemorrhage: Hyperosmolar solutions may worsen neurologic outcomes.
• Delirium Tremens (if severely dehydrated): Risk of worsening dehydration and electrolyte imbalance.
• Uncontrolled Diabetes Mellitus: Can cause severe hyperglycemia and complications such as ketoacidosis or hyperosmolar coma.
• Anuria or Severe Renal Impairment: Risk of fluid overload and electrolyte disturbances.
• Known Hypersensitivity: Rare but possible reaction to dextrose or components of the solution.
• Thiamine Deficiency (e.g., Wernicke’s encephalopathy): High glucose administration without thiamine can worsen symptoms; thiamine should be given before dextrose in such cases.

Caution is also advised in elderly patients, neonates, and those with cardiac insufficiency.

Storage of 50% w/v DEXTROSE INJECTION USP

Proper storage conditions are critical to ensure the safety and efficacy of 50% Dextrose Injection USP:

• Temperature: Store at controlled room temperature between 20°C to 25°C (68°F to 77°F). Avoid exposure to extreme heat or cold.
• Light Protection: Although the solution is relatively stable, it's best stored away from direct sunlight or fluorescent light to preserve integrity.
• Container Integrity: Do not use the bag if there is any leakage, discoloration, or presence of particles.
• Single-Use Only: Once opened, the solution must be used immediately and should not be stored for later use.
• Keep Out of Reach of Children: As with all IV medications, proper storage away from unauthorized access is essential.

Check expiration date before administration and dispose of unused portions according to local pharmaceutical waste protocols.