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Overview

Welcome to Dwaey, specifically on KARNIM PLUS page.
This medicine contains an important and useful components, as it consists of
Azadirachta indica (Neem), Momordica charantia (Karela), Ocimum sanctum (Tulsi/holy basil), Kutki (Picorhiza kurroa), Zingiber officinale (Sounth)is available in the market in concentration

Name

Dextrose 20%

Precaution

Dextrose 20% is a hypertonic glucose solution that should be used with caution in several patient populations. In patients with diabetes or those who have uncontrolled blood sugar levels, Dextrose 20% may cause a rapid increase in blood glucose, leading to hyperglycemia and potentially diabetic complications, such as diabetic ketoacidosis. Frequent monitoring of blood glucose levels is essential to avoid such adverse events. For pregnant women, Dextrose 20% should only be used when clearly needed, as glucose can cross the placenta, and excessive glucose levels could affect both maternal and fetal health. It is essential to monitor both maternal and fetal blood glucose levels during administration. Breastfeeding mothers should also be cautious, as glucose can be excreted in breast milk, and excess glucose may affect the infant's metabolism. Patients with kidney disease or heart failure should be monitored carefully for fluid overload or electrolyte disturbances, especially if the solution is administered rapidly or in large volumes. Dextrose 20% can lead to sodium and water retention, exacerbating these conditions. Close monitoring of renal function, fluid balance, and electrolytes is recommended for patients receiving Dextrose 20%.

Indication

Dextrose 20% is primarily used for intravenous glucose supplementation in patients experiencing moderate hypoglycemia, especially in cases where oral glucose administration is not feasible. This higher concentration of glucose is used in emergency situations where a rapid correction of blood glucose levels is required to prevent complications like loss of consciousness or seizures associated with severe hypoglycemia. In addition to treating hypoglycemia, Dextrose 20% may be used as part of fluid resuscitation therapy in cases of shock, trauma, or surgery, as the solution helps restore both glucose and circulatory volume. It is also used in parenteral nutrition to provide glucose in patients who cannot consume food orally. Dextrose 20% can be used when a more concentrated glucose solution is needed, especially in clinical settings requiring rapid correction of blood glucose levels or fluid deficits. Off-label uses may include its use in certain medical conditions where a rapid and significant increase in blood glucose is required, such as in critically ill patients with sepsis or trauma, though its use should be determined on a case-by-case basis by healthcare professionals.

Contra indication

Dextrose 20% is contraindicated in patients who have hyperglycemia or uncontrolled diabetes. In these individuals, the high concentration of glucose may exacerbate elevated blood sugar levels, increasing the risk of diabetic complications. It is also contraindicated in patients with known hypersensitivity or allergy to dextrose or any other components of the solution. Patients with severe renal impairment should avoid Dextrose 20%, as their kidneys may struggle to clear the excess glucose, leading to complications such as fluid retention or electrolyte imbalances. In patients with heart failure or severe pulmonary edema, fluid overload due to the hypertonic nature of the solution can worsen symptoms, including breathing difficulties, edema, and hypertension. This solution is not suitable for neonates or infants due to the high glucose concentration, which could overwhelm their immature glucose metabolism systems and lead to hyperglycemia, electrolyte imbalances, or fluid shifts.

Side Effect

The most common side effects of Dextrose 20% are related to its hyperosmolarity. Hyperglycemia is the primary concern, which can lead to symptoms like excessive thirst, frequent urination, blurred vision, headache, fatigue, and in severe cases, diabetic ketoacidosis if not managed appropriately. Fluid overload is another potential side effect, particularly if Dextrose 20% is administered too rapidly or in excessive volumes. This can lead to edema (swelling), hypertension, or worsening heart failure, especially in patients with preexisting cardiovascular or renal conditions. The osmotic effect of Dextrose 20% can cause hypernatremia (high sodium levels), which can lead to confusion, muscle twitching, and seizures in severe cases. Patients receiving Dextrose 20% should be closely monitored for signs of electrolyte imbalances, including hypokalemia (low potassium) or hyperkalemia (high potassium), which can occur due to shifts in fluids and electrolytes. Infusion-related reactions such as vein irritation, pain, or thrombophlebitis can also occur, especially when the solution is administered rapidly or in peripheral veins.

Pregnancy Category ID

3

Mode of Action

Dextrose 20% provides a rapid source of glucose that is immediately available for cellular energy production. Once infused intravenously, the glucose is absorbed into the bloodstream, where it rapidly increases blood glucose levels. This quick influx of glucose is particularly beneficial in patients suffering from hypoglycemia, as it provides an immediate energy source for cells, especially those in the brain, which rely heavily on glucose for function. The pharmacokinetics of Dextrose 20% involve rapid absorption into the bloodstream, followed by insulin-mediated uptake into various tissues. This results in a prompt correction of low blood sugar and an increase in circulatory volume due to the osmotic properties of the solution. The solution’s high osmolarity also helps to shift fluids into the bloodstream, providing immediate volume expansion for patients in need of resuscitation. The dextrose in the solution is metabolized by cells for energy, and any excess glucose is excreted by the kidneys if renal function is normal.

Interaction

Dextrose 20% can interact with several medications and substances, primarily through its effect on blood glucose levels. Medications that increase blood glucose, such as corticosteroids, epinephrine, and certain diuretics (e.g., thiazides), may exacerbate the hyperglycemic effects of Dextrose 20%, requiring adjustments to insulin or oral hypoglycemic medications. Insulin therapy should be carefully monitored and adjusted to avoid significant fluctuations in blood glucose levels. The use of Dextrose 20% in patients receiving insulin may require more frequent insulin dosing to prevent hyperglycemia. In cases where Dextrose 20% is used with other fluids or medications that affect fluid or electrolyte balance, such as potassium or calcium infusions, careful monitoring of electrolytes is necessary. Patients should avoid alcohol while receiving Dextrose 20%, as alcohol can impair the body’s ability to regulate blood glucose and increase the risk of hypoglycemia, counteracting the intended effect of dextrose. Furthermore, Dextrose 20% may cause electrolyte shifts when used with other hyperosmolar solutions, so these should be carefully considered by healthcare professionals.

Pregnancy Category Note

Information not available

Adult Dose

The typical adult dose of Dextrose 20% for the treatment of hypoglycemia is 20-50 mL administered intravenously as a bolus. The exact dose depends on the severity of hypoglycemia and the patient’s clinical condition. For severe hypoglycemia, 25 mL of Dextrose 20% is commonly used, which provides 5 grams of glucose, rapidly increasing blood glucose levels. In patients who require fluid resuscitation, the dose may vary depending on their condition and the severity of dehydration. The infusion rate is typically adjusted based on the patient's response to treatment, but it should not exceed 0.5-1 g/kg/min to prevent complications such as fluid overload or hyperglycemia. In emergency situations, Dextrose 20% can be infused at a rate of 100-200 mL per hour, though this should be adjusted based on the patient’s clinical condition, renal function, and overall fluid balance.

Child Dose

Dextrose 20% should be used cautiously in pediatric patients, especially in neonates and infants, due to the high glucose concentration. For children, the dose is generally based on weight, with typical dosages ranging from 2-5 mL/kg of body weight, given intravenously. This ensures that the child receives an adequate amount of glucose without risking hyperglycemia. In cases of moderate hypoglycemia, an initial bolus of 2-5 mL/kg may be sufficient, but the dose can be adjusted depending on the severity of the condition and the child’s clinical response. As with adults, monitoring of blood glucose levels is crucial in pediatric patients to avoid excessive glucose levels. In neonates, it is typically preferred to use more dilute forms of glucose, such as Dextrose 10%, to reduce the risk of hyperglycemia and metabolic complications. Careful monitoring of the child’s blood glucose, electrolytes, and fluid balance is required throughout the treatment course.

Renal Dose

In patients with renal impairment, the administration of Dextrose 20% should be done cautiously. Renal impairment can impair the body’s ability to excrete excess glucose, increasing the risk of fluid overload and electrolyte disturbances. For patients with mild to moderate renal insufficiency, the infusion rate should be reduced, and careful monitoring of blood glucose, renal function, and electrolytes is essential. In patients with severe renal failure or those on dialysis, the use of Dextrose 20% should be avoided if possible, as the high glucose load may overwhelm the kidneys' ability to process and clear the excess glucose. Continuous monitoring of serum creatinine, glomerular filtration rate (GFR), and blood glucose is recommended in these patients. In such cases, alternative treatments with lower concentrations of glucose may be considered to reduce the risk of complications.

Administration

Information not available