ﺑﺎﺯﮔﺸﺖ ﺑﻪ ﺻﻔﺤﻪ ﻗﺒﻠﯽ
خرید پکیج
تعداد آیتم قابل مشاهده باقیمانده : 3 مورد
نسخه الکترونیک
medimedia.ir

Instant glucose and intravenous dextrose: Drug information

Instant glucose and intravenous dextrose: Drug information
(For additional information see "Instant glucose and intravenous dextrose: Patient drug information" and see "Instant glucose and intravenous dextrose: Pediatric drug information")

For abbreviations, symbols, and age group definitions used in Lexicomp (show table)
Brand Names: US
  • Gluco to Go 15 [OTC];
  • Gluco To Go [OTC];
  • Glucose Nursette [OTC];
  • Glutol [OTC];
  • Glutose 5 [OTC];
  • Good Start 5% Glucose Water [OTC];
  • Insta-Glucose [OTC]
Brand Names: Canada
  • Glucodex
Pharmacologic Category
  • Antidote, Hypoglycemia;
  • Intravenous Nutritional Therapy
Dosing: Adult
Calcium channel blocker or beta-blocker overdose/toxicity

Calcium channel blocker or beta-blocker overdose/toxicity (adjunctive agent) (off-label use): Note: For use only as an adjuvant component of high-dose insulin therapy (HDIT). Optimal dosage regimen has not been determined; HDIT is used for patients who are refractory to initial therapies (eg, atropine, calcium, vasopressors). Monitor blood glucose and electrolytes frequently, especially at the initiation of therapy. Use of concentrated dextrose solutions may help to avoid fluid overload (Ref).

Patients with existing hypoglycemia: Note: Correct relative hypoglycemia (baseline blood glucose <200 mg/dL) prior to initiation of HDIT (Ref); some experts recommend a lower baseline blood glucose (<150 mg/dL) at which to correct hypoglycemia (Ref).

IV: 25 g (50 mL D50W) as a single bolus dose followed by a continuous infusion of 0.5 g/kg/hour when HDIT is initiated; titrate dextrose to maintain blood glucose concentration >100 mg/dL. Hold dextrose for blood glucose concentration ≥200 mg/dL (Ref).

Patients without existing hypoglycemia: Initiate a continuous infusion of 0.5 g/kg/hour when HDIT is initiated; titrate dextrose infusion to maintain blood glucose concentration >100 mg/dL. Hold dextrose for blood glucose concentration ≥200 mg/dL (Ref).

Glucose tolerance test

Glucose tolerance test (diagnostic test for diabetes): Glutol: Oral:

One-step: 75 g as single dose to a fasting patient; assess plasma glucose 2 hours after dose in nonpregnant patients or 1 and 2 hours after dose in pregnant patients (Ref).

Two-step: Pregnant patients:

First step: 50 g as a single dose to a nonfasting patient; assess plasma glucose 1 hour after dose; if plasma glucose levels ≥130 mg/dL proceed to 100 g oral glucose tolerance test. Note: Cutoffs of ≥135 or ≥140 mg/dL have also been recommended; increased sensitivity and decreased specificity have been associated with use of a lower cutoff (Ref).

Second step: 100 g as a single dose to a fasting patient; assess plasma glucose at 1, 2, and 3 hours after dose (Ref).

Hyperkalemia, severe/emergent

Hyperkalemia, severe/emergent (adjunctive agent) (off-label use): Note: Used as an adjunct to insulin therapy. Consider omitting dextrose from regimen if blood glucose is ≥250 mg/dL (Ref). Practice may vary; refer to institutional protocols.

IV: 25 to 50 g dextrose over 5 minutes; only administer along with separate administration of IV insulin (eg, regular insulin); repeat as needed (Ref). After initial dose of dextrose, some experts administer 10% dextrose continuous IV infusion at 50 to 100 mL/hour for ~5 hours (Ref). Note: Monitor blood glucose every hour for up to 6 hours after insulin has been administered (Ref).

Hypernatremia

Hypernatremia (off- label use):

Note: Use caution in patients with elevated intracranial pressure. Most patients with hypernatremia have chronic hypernatremia, including those who present with acute concerns (eg, change in mental status). Dosing requires individualization based on serum sodium levels and clinical factors (eg, presence of symptoms, duration of hypernatremia, volume status). Approach below provides a guide to initial therapy based on estimation of water deficit and appropriate rates of correction. Address sources of ongoing free water loss and reversible causes of hypernatremia. Patients with concurrent medical conditions may need additional therapies (eg, hypovolemic patients may require additional isotonic fluid; patients with diabetes insipidus may require desmopressin). Refer to institution-specific protocols where available (Ref).

Chronic (>48 hours or unknown duration):

Note: Goal rate of serum sodium decrease is ≤0.5 mEq/L per hour (~10 mEq/L/24 hours; no more than 12 mEq/L/24 hours). In clinically stable, asymptomatic patients, may consider enteral correction of hypernatremia (Ref).

5% dextrose: IV: Initial: ~1.35 mL/kg/hour up to a maximum of 150 mL/hour; add ongoing hourly water losses (eg, urinary or GI) to initial infusion rate, if known. Adjust rate based on repeat serum sodium levels (eg, every 4 to 6 hours initially, then every 12 to 24 hours after target rate of sodium decrease is attained) (Ref).

Acute ( ≤48 hours in duration):

Note: For use in patients with confirmed hypernatremia ≤48 hours in duration (eg, diabetes insipidus with abrupt cessation of water intake, acute salt poisoning). Goal rate of initial serum sodium decrease is ≤1 to 2 mEq/L per hour to reach a serum sodium of 140 mEq/L in <24 hours. In patients with hypernatremia secondary to correction of severe hyperglycemia, consider an alternative source of free water (eg, sodium chloride 0.45%); if treating hypernatremia secondary to correction of severe hyperglycemia in younger patients (eg, ≤40 years of age), some experts correct serum sodium more slowly (ie, with chronic regimen above) to prevent cerebral edema (Ref).

5% dextrose: IV: Initial: 3 to 6 mL/kg/hour up to a maximum of 666 mL/hour; add ongoing hourly water losses (eg, urinary or GI) to initial infusion rate, if known. Adjust dose based on frequent serum sodium monitoring (eg, every 1 to 3 hours). When serum sodium is ≤145 mEq/L, reduce rate to ~1 mL/kg/hour, monitor serum sodium every 2 to 4 hours, and continue until serum sodium reaches 140 mEq/L (Ref).

Hypoglycemia

Hypoglycemia:

IV: 10 to 25 g (20 to 50 mL of 50% solution); repeat as needed in severe cases.

Note: The Society of Critical Care Medicine suggests that blood glucose <70 mg/dL (or <100 mg/dL in neurologic injury patients) be treated immediately by discontinuing insulin therapy (if receiving) and administering 10 to 20 g (20 to 40 mL of 50% solution) IV; repeat blood glucose measurement in 15 minutes with repeat dextrose administration as necessary; avoid overcorrection (Ref).

Oral: 15 to 20 g as a single dose; may repeat in 15 minutes if hypoglycemia persists. Once plasma glucose returns to normal, a meal or snack should be consumed to prevent recurrence of hypoglycemia (Ref).

Dosing: Kidney Impairment: Adult

There are no specific dosage adjustments provided in the manufacturer's labeling; however, dextrose is excreted by the kidney, and closer monitoring for adverse effects may be warranted in patients with renal impairment.

Dosing: Hepatic Impairment: Adult

There are no dosage adjustments provided in the manufacturer's labeling.

Dosing: Older Adult

Refer to adult dosing.

Dosing: Pediatric

(For additional information see "Instant glucose and intravenous dextrose: Pediatric drug information")

Hypoglycemia

Hypoglycemia: Note: Doses may be repeated in severe cases:

IV, Intraosseous:

Infants and Children: Dextrose 25% solution: IV, Intraosseous: 0.5 to 1 g/kg/dose (2 to 4 mL/kg/dose of 25% solution); maximum dose: 25 g/dose (Ref).

Adolescents: Dextrose 50% solutions: IV, Intraosseous: 0.5 to 1 g/kg/dose (1 to 2 mL/kg/dose of 50% solution); maximum dose: 25 g/dose (Ref).

Oral: Children and Adolescents: Oral: 0.3 g/kg as a single dose; usual maximum dose: 15 to 20 g/dose; repeat in 15 minutes if hypoglycemia persists; smaller doses (eg, 5 to 10 g) could be considered for patients on automated insulin delivery to help avoid rebound hyperglycemia (Ref).

Hyperkalemia, treatment

Hyperkalemia, treatment: Limited data available: Note: Experts suggest using a ratio of 1 unit of insulin for every 5 g of dextrose (Ref).

Infants, Children, and Adolescents: IV: 0.5 to 1 g/kg/dose combined with regular insulin over 15 to 30 minutes; dose may be repeated; in some cases, a continuous IV infusion may be necessary. In adults, the usual initial dose of dextrose is 25 to 50 g (Ref).

Parenteral nutrition

Parenteral nutrition: Dextrose component (Ref):

Infants: IV: Initial: 6 to 8 mg/kg/minute; usual daily increase: 1 to 2 mg/kg/minute as tolerated; usual goal: 10 to 14 mg/kg/minute; maximum daily rate: 18 mg/kg/minute.

Children ≤10 years: IV: Initial: 3 to 6 mg/kg/minute; usual daily increase: 1 to 2 mg/kg/minute; usual goal as tolerated: 8 to 10 mg/kg/minute.

Children >10 years and Adolescents: IV: Initial: 2.5 to 3 mg/kg/minute; usual daily increase: 1 to 2 mg/kg/minute as tolerated; usual goal: 5 to 6 mg/kg/minute.

Glucose tolerance test

Glucose tolerance test (diagnostic test for diabetes): Oral liquid: Children and Adolescents: Oral: 1.75 g/kg as a single dose; maximum dose: 75 g/dose; assess plasma glucose 2 hours after dose (Ref).

Dosing: Kidney Impairment: Pediatric

There are no specific dosage adjustments provided in the manufacturer's labeling; however, dextrose is excreted by the kidney, and closer monitoring for adverse effects may be warranted in patients with renal impairment.

Dosing: Hepatic Impairment: Pediatric

There are no dosage adjustments provided in the manufacturer's labeling.

Adverse Reactions

The following adverse drug reactions and incidences are derived from product labeling unless otherwise specified.

Frequency not defined:

Cardiovascular: Localized phlebitis, phlebitis, venous thrombosis

Central nervous system: Confusion, loss of consciousness

Endocrine & metabolic: Dehydration, glycosuria, hyperglycemia, hyperosmolar syndrome, hypervolemia, hypokalemia

Local: Local pain

Respiratory: Pulmonary edema

<1%, postmarketing, and/or case reports: Hypersensitivity reaction (including anaphylaxis)

Contraindications

Injectable: Hypersensitivity to dextrose, corn or corn products, or any component of the formulation; hypertonic solutions in patients with intracranial or intraspinal hemorrhage; delirium tremens (if dehydrated); severe dehydration; clinically significant hyperglycemia; anuria; hepatic coma; dextrose solutions without electrolytes should not be administered simultaneously with blood through the same infusion set because of the possibility that pseudoagglutination of red cells may occur. Contraindications may vary by product (also refer to manufacturer's labeling).

Warnings/Precautions

Concerns related to adverse effects:

• Extravasation: Dextrose 10% may be an irritant. Concentrated IV dextrose (>10%) may be an irritant or a vesicant. Higher concentration (higher osmolarity) is associated with a higher risk. Ensure proper catheter or needle position prior to and during infusion. Avoid extravasation.

• Hepatobiliary effects: Hepatobiliary disorders (eg, cholecystitis, cholelithiasis, cholestasis, cirrhosis, hepatic steatosis, fibrosis) may occur in patients without liver disease who receive parenteral nutrition and may lead to hepatic failure. Increase in blood ammonia levels and hyperammonemia may also occur.

• Hyperglycemia or hyperosmolar hyperglycemic state: Use of dextrose infusions with impaired glucose intolerance may worsen hyperglycemia. Administration of dextrose at a rate exceeding the patient's utilization rate may lead to hyperglycemia, coma, and death. Patients with underlying CNS disease and renal impairment may be at greater risk of developing hyperosmolar hyperglycemic state.

• Hypersensitivity: Hypersensitivity/infusion reactions, including anaphylaxis, have been reported.

• Hypokalemia: Administration of IV dextrose solutions (particularly high concentrations) without the addition of potassium may result in significant hypokalemia; monitor closely and/or add potassium to dextrose solutions for patients with adequate renal function.

• Hyponatremia/sodium disorders: Administration of low sodium or sodium-free IV dextrose solutions may result in excessive reduction of serum sodium, significant hyponatremia, or water intoxication. Risk is increased in pediatric patients, older adults, postoperative patients, and those with psychogenic polydipsia. Avoid dextrose injection in patients with or at risk for hyponatremia; if used, monitor serum sodium concentration. Use high-volume infusion with caution in patients with cardiac or pulmonary failure and in patients with nonosmotic vasopressin release (ie, syndrome of inappropriate antidiuretic hormone secretion) due to the risk of hospital-acquired hyponatremia. Rapid correction of sodium disorders is potentially dangerous (eg, may cause cerebral edema or osmotic demyelination syndrome) (Kraft 2005; manufacturer's labeling).

• Infection: Patients requiring parenteral nutrition may be at high risk of infection, including sepsis. Risk of infection is increased with malnutrition, hyperglycemia exacerbated by dextrose infusion, or catheters required for administration. Proper aseptic technique should be followed; monitor for signs of early infection. Patients with diabetes are at a greater risk of developing catheter-related infections compared with nondiabetic patients (McMahon 1996).

• Parenteral nutrition-associated liver disease: Has been reported in patients receiving parenteral nutrition for extended periods of time, especially preterm infants, and can present as cholestasis or steatohepatitis.

• Refeeding syndrome: Refeeding severely undernourished patients may result in refeeding syndrome (eg, intracellular shift of potassium, phosphorus, and magnesium as the patient becomes anabolic); thiamine deficiency and fluid retention may also develop. Carefully monitor severely undernourished patients and slowly increase dextrose and other nutrient intakes.

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.

• Hyperkalemia: The use of dextrose with insulin for the treatment of hyperkalemia achieves a rapid reduction in serum potassium concentrations by redistributing serum potassium intracellularly; however, this effect is transient (lasts up to 2 hours) and does not remove potassium body stores. Other therapies can be used to increase potassium elimination (eg, sodium polystyrene sulfonate, hemodialysis) (Elliott 2010; Khilnani 1992; Kraft 2005).

• Pulmonary edema: Use with caution in patients with pulmonary edema; these patients are susceptible to excessive fluid accumulation.

• Renal impairment: Use with caution in patients with renal impairment; may be at risk of electrolyte and fluid volume overload and of developing hyperosmolar hyperglycemic state. Parenteral product may contain aluminum, which may accumulate following prolonged administration in patients with renal impairment.

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.

Dosage form specific issues:

• Aluminum: The parenteral product may contain aluminum; toxic aluminum concentrations may be seen with high doses, prolonged use, or renal dysfunction. Premature neonates are at higher risk due to immature renal function and aluminum intake from other parenteral sources. Parenteral aluminum exposure of >4 to 5 mcg/kg/day is associated with CNS and bone toxicity; tissue loading may occur at lower doses (Federal Register 2002). See manufacturer's labeling.

• Oral dosage forms: In patients with impaired consciousness, oral dextrose administration may increase the risk of aspiration; use only when no alternatives (eg, parenteral dextrose, glucagon) are available (Desimone 2018).

• Precipitates: Periodically inspect solution, infusion set, and catheter for precipitates. Pulmonary vascular precipitates causing pulmonary vascular emboli and pulmonary distress have been reported (some fatal). If signs of pulmonary distress occur, stop the infusion.

Other warnings/precautions:

• Abrupt withdrawal: Rebound hypoglycemia may occur when a concentrated dextrose infusion is abruptly withdrawn.

• Administration: Hypertonic solutions (>10%) may cause thrombosis if infused via peripheral veins; administer hypertonic solutions via a central venous catheter.

Dosage Forms: US

Excipient information presented when available (limited, particularly for generics); consult specific product labeling. [DSC] = Discontinued product

Gel, Oral:

Gluco to Go 15: 40% (37.5 g) [contains methylparaben, propylparaben; lemon flavor]

Glutose 5: 40% (12.5 g) [contains methylparaben, propylparaben]

Insta-Glucose: 40% dextrose (77.4% total carbohydrate) (31 g) [contains fd&c red #40 (allura red ac dye), methylparaben, propylparaben, sodium benzoate]

Liquid, Oral:

Glutol: 100 g/180 mL (180 mL) [lemon flavor]

Solution, Intravenous:

Generic: 250 mg/mL (10 mL); 5% (25 mL, 50 mL, 100 mL, 250 mL, 500 mL, 1000 mL); 10% (250 mL, 500 mL, 1000 mL); 40% (500 mL); 70% (2000 mL)

Solution, Intravenous [preservative free]:

Generic: 5% (100 mL, 150 mL, 250 mL, 500 mL, 1000 mL); 10% (250 mL, 500 mL, 1000 mL); 20% (500 mL); 30% (500 mL); 50% (50 mL, 500 mL); 70% (500 mL, 2000 mL)

Solution, Oral:

Glucose Nursette: 5% (59 mL)

Good Start 5% Glucose Water: 5% (88.7 mL)

Tablet Chewable, Oral:

Gluco To Go: 4 g [fat free, gluten free, sodium free; contains fd&c red #40(allura red ac)aluminum lake; raspberry flavor]

Generic: 4 g [DSC]

Generic Equivalent Available: US

May be product dependent

Pricing: US

Chewable (Gluco To Go Oral)

4 g (per each): $0.12

Gel (Gluco to Go 15 Oral)

40% (per gram): $0.11

Gel (Glutose 15 Oral)

40% (per gram): $0.11

Gel (Glutose 5 Oral)

40% (per gram): $0.21

Gel (Insta-Glucose Oral)

77.4% (per gram): $0.11

Solution (Dextrose Intravenous)

5% (per mL): $0.05 - $0.19

10% (per mL): $0.01 - $0.02

20% (per mL): $0.03

30% (per mL): $0.03

40% (per mL): $0.03

50% (per mL): $0.10 - $0.40

70% (per mL): $0.01

Solution (Glucose Nursette Oral)

5% (per mL): $0.03

Solution (Good Start 5% Glucose Water Oral)

5% (per mL): $0.02

Disclaimer: A representative AWP (Average Wholesale Price) price or price range is provided as reference price only. A range is provided when more than one manufacturer's AWP price is available and uses the low and high price reported by the manufacturers to determine the range. The pricing data should be used for benchmarking purposes only, and as such should not be used alone to set or adjudicate any prices for reimbursement or purchasing functions or considered to be an exact price for a single product and/or manufacturer. Medi-Span expressly disclaims all warranties of any kind or nature, whether express or implied, and assumes no liability with respect to accuracy of price or price range data published in its solutions. In no event shall Medi-Span be liable for special, indirect, incidental, or consequential damages arising from use of price or price range data. Pricing data is updated monthly.

Dosage Forms: Canada

Excipient information presented when available (limited, particularly for generics); consult specific product labeling. [DSC] = Discontinued product

Liquid, Oral:

Glucodex: 250 mg/mL (300 mL)

Solution, Intravenous:

Generic: 5% (10 mL, 25 mL, 50 mL, 100 mL, 150 mL, 250 mL, 500 mL, 1000 mL); 10% (250 mL, 500 mL, 1000 mL); 20% (500 mL, 1000 mL); 40% ([DSC]); 50% (50 mL, 500 mL, 1000 mL, 2000 mL); 70% (500 mL, 1000 mL, 2000 mL, 3000 mL)

Administration: Adult

Oral: Must be swallowed to be absorbed; buccal absorption has been shown to be minimal (Ref).

IV: Injectable is not for SUBQ or IM administration; concentrated dextrose solutions for peripheral venous administration must be diluted (maximum concentration: 12.5%); in emergency situations only, 25% and 50% dextrose have been used peripherally; for direct IV infusion, infuse at a maximum rate of 200 mg/kg over 1 minute; continuous infusion rates vary with tolerance and range from 4.5 to 15 mg/kg/minute. Refer to indication-specific infusion rates in dosing for detailed recommendations.

Dextrose 10% may be an irritant. Concentrated IV dextrose (>10%) may be an irritant or a vesicant. Higher concentration (higher osmolarity) is associated with a higher risk. Ensure proper needle or catheter placement prior to and during IV infusion. Avoid extravasation.

Extravasation management: If extravasation occurs, stop infusion immediately; leave needle/cannula in place temporarily but do NOT flush the line; gently aspirate extravasated solution, then remove needle/cannula; elevate extremity; apply dry warm compresses; initiate hyaluronidase antidote (Ref).

Hyaluronidase:

Dextrose 10% to <50%: Intradermal or SUBQ: Inject a total of hyaluronidase 1 mL (15 units/mL) as 5 separate 0.2 mL injections (using a tuberculin syringe) around the site of extravasation; if IV catheter remains in place, administer IV through infiltrated catheter; may repeat in 30 to 60 minutes if no resolution (Ref).

Dextrose 50%: SUBQ : Inject a total of hyaluronidase 1 mL (150 units/mL) as 5 separate 0.2 mL injections administered along the leading edge of erythema (Ref).

Administration: Pediatric

Oral: May be swallowed or administered via buccal or sublingual routes (Ref).

Buccal: Neonate: Dry mouth with gauze; massage gel into buccal mucosa (Ref).

Parenteral: For IV administration only, not SUBQ or IM. Maximum concentration for peripheral administration is 12.5% and for central administration is 25% (Ref); although generally not recommended, in emergency situations, IV bolus doses of dextrose 25% have been used peripherally in infants and children and dextrose 50% has been used peripherally in adolescents (Ref).

Neonates: Continuous infusion rates vary with tolerance and range from 4 to 14 mg/kg/minute (Ref); neonates with hyperinsulinemia may require up to 15 to 20 mg/kg/minute (Ref); a more rapid administration of 0.2 g/kg bolus of D10W over ≥1 minute for treatment of hypoglycemia has been described (Ref).

Dextrose 10% may be an irritant. Concentrated IV dextrose (>10%) may be an irritant or a vesicant; higher concentration (higher osmolarity) is associated with a higher risk. Ensure proper needle or catheter placement prior to and during IV infusion. Avoid extravasation. If extravasation occurs, stop infusion immediately; leave needle/cannula in place temporarily but do NOT flush the line; gently aspirate extravasated solution, then remove needle/cannula; elevate extremity; apply dry warm compresses; initiate hyaluronidase antidote (Ref).

Use: Labeled Indications

Oral:

Hypoglycemia: Treatment of hypoglycemia

Glucose tolerance test (Glutol): Oral glucose tolerance test for diagnosis of diabetes mellitus

Intravenous:

5% and 10% solutions: Fluid replacement/calories: Provision of calories and/or fluid replacement

25% (hypertonic) solution: Hypoglycemia: Treatment of acute symptomatic episodes of hypoglycemia in infants and children to restore depressed blood glucose levels

50% (hypertonic) solution: Hyperinsulinemia, insulin shock: Treatment of insulin-induced hypoglycemia (hyperinsulinemia or insulin shock)

≥10% solutions: Nutritional support: Infusion after admixture with other intravenous nutrients (eg, amino acids, fat emulsion) for nutritional support

Use: Off-Label: Adult

Calcium channel blocker or beta-blocker overdose/toxicity (adjunctive agent); Hyperkalemia, severe/emergent; Hypernatremia

Medication Safety Issues
Sound-alike/look-alike issues:

Glutose may be confused with Glutofac

High alert medication:

The Institute for Safe Medication Practices (ISMP) includes this medication (hypertonic solutions ≥20%) among its list of drugs which have a heightened risk of causing significant patient harm when used in error.

Other safety concerns:

Inappropriate use of low sodium or sodium-free intravenous fluids (eg D5W, hypotonic saline) in pediatric patients can lead to significant morbidity and mortality due to hyponatremia (ISMP 2009).

Metabolism/Transport Effects

None known.

Drug Interactions

There are no known significant interactions.

Pregnancy Considerations

Appropriate use of dextrose injection would not be expected to cause adverse developmental outcomes to the fetus when used during pregnancy. Maternal hyperglycemia or malnutrition may be associated with adverse pregnancy outcomes.

In patients with nausea and vomiting of pregnancy who cannot tolerate oral liquids for prolonged periods or who are clinically dehydrated, intravenous hydration that includes dextrose is recommended. Due to potential maternal complications, enteral therapy is preferred over parenteral if nutrition support is required. Parenteral nutrition (which may include dextrose) should be reserved for use in patients with severe nausea and vomiting not responsive to enteral therapy (ACOG 189 2018). Medications used for the treatment of cardiac arrest in pregnancy are the same as in the non-pregnant patient. Doses and indications should follow current Advanced Cardiovascular Life Support guidelines. Appropriate medications should not be withheld due to concerns of fetal teratogenicity (Jeejeebhoy [AHA] 2015).

Oral dextrose is used for the screening and diagnosis of gestational diabetes mellitus in pregnant patients not previously diagnosed with diabetes (ADA 2023).

Breastfeeding Considerations

Glucose is endogenous to breast milk (IOM 2005).

According to the manufacturer, the decision to breastfeed during therapy should consider the risk of infant exposure, the benefits of breastfeeding to the infant, and benefits of treatment to the mother.

Dietary Considerations

Some products may contain potassium and/or sodium.

Monitoring Parameters

Blood glucose, serum electrolytes, fluid status, caloric intake, acid-base balance, infusion site.

Calcium channel blocker or beta-blocker overdose/toxicity: Monitor blood glucose concentrations every 10 minutes at the initiation and titration of high-dose insulin therapy and adjunctive dextrose. Decrease frequency of monitoring to every 30 to 60 minutes once insulin dose is stable (Engebretsen 2011).

Reference Range

Classification of hypoglycemia (ADA 2023):

Level 1: 54 to 70 mg/dL; hypoglycemia alert value; initiate fast-acting carbohydrate (eg, glucose) treatment

Level 2: <54 mg/dL; threshold for neuroglycopenic symptoms; requires immediate action

Level 3: Hypoglycemia associated with a severe event characterized by altered mental and/or physical status requiring assistance

Glucose tolerance test (diagnostic criteria) (ADA 2023):

One step (75 g dose [fasting]):

Non-pregnant adults: Plasma glucose ≥200 mg/dL at 2 hours post-dose meets diagnostic criteria for diabetes; diagnosis requires two abnormal test results from the same sample or in two separate test samples (using the same or different tests) unless there is a clear clinical diagnosis.

Pregnant adults: Any of the following plasma glucose levels meet diagnostic criteria for gestational diabetes: Fasting: ≥92 mg/dL; 1 hour post-dose: ≥180 mg/dL; 2 hours post-dose: ≥153 mg/dL.

Two-step (first dose: 50 g [nonfasting]; second dose: 100 g [fasting]): Pregnant adults:

First step (50 g dose): If plasma glucose levels ≥130 mg/dL at 1 hour post-dose, proceed to 100 g oral glucose tolerance test. Note: Cutoffs of ≥135 or ≥140 mg/dL have also been recommended; increased sensitivity and decreased specificity have been associated with use of a lower cutoff.

Second step (100 g dose): 2 or more of the following plasma glucose levels meet diagnostic criteria for gestational diabetes: Fasting ≥95 mg/dL; 1 hour post-dose: ≥180 mg/dL; 2 hours post-dose: ≥155 mg/dL; 3 hours post-dose: ≥140 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 transient uptake of potassium by cells, especially in muscle tissue, lowering serum potassium.

Pharmacokinetics (Adult Data Unless Noted)

Onset of action: Treatment of hypoglycemia: Oral: 10 minutes

Maximum effect: Treatment of hyperkalemia: IV: 30 minutes

Absorption: Oral: Rapidly from the small intestine by an active mechanism; Buccal: negligible (Gunning 1978)

Metabolism: Metabolized to carbon dioxide and water

Time to peak, serum: Oral: 40 minutes

Brand Names: International
International Brand Names by Country
For country code abbreviations (show table)

  • (AE) United Arab Emirates: Dextrose;
  • (AR) Argentina: Soluc. dextrosa isotonica | Soluc. glucosada hipertonica | Solucion de dextrosa | Solucion de dextrosa norgreen | Solucion dextrosa jayor;
  • (AT) Austria: Glucose Baxter | Glucose Braun | Glucose Fresenius Kabi | Glucose mayrhofer | Traubenzucker fresenius kabi;
  • (AU) Australia: Dextrose | TRUEplus glucose;
  • (BD) Bangladesh: Acme's dextrose | Acme's dextrose ds | Dexaqua | Dexoride | Dextropac | Dextrose | Dextrose water | Libott | Libott s junior | Neosol | Nutridex;
  • (BE) Belgium: Gluc10% baxter | Glucose 10% baxter | Glucose 10% braun | Glucose 10% braun pharma | Glucose 15% clintec benelux | Glucose 20% braun | Glucose 20% braun pharma | Glucose 30% baxter | Glucose 30% braun | Glucose 30% braun pharma | Glucose 40% clintec benelux | Glucose 5% braun | Glucose 5% braun pharma | Glucose 50% baxter | Glucose 50% braun | Glucose 50% braun pharma | Glucose Baxter | Glucose sterop;
  • (BF) Burkina Faso: Glucose b braun | Glucose intravenous;
  • (BG) Bulgaria: Dextrosa | Dextrose | Glucose Biopharm;
  • (BR) Brazil: Baxter glicose | Farmace glicose 5% solucao isotonica | Glicofisiologica | Glicosado | Glicose | Glicose beker | Glicose halex istar | Glicose hipertonica | Glicose monoidratada | Jp glicose | Sol glic.fisiolog. | Sol glic.isotonico | Solucao de glicose | Solucao de glicose b. braun | Solucao de glicose hipertonica | Solucao de glicose isotonica | Soro glico cloreta | Soro glico fisiolo | Soro glicosado isotonico;
  • (CH) Switzerland: Glucose Amino | Glucose B. Braun | Glucose Baxter;
  • (CI) Côte d'Ivoire: Axadex | Axadex dns;
  • (CL) Chile: Glucosa;
  • (CO) Colombia: Dextrosa | Dextrosa agua | Dextrosa al | Dextrovit | Dx 5 | Glucoquick | Solucion Dx 10 | Solucion dx 5;
  • (CZ) Czech Republic: Ardeanutrisol g | Ardeanutrisol g 33 | Ardeanutrisol gsp | Dextrose | Glucosa | Glucose losung | Glucosum | Glucosum spofa | Infusio f 1/2 | Infusio glucosi | Viaflo Glucose;
  • (DE) Germany: Dextromed | Glucose demo | Glucose loesung | Glucose loesung 50 % deltamedica | Glucose loesung deltaselect | Glucoseloesung | Traubenzucker;
  • (DO) Dominican Republic: Dextrosa | Dextrosa en agua | Indodextro;
  • (EC) Ecuador: Dextrosa | Dextrosa en agua | Glucosa;
  • (EE) Estonia: Glikozes | Glucos | Glucosa | Glucose Braun | Glucose fresenius | Glucose groteks | Glucosi | Glucosteril | Glucosum | Glucosum physioneal | Natrosteril-3 | Solutio glucosi;
  • (EG) Egypt: Dextrose | Dextrose water;
  • (ES) Spain: Apir glucosado isotonico | Apiroflex glucosada | Dextrosa braun | Dextrosa fresenius | Dextrosa pharmacia | Flebobag glucosada grifols | Freeflex glucosa | Glucocemin | Glucosa baxter | Glucosa biomendi | Glucosa braun | Glucosa ife | Glucosa mein | Glucosa physan | Glucosa tecsolpar | Glucosada fresenius | Glucosada Grifols | Glucosado bieffe | Glucosado vitulia | Glucosmon | Glucosmon r50 | Meinvenil glucosa | Venofusin glucosa;
  • (ET) Ethiopia: 5d;
  • (FI) Finland: Glucos | Glucos b.braun | Glucos baxter | Glucosteril;
  • (FR) France: Glucose aguettant | Glucose b braun | Glucose Baxter | Glucose bieffe | Glucose bioluz | Glucose biosedra | Glucose cooper | Glucose elbiol | Glucose fandre | Glucose fresenius | Glucose lavoisier | Glucose macopharma | Glucose Renaudin | Hydros g5 | Hypostop;
  • (GB) United Kingdom: Braun glucose | Dextrogel | Dextrose | Easyflex n glucose | Glucogel | Glucose intravenous | Ims dextrose | Intravenous dextrose | Polyfusor dextrose | Trav dextrose;
  • (GR) Greece: Dextrose | Dextrose injection/bradex | Dextrose water;
  • (HK) Hong Kong: Dextrose;
  • (HR) Croatia: Glukoza | Glukoza braun;
  • (HU) Hungary: Dextrose | Glucosi | Glucosio Monico | Glucosum-pannonpharma | Glukoz | Glukoz bieffe | Glukoz teva | Invertosol 10 | Isodex | Szorbit;
  • (ID) Indonesia: Dextrose | Fima D5 | Glucosum | Infusan D10 | Infusan D5 | Ka-en 1b | Tridex Plain | Viaflex dextrose;
  • (IE) Ireland: Braun dextrose | Dextrose;
  • (IL) Israel: Dextrose;
  • (IN) India: Dextrose | Hydrofast-22 | Hydrofast-33 | Hydrofast-45 | Hypotab | Levodex-s | Premodex;
  • (IQ) Iraq: Dextrose;
  • (IT) Italy: Glucosio | Glucosio B. Braun;
  • (JO) Jordan: Dextrose;
  • (JP) Japan: Gluco b | Glucose afp | Glucose ajinomoto | Glucose amel | Glucose arax | Glucose boehringer | Glucose chemix | Glucose chugai | Glucose daiichi | Glucose hikari | Glucose isei | Glucose kobayashi | Glucose kyorin | Glucose kyosei | Glucose merck hoei | Glucose mohan | Glucose mp sawai | Glucose nichiiko | Glucose nipro | Glucose otsuka | Glucose sanko | Glucose sn | Glucose t | Glucose teisan | Glucose terumo | Glucose towa | Glunon fuso | Lodinon | Nahron;
  • (KE) Kenya: 5d | Axadex d5 | D10 | D5 | Dextrose | Infusol D5;
  • (KR) Korea, Republic of: Braun glucose | Daihan dextrose | Dextrose | Dextrose bax | Dextrose injection 20% huons | Dextrose jeil | Huons glucose | Inno.n 10% dextrose | Inno.n 20% dextrose | Inno.n 5% dextrose | Inno.n 50% dextrose | Jw 10% dextrose | Jw 15% dextrose | Jw 20% glucose | Jw 30% glucose | Jw 5% glucose | Jw 70% dextrose | Normodex | One four | One three | One two | Uk dextrose;
  • (LB) Lebanon: Dextrose | Glucose Renaudin | Serum dextrose;
  • (LT) Lithuania: Dextrose | Glucose Baxter | Glucosi | Glucosum;
  • (LU) Luxembourg: Glucosteril;
  • (LV) Latvia: Dextrose | Glucosum;
  • (MA) Morocco: Glucose laprophan;
  • (MX) Mexico: Dc6 claire | Delmed six | Dex4 | Dextrabbott | Dextralpha | Dextrosa | Dextrosa al | Kabidecs | Solucion dextrosa baxter | Solucion dextrosa pisa | Solucion dx 5 pisa | Solucion dx-cs;
  • (MY) Malaysia: Dextrose | Infusol D10 | Infusol D20 | Infusol D5 | Infusol D50;
  • (NG) Nigeria: 5% dextrose infusion | Bioflex dextrose | Dextrose | Drugfield Dextrose | Juhel dextrose | Unidex;
  • (NL) Netherlands: Glucosum;
  • (NO) Norway: Glucos | Glucos baxter viaflo | Glucose Fresenius Kabi | Glucotabs | Glukos Fresenius kabi | Glukose;
  • (NZ) New Zealand: Bio organics glycemix glucose rapid | Biomed dextrose | Biomed glucose | Dextrose;
  • (PE) Peru: Dextro lusa | Dextrosa | Dextrosa agua | Soludex;
  • (PH) Philippines: Dextrose | Endure Medical Dextrose in Water;
  • (PK) Pakistan: Aquasol | Aquasol s | Batalasol | Dexsol | Dextrose water | Immuasol | Immunasol | Istrose | Lifesol s | Lifesol water | Macsol | Medisol | Neustore 10 | Neustore 5 | Paksol dextrose | Pladex | Revasol | Searle 10% | Searle 5% | Solvein ds | Solvein water | Steriflex dw | Zeesol;
  • (PL) Poland: Glucosteril | Glucosum;
  • (PR) Puerto Rico: Glutose;
  • (PT) Portugal: Glucosada Grifols | Glucosado | Glucosado Braun | Glucose Basi | Glucose Braun | Glucose fresenius | Glucose Labesfal | Glucose paracelsia | Glucose Viaflo | Glucosteril | Soro Glucosado | Soro Glucosado B.Braun | Soro Glucosado Isotonico | Viaflex Glucose | Viaflo Glucose;
  • (PY) Paraguay: Dextrosa 5% bergamo | Dextrosa 5% prosalud | Dextrosa demotek | Glucosa 10 % vioser | Glucosa 5 % vioser | Glucosa 5% imh | Glucosa 5% medicine | Glucosa 5% sanderson | Glucosa hipertonica sanderson | Glucosa sanderson | Solucion dextrosa al baxter | Solucion dextrosa baxter | Solucion dextrosa hipertonica | Solucion dextrosa index | Solucion glucofisiologica diproan | Solucion glucosada hipertonica catedral | Solucion hipertonica de glucosa b braun | Solucion isotonica de dextrosa roux ocefa | Solucion isotonica de glucosa | Suero glucosado hipertonico fusa | Suero glucosado isotonico fusa | Suero glucosado isotonico fusa np;
  • (QA) Qatar: Ansyr II | Fluidex | Insta-Glucose | Microdot | Rapilose | Transcend;
  • (RO) Romania: Dextrose vioser | Glucose b braun | Glucosteril;
  • (RU) Russian Federation: Dextrose | Glucose bufus | Glucose solopharm | Glucose vial | Glucosteril | Lycadex PF dextrose monohydrate;
  • (SA) Saudi Arabia: Dextrose;
  • (SE) Sweden: Glucos b.braun | Glucos baxter | Glucos baxter viaflo | Glucos fresenius kabi | Glukos Fresenius kabi;
  • (SG) Singapore: Dextrose | Gluco 4;
  • (SI) Slovenia: Glucosi | Glucosum | Glukosa | Glukoza | Glukoza Baxter | Glukoza Pliva;
  • (SK) Slovakia: Dextrose | Glucose B P Bieffe | Glucosum | Infusio glucosi;
  • (SL) Sierra Leone: 5d | Dextrose;
  • (TH) Thailand: Dextrose | Dextrosol | Umeda glucose;
  • (TN) Tunisia: Glucose Fresenius Kabi | Serum glucose;
  • (TR) Turkey: Dekstroz | Dextrose | Dextrose mediflex | Glucotabs | Kanfleks dekstroz | Lafleks dekstroz | Neofleks dekstroz | Pro fleks dekstroz | Turkfleks dekstroz;
  • (TW) Taiwan: Bluton | Deose | Dextrose | Ditrose | Electrose | Fulin | Gitose | Suntose | Vitagen;
  • (UA) Ukraine: Dextrose | Gastrovitol | Glucose Cytoclin;
  • (UG) Uganda: 5d | D10 | D5 | D50;
  • (UY) Uruguay: Dextrosa | Suero glucosado | Suero Glucosado Hipertonico | Suero Glucosado Isotonico;
  • (VE) Venezuela, Bolivarian Republic of: Dextrosa | Dextrosa agua;
  • (ZA) South Africa: Adco-dextrose | Autosterile glucos | Dex4 | Dextrose | Dextrose forrester | Dextrose in water | Glucose b braun | Sabax glucose;
  • (ZM) Zambia: Dextrose;
  • (ZW) Zimbabwe: Dextrose | Dextrose fresenius
  1. Abraham MB, Karges B, Dovc K, et al. ISPAD Clinical Practice Consensus Guidelines 2022: Assessment and management of hypoglycemia in children and adolescents with diabetes. Pediatr Diabetes. 2022;23(8):1322-1340. doi:10.1111/pedi.13443 [PubMed 36537534]
  2. Adamkin DH and Committee on Fetus and Newborn. Postnatal Glucose Homeostasis in Late-Preterm and Term Infants. Pediatrics. 2011;127(3):575-579. [PubMed 21357346]
  3. Adamkin DH. Neonatal hypoglycemia. Semin Fetal Neonatal Med. 2017;22(1):36-41. doi:10.1016/j.siny.2016.08.007 [PubMed 27605513]
  4. Adrogué HJ, Madias NE. Hypernatremia. N Engl J Med. 2000;342(20):1493-1499. doi:10.1056/NEJM200005183422006 [PubMed 10816188]
  5. Allon M, Copkney C. Albuterol and insulin for treatment of hyperkalemia in hemodialysis patients. Kidney Int. 1990;38(5):869-872. doi:10.1038/ki.1990.284 [PubMed 2266671]
  6. Aluminum in large and small volume parenterals used in total parenteral nutrition. Fed Regist. 2002;67(244):77792-77793. To be codified at 21 CFR §201.323.
  7. American College of Obstetricians and Gynecologists (ACOG) Committee on Practice Bulletins—Obstetrics. ACOG Practice Bulletin No. 189: Nausea and Vomiting of Pregnancy. Obstet Gynecol. 2018;131(1):e15-e30. doi:10.1097/AOG.0000000000002456 [PubMed 29266076]
  8. American Diabetes Association (ADA). Standards of care in diabetes–2023. Diabetes Care. 2023;46(suppl 1):S1-S291. https://diabetesjournals.org/care/issue/46/Supplement_1. Accessed May 8, 2023.
  9. American Society for Parenteral and Enteral Nutrition (ASPEN). Appropriate dosing for parenteral nutrition: ASPEN recommendations. https://www.nutritioncare.org/uploadedFiles/Documents/Guidelines_and_Clinical_Resources/PN%20Dosing%201-Sheet-Nov%202020-FINAL.pdf. Updated November 17, 2020. Accessed May 8, 2023.
  10. ASPEN Board of Directors and the Clinical Guidelines Task Force. Guidelines for the Use of Parenteral and Enteral Nutrition in Adult and Pediatric Patients. JPEN J Parenter Enteral Nutr. 2002;26(1)(suppl):1-138.
  11. Barrero-Castillero A, Simmons R. Hypoglycemia and hyperglycemia. In: Eichenwald EC, Hansen AR, Martin CR, Stark AR, eds. Cloherty and Stark's Manual of Neonatal Care. 9th ed. Lippincott Williams & Wilkins; 2022: chap. 24.
  12. Barrueto F. Calcium channel blocker poisoning. Post TW, ed. UpToDate. Waltham, MA: UpToDate Inc. http://www.uptodate.com. Accessed August 30, 2019.
  13. Chiang JL, Maahs DM, Garvey KC, et al. Type 1 diabetes in children and adolescents: a position statement by the American Diabetes Association. Diabetes Care. 2018;41(9):2026-2044. [PubMed 30093549]
  14. Clase CM, Carrero JJ, Ellison DH, et al; Conference Participants. Potassium homeostasis and management of dyskalemia in kidney diseases: conclusions from a Kidney Disease: Improving Global Outcomes (KDIGO) Controversies Conference. Kidney Int. 2020;97(1):42-61. doi:10.1016/j.kint.2019.09.018 [PubMed 31706619]
  15. Cole JB, Arens AM, Laes JR, Klein LR, Bangh SA, Olives TD. High dose insulin for beta-blocker and calcium channel-blocker poisoning. Am J Emerg Med. 2018;36(10):1817-1824. doi:10.1016/j.ajem.2018.02.004 [PubMed 29452919]
  16. Corkins MR, Balint J, Bobo E, Plogsted S, Yaworski, JA, eds. The A.S.P.E.N. Pediatric Nutrition Support Core Curriculum. 2nd ed. American Society for Parenteral and Enteral Nutrition; 2015.
  17. Daly K, Farrington E. Hypokalemia and hyperkalemia in infants and children: pathophysiology and treatment. J Pediatr Health Care. 2013;27(6):486-498. doi:10.1016/j.pedhc.2013.08.003 [PubMed 24139581]
  18. De Buck E, Borra V, Carlson JN, Zideman DA, Singletary EM, Djärv T. First aid glucose administration routes for symptomatic hypoglycaemia (review). Cochrane Database Syst Rev. 2019;4(4):CD013283. doi:10.1002/14651858.CD013283.pub2 [PubMed 30973639]
  19. Desimone ME, Weinstock RS. Hypoglycemia. In: Feingold KR, Anawalt B, Boyce A, et al, eds. Endotext. MDText.com Inc; 2000. https://www.ncbi.nlm.nih.gov/books/NBK279137. [PubMed 25905360]
  20. Dex4 (dextrose) [prescribing information]. Allegan MI: Perrigo; 2015.
  21. Dex4 liquid (dextrose) [prescribing information]. Allegan MI: Perrigo; 2015.
  22. Dextrose 5% injection [prescribing information]. Deerfield, IL: Baxter Healthcare Corporation; August 2019.
  23. Dextrose 5% injection [prescribing information]. Deerfield, IL: Baxter Healthcare Corporation; January 2021.
  24. Dextrose 5% injection [prescribing information]. Lake Zurich, IL: Fresenius Kabi; September 2021.
  25. Dextrose 5% and 10% injection [prescribing information]. Deerfield, IL: Baxter Healthcare Corporation; August 2019.
  26. Dextrose 10% injection [prescribing information]. Franklin Lakes, NJ: Becton, Dickinson and Company; February 2022.
  27. Dextrose 10% injection [prescribing information]. Lake Forest, IL: Hospira Inc; June 2010.
  28. Dextrose 20%, 30%, 40%, 50%, and 70% injection [prescribing information]. Lake Forest, IL: Hospira Inc; May 2018.
  29. Dextrose 25% injection [prescribing information]. Lake Forest, IL: Hospira Inc; February 2018.
  30. Dextrose 25% injection [prescribing information]. Lake Forest, IL: Hospira Inc; August 2020.
  31. Dextrose 50% injection [prescribing information]. Lake Forest, IL: Hospira Inc; September 2019.
  32. Dextrose 50% injection [prescribing information]. South El Monte, CA: International Medication Systems Ltd; January 2021.
  33. Dextrose 70% injection [prescribing information]. Deerfield, IL: Baxter Healthcare Corporation; July 2019.
  34. Dextrose injection in Viaflex plastic container [prescribing information]. Deerfield, IL: Baxter Healthcare Corporation; February 2018.
  35. Edwards T, Liu G, Battin M, et al. Oral dextrose gel for the treatment of hypoglycaemia in newborn infants. Cochrane Database Syst Rev. 2022;3(3):CD011027. doi:10.1002/14651858.CD011027.pub3 [PubMed 35302645]
  36. Elliott MJ, Ronksley PE, Clase CM, Ahmed SB, Hemmelgarn BR. Management of patients with acute hyperkalemia. CMAJ. 2010;182(15):1631-1635. [PubMed 20855477]
  37. Engebretsen KM, Kaczmarek KM, Morgan J, Holger JS. High-dose insulin therapy in beta-blocker and calcium channel-blocker poisoning. Clin Toxicol (Phila). 2011;49(4):277-283. doi:10.3109/15563650.2011.582471 [PubMed 21563902]
  38. Garg M, Devaskar SU. Disorders of carbohydrate metabolism in the neonate. In: Martin RJ, Fanaroff AA, Walsh MC, eds. Fanaroff and Martin's Neonatal-Perinatal Medicine. 11th ed. Elsevier; 2020: chap. 86.
  39. Glucose tablets (dextrose) [prescribing information]. Livonia, MI: Rugby Laboratories; May 2020.
  40. Glutol (dextrose) [prescribing information]. Minneapolis, MN: Perrigo; February 2013.
  41. Glutose 15 (dextrose) [prescribing information]. Minneapolis, MN: Padagis; February 2022.
  42. Gunning RR, Garber AJ. Bioactivity of instant glucose. Failure of absorption through oral mucosa. JAMA. 1978;240(15):1611-1612. [PubMed 691147]
  43. Hadaway L. Infiltration and extravasation. Am J Nurs. 2007;107(8):64-72. [PubMed 17667395]
  44. Harding JE, Hegarty JE, Crowther CA, et al. Evaluation of oral dextrose gel for prevention of neonatal hypoglycemia (hPOD): a multicenter, double-blind randomized controlled trial. PLoS Med. 2021;18(1):e1003411. doi:10.1371/journal.pmed.1003411 [PubMed 33507929]
  45. Harris DL, Alsweiler JM, Ansell JM, et al. Outcome at 2 years after dextrose gel treatment for neonatal hypoglycemia: follow-up of a randomized trial. J Pediatr. 2016;170:54-9.e92. doi:10.1016/j.jpeds.2015.10.066 [PubMed 26613985]
  46. Harris DL, Weston PJ, Signal M, Chase JG, Harding JE. Dextrose gel for neonatal hypoglycaemia (the Sugar Babies Study): a randomised, double-blind, placebo-controlled trial. Lancet. 2013;382(9910):2077-2083. [PubMed 24075361]
  47. Infant Dextrose 25% (dextrose) [prescribing information]. Lake Forest, IL: Hospira Inc; February 2018.
  48. Institute for Safe Medication Practice. Plain D5W or Hypotonic Saline Solutions Post-Op Could Result in Acute Hyponatremia and Death in Healthy Children. ISMP Medication Safety Alert. August 13, 2009. http://www.ismp.org/Newsletters/acutecare/articles/20090813.asp
  49. Institute of Medicine (IOM). Dietary reference intakes for energy, carbohydrate, fiber, fat, fatty acids, cholesterol, protein, and amino acids (macronutrients). Washington, D.C.: The National Academies Press; 2005. https://www.nap.edu/catalog/10490/dietary-reference-intakes-for-energy-carbohydrate-fiber-fat-fatty-acids-cholesterol-protein-and-amino-acids.
  50. Jacobi J, Bircher N, Krinsley J, et al. Guidelines for the Use of an Insulin Infusion for the Management of Hyperglycemia in Critically Ill Patients. Crit Care Med. 2012;40(12):3251-3276. [PubMed 23164767]
  51. Jeejeebhoy FM, Zelop CM, Lipman S, et al; American Heart Association Emergency Cardiovascular Care Committee, Council on Cardiopulmonary, Critical Care, Perioperative and Resuscitation, Council on Cardiovascular Diseases in the Young, and Council on Clinical Cardiology. Cardiac Arrest in Pregnancy: A Scientific Statement From the American Heart Association. Circulation. 2015;132(18):1747-1773. doi:10.1161/CIR.0000000000000300 [PubMed 26443610]
  52. Khilnani P. Electrolyte abnormalities in critically ill children. Crit Care Med. 1992;20(2):241-250. [PubMed 1737458]
  53. Kleinman ME, Chameides L, Schexnayder SM, et al. Part 14: Pediatric Advanced Life Support: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2010;122(18)(suppl 3):876-908. [PubMed 20956230]
  54. Kraft MD, Btaiche IF, Sacks GS, Kudsk KA. Treatment of electrolyte disorders in adult patients in the intensive care unit. Am J Health Syst Pharm. 2005;62(16):1663-1682. doi:10.2146/ajhp040300 [PubMed 16085929]
  55. Krenz JR, Kaakeh Y. An Overview of hyperinsulinemic-euglycemic therapy in calcium channel blocker and β-blocker overdose. Pharmacotherapy. 2018;38(11):1130-1142. doi:10.1002/phar.2177 [PubMed 30141827]
  56. Kusumoto FM, Schoenfeld MH, Barrett C, et al. 2018 ACC/AHA/HRS guideline on the evaluation and management of patients with bradycardia and cardiac conduction delay: a report of the American College of Cardiology/American Heart Association Task Force on clinical practice guidelines and the Heart Rhythm Society. J Am Coll Cardiol. 2019;74(7):e51-e156. doi:10.1016/j.jacc.2018.10.044 [PubMed 30412709]
  57. LaFranchi S. Hypoglycemia of infancy and childhood. Pediatr Clin North Am. 1987;34(4):961-982. [PubMed 3302901]
  58. Le A, Patel S. Extravasation of noncytotoxic drugs: a review of the literature. Ann Pharmacother. 2014;48(7):870-886. [PubMed 24714850]
  59. Lehnhardt A, Kemper MJ. Pathogenesis, diagnosis and management of hyperkalemia. Pediatr Nephrol. 2011;26(3):377-384. [PubMed 21181208]
  60. Libman I, Haynes A, Lyons S, et al. ISPAD Clinical Practice Consensus Guidelines 2022: Definition, epidemiology, and classification of diabetes in children and adolescents. Pediatr Diabetes. 2022;23(8):1160-1174. doi:10.1111/pedi.13454 [PubMed 36537527]
  61. Lindner G, Funk GC. Hypernatremia in critically ill patients. J Crit Care. 2013;28(2):216.e11-e20. doi:10.1016/j.jcrc.2012.05.001 [PubMed 22762930]
  62. Lilien LD, Pildes RS, Srinivasan G, Voora S, Yeh TF. Treatment of neonatal hypoglycemia with minibolus and intravenous glucose infusion. J Pediatr. 1980;97(2):295-298. [PubMed 7400902]
  63. Lynch R, Wood EG, Neumayr TM. Fluid and electrolyte issues in pediatric critical illness. In: Fuhrman B, Zimmerman J, eds. Pediatric Critical Care. 5th ed. Elsevier; 2016:chap. 73.
  64. MacCara ME. Extravasation - A Hazard of Intravenous Therapy. Drug Intell Clin Pharm. 1983;17(10):713. [PubMed 6628223]
  65. Masilamani K, van der Voort J. The management of acute hyperkalaemia in neonates and children. Arch Dis Child. 2012;97(4):376-380. [PubMed 21920871]
  66. McMahon MM, Rizza RA. Nutrition support in hospitalized patients with diabetes mellitus. Mayo Clin Proc. 1996;71(6):587-594. doi:10.4065/71.6.587 [PubMed 8642888]
  67. Mirtallo J, Canada T, Johnson D, et al. Safe Practices for Parenteral Nutrition. JPEN J Parenter Enteral Nutr. 2004;28(6):S39-S70. [PubMed 15568296]
  68. Mount DB. Treatment and prevention of hyperkalemia in adults. Post TW, ed. UpToDate. Waltham, MA: UpToDate Inc. http://www.uptodate.com. Accessed November 9, 2021.
  69. Moussavi K, Fitter S, Gabrielson SW, Koyfman A, Long B. Management of hyperkalemia with insulin and glucose: pearls for the emergency clinician. J Emerg Med. 2019;57(1):36-42. doi:10.1016/j.jemermed.2019.03.043 [PubMed 31084947]
  70. Narvey MR, Marks SD. The screening and management of newborns at risk for low blood glucose. Paediatr Child Health. 2019;24(8):536-554. doi:10.1093/pch/pxz134 [PubMed 31844395]
  71. Panchal AR, Bartos JA, Cabañas JG, et al; Adult basic and advanced life support writing group. Part 3: adult basic and advanced life support: 2020 American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation. 2020;142(16)(suppl 2):S366-S468. doi:10.1161/CIR.0000000000000916 [PubMed 33081529]
  72. Polin RA, Adamkin DH. Glucose, calcium, and magnesium. In: Fanaroff AA, Fanaroff JM, eds. Klaus and Fanaroff's Care of the High-Risk Neonate. 7th ed. Elsevier; 2020: chap. 11.
  73. Qian Q. Hypernatremia. Clin J Am Soc Nephrol. 2019;14(3):432-434. doi:10.2215/CJN.12141018 [PubMed 30728169]
  74. Rajajee V. Management of acute moderate and severe traumatic brain injury. Post TW, ed. UpToDate. Waltham, MA: UpToDate Inc. http://www.uptodate.com. Accessed August 30, 2021.
  75. Shenoi RP, Timm N; Committee on Drugs; Committee on Pediatric Emergency Medicine. Drugs used to treat pediatric emergencies. Pediatrics. 2020;145(1):e20193450. doi:10.1542/peds.2019-3450 [PubMed 31871244]
  76. Stefanos SS, Kiser TH, MacLaren R, Mueller SW, Reynolds PM. Management of noncytotoxic extravasation injuries: a focused update on medications, treatment strategies, and peripheral administration of vasopressors and hypertonic saline. Pharmacotherapy. 2023;43(4):321-337. doi:10.1002/phar.2794 [PubMed 36938775]
  77. Sterns RH, Hoorn EJ. Treatment of hypernatremia in adults. Post TW, ed. UpToDate. Waltham, MA: UpToDate Inc. http://www.uptodate.com. Accessed August 30, 2021.
  78. Sweet CB, Grayson S, Polak M. Management strategies for neonatal hypoglycemia. J Pediatr Pharmacol Ther. 2013;18(3):199-208. doi:10.5863/1551-6776-18.3.199 [PubMed 24052783]
  79. Thornton PS, Stanley CA, De Leon DD, et al. Recommendations from the Pediatric Endocrine Society for evaluation and management of persistent hypoglycemia in neonates, infants, and children. J Pediatr. 2015;167(2):238-245. doi:10.1016/j.jpeds.2015.03.057 [PubMed 25957977]
  80. Vanden Hoek TL, Morrison LJ, Shuster M, et al. Part 12: cardiac arrest in special situations: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care [published corrections appear in Circulation. 2011;123(6):e239 and Circulation. 2011;124(15):e405]. Circulation. 2010;122(18)(suppl 3):s829-s861. [PubMed 20956228]
  81. Whitesel E. Fluid and electrolyte management. In: Eichenwald EC, Hansen AR, Martin CR, Stark AR, eds. Cloherty and Stark's Manual of Neonatal Care. 9th ed. Lippincott Williams & Wilkins; 2022: chap. 23.
  82. Wiegand R, Brown J. Hyaluronidase for the management of dextrose extravasation. Am J Emerg Med. 2010;28(2):257. [PubMed 20159411]
  83. Wilkins B, Hazell W. Disorders of fluids, electrolytes and acid-base. In: Cameron P, Jelinek G, Everitt I, Browne G, Raftos J, eds. Textbook of Paediatric Emergency Medicine. 2nd ed. Churchill Livingstone; 2011:chap. 10.5.
  84. Zenk KE. Management of intravenous extravasations. Infusion. 1981;5(4):77-79.
Topic 8711 Version 542.0

آیا می خواهید مدیلیب را به صفحه اصلی خود اضافه کنید؟