dextrose
Glucose (carbohydrate)· Brands: Glucosteril, GlucoplexIVPO
Mechanism of action
Dextrose is a monosaccharide that rapidly elevates blood glucose by direct absorption into the bloodstream. It is metabolised via glycolysis to pyruvate, which enters the Krebs cycle, producing ATP. This provides an immediate source of energy and, in hypoglycaemia, restores normal glucose levels essential for brain function.
Pharmacokinetics
Dextrose is administered intravenously or orally. After IV administration, it is immediately available in the circulation. It distributes into extracellular fluid and is taken up into cells via GLUT transporters, with insulin promoting uptake. It is metabolised by glycolysis and oxidative phosphorylation to carbon dioxide and water. The half-life is short, and excess glucose is excreted in urine if hyperglycaemia occurs.
Indications & dosing
Hypoglycaemia (severe)
Administer as 50% dextrose solution; may be repeated as needed.
- adult · IV: 10–25 g Once · Administer as 50% dextrose solution; may be repeated as needed.
Hypoglycaemia (children)
Use 10% dextrose solution; monitor blood glucose.
- pediatric · IV: 0.2–0.5 g/kg Once · Use 10% dextrose solution; monitor blood glucose.
Hyperkalaemia (adjunct to insulin)
Give with insulin (e.g. 10 units) to shift potassium intracellularly.
- adult · IV: 25 g Once · Give with insulin (e.g. 10 units) to shift potassium intracellularly.
Oral glucose tolerance test (OGTT)
For diagnosis of diabetes mellitus; measure blood glucose at intervals.
- adult · PO: 75 g Once · For diagnosis of diabetes mellitus; measure blood glucose at intervals.
Contraindications & precautions
- Severe hyperglycaemia · Dextrose may exacerbate hyperglycaemia and cause hyperosmolar complications.
- Diabetic ketoacidosis without concurrent insulin therapy · Dextrose should only be used in DKA alongside insulin.
- Known hypersensitivity to dextrose or corn products · Rare, but can cause allergic reactions.
- Severe dehydration when using hypertonic solutions · Hypertonic dextrose may worsen dehydration due to osmotic diuresis.
- Intracranial or intraspinal haemorrhage when using hypertonic solutions · Hypertonic dextrose may increase intracranial pressure.
- Monitor blood glucose regularly during infusion, especially in patients with diabetes or at risk of hyperglycaemia.
- Administer hypertonic dextrose solutions slowly and via a large vein to minimise venous irritation.
- Use caution in patients with cardiac, renal, or pulmonary disease due to risk of fluid overload.
- In neonates, monitor for rebound hypoglycaemia after rapid administration of glucose.
- Adjust insulin therapy in diabetic patients when dextrose is given concurrently.
Adverse effects
- Hyperglycaemiaserious
- Osmotic diuresisserious
- Fluid overloadserious
- Phlebitis at injection site
- Extravasation causing tissue necrosisserious
- Rebound hypoglycaemia (especially in neonates)serious
Monitoring, pregnancy & toxicity
- Serum glucose · Before and during infusion
- Serum potassium · During prolonged infusion
- Fluid balance · In patients at risk of fluid overload
- Serum sodium · When large volumes are administered
- Pregnancy: Safe to use for the treatment of hypoglycaemia in pregnancy. Dextrose is a normal constituent of blood, and adequate glucose control is essential for maternal and fetal wellbeing.
- Toxicity: Hyperglycaemia · Stop infusion, monitor blood glucose, administer insulin if symptomatic.
- Toxicity: Fluid overload · Stop infusion, assess fluid balance, use loop diuretics if needed.
- Toxicity: Hyponatraemia · Stop infusion, restrict free water, monitor serum sodium.
- Toxicity: Local phlebitis · Change infusion site, apply warm compresses.
Clinical notes
Dextrose is used to treat hypoglycaemia, provide calories in parenteral nutrition, and act as a carrier for other drugs. Hypertonic solutions can cause phlebitis; hence, they are given via a central line or diluted. Blood glucose should be monitored, especially in diabetic patients. Extravasation can cause tissue necrosis.
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BNF; local formulary