Dextrose 25% w/v is a sterile, hypertonic solution of dextrose monohydrate in water for injection, providing 25 grams of dextrose per 100 mL. It is a rapid source of carbohydrate calories and fluid. In clinical practice, it is primarily used for the rapid correction of hypoglycemia, as a source of calories in total parenteral nutrition (TPN), and for the management of hyperkalemia and cerebral edema when used in conjunction with insulin. Its hypertonic nature (approximately 1262 mOsm/L) mandates administration via a central venous catheter to avoid severe phlebitis and sclerosis of peripheral veins.
Adult: Highly individualized. For hypoglycemia: 25-50 mL (6.25-12.5g dextrose) IV push, followed by infusion guided by glucose monitoring. For TPN: As part of a calculated daily caloric requirement, typically infused over 12-24 hours. For hyperkalemia: 25-50g (100-200 mL) with 10-20 units of regular insulin IV over 15-60 minutes.
Note: STRICTLY FOR INTRAVENOUS USE ONLY. MUST be administered via a large-bore central venous catheter. Check for extravasation constantly. Do not administer simultaneously with blood through the same line (causes hemolysis). The solution is hypertonic and may be mixed with amino acids, lipids, and other TPN components. Infusion rate must be controlled by an infusion pump. Patient must be monitored for signs of infection, thrombosis, and metabolic complications.
Dextrose provides a readily metabolizable source of carbohydrate calories and water. It corrects hypoglycemia by directly increasing plasma glucose concentration. Its hypertonic nature creates an osmotic gradient, drawing fluid from the interstitial and intracellular compartments into the intravascular space, which is useful in managing cerebral edema (with insulin) and can transiently expand plasma volume. When combined with insulin for hyperkalemia, it promotes intracellular shift of potassium.
Pregnancy: Category C (US FDA). Dextrose crosses the placenta. Use is acceptable for treatment of maternal hypoglycemia or as part of TPN when clearly needed. Fetal hyperinsulinemia and subsequent neonatal hypoglycemia are risks with prolonged maternal hyperglycemia.
Driving: Not directly applicable to IV therapy. However, patients receiving dextrose for hypoglycemia should not drive until fully recovered and glucose is stable.
| Insulin | Additive hypoglycemic effect; used therapeutically for hyperkalemia. Risk of severe hypoglycemia if not coordinated. | Major |
| Corticosteroids (e.g., Dexamethasone, Prednisolone) | May antagonize the glucose-lowering effect, leading to hyperglycemia. | Moderate |
| Thiazide and Loop Diuretics (e.g., Furosemide) | May impair glucose tolerance, potentiating hyperglycemia. | Moderate |
| Beta-blockers (e.g., Propranolol) | May mask tachycardia symptoms of hypoglycemia and impair glycogenolysis. | Moderate |
| Phenytoin | May be incompatible in same IV line; can precipitate. Phenytoin can also cause hyperglycemia. | Moderate |
Same composition (Dextrose (25% w/v)), different brands: