1. Clinical Overview
Dextrose 10% w/v is a sterile, non-pyrogenic, hypertonic solution of dextrose monohydrate in water for injection. It provides 10 grams of dextrose monohydrate per 100 mL, equivalent to 5.5 grams of dextrose anhydrous per 100 mL, delivering approximately 3.4 kcal per gram of dextrose. It is a source of calories and fluid, used for hydration and as a source of carbohydrate in patients unable to maintain adequate oral intake. In the Indian context, it is a fundamental intravenous fluid used across all levels of healthcare, from primary health centers to tertiary care hospitals.
| Onset | Duration | Bioavailability |
|---|---|---|
| Immediate upon intravenous administration. | Duration is dependent on the rate of infusion and metabolic demand; dextrose is rapidly metabolized, with effects lasting for the duration of the infusion and shortly thereafter. | 100% when administered intravenously. |
2. Mechanism of Action
Dextrose (D-glucose) is a fundamental monosaccharide that serves as the primary source of energy for cellular metabolism. When administered intravenously, it provides readily available carbohydrate calories. It is metabolized to produce adenosine triphosphate (ATP) via glycolysis, the Krebs cycle, and oxidative phosphorylation. The 10% w/v solution is hypertonic and exerts an osmotic effect, drawing fluid from the intracellular compartment into the extracellular space, thereby expanding plasma volume.
3. Indications & Uses
- Source of calories and fluid for patients unable to maintain adequate oral intake.
- Fluid replacement and caloric supplementation in dehydration.
- As a vehicle for the administration of compatible IV medications.
- Management of hypoglycemia (when more concentrated solutions are not immediately available or for maintenance after correction with 25%/50% dextrose).
4. Dosage & Administration
Adult Dosage: Dosage is highly individualized based on fluid requirements, caloric needs, and clinical condition. Typical range: 1 to 3 liters per 24 hours. Infusion rate should not exceed 5 mg/kg/min (approx. 500 mL/hr for a 70 kg adult) to avoid hyperglycemia and glycosuria. For caloric support: 2-3 L/day can provide 680-1020 kcal.
Administration: For intravenous use only. Must be administered using sterile technique. Use a large vein to minimize risk of venous irritation and thrombophlebitis. Use a dedicated IV line or Y-site connection for drug admixtures. Check for clarity and absence of particulate matter before use. Do not administer simultaneously with blood through the same infusion set due to risk of pseudoagglutination. Infusion rate must be controlled using an infusion pump, especially in pediatric, geriatric, and critical care patients.
5. Side Effects
Common side effects may include:
- Hyperglycemia (especially with rapid infusion).
- Venous irritation or thrombophlebitis at the injection site.
- Fluid overload (manifested as peripheral edema, pulmonary edema).
6. Drug Interactions
| Drug | Effect | Severity |
|---|---|---|
| Insulin and Oral Hypoglycemic Agents | Dextrose infusion will raise blood glucose, antagonizing the effect of hypoglycemic agents. Insulin requirements may increase. | Major |
| Corticosteroids (e.g., Dexamethasone, Prednisolone) | Can cause significant hyperglycemia by increasing insulin resistance and gluconeogenesis. | Major |
| Catecholamines (e.g., Adrenaline, Noradrenaline) | Increase blood glucose levels by promoting glycogenolysis and gluconeogenesis. | Moderate |
| Potassium-Sparing Diuretics (e.g., Spironolactone) | Risk of hyperkalemia when dextrose solution is used with potassium supplements, as dextrose can initially cause hypokalemia. | Moderate |
| Phenytoin | Loss of seizure control if dextrose solution is used as a diluent for phenytoin (causes precipitation). Use only 0.9% Sodium Chloride. | Major |
| Blood Products | Physical incompatibility - can cause hemolysis or pseudoagglutination. Do not administer through the same line. | Major |
7. Patient Counselling
- Do inform the doctor/nurse of any burning or pain at the IV site.
- Do report any sudden shortness of breath, chest pain, or swelling in the limbs.
- Do inform if you have diabetes or a history of kidney/heart problems.
- Don't attempt to adjust the speed of the infusion drip.
- Don't pull on the IV line.
8. Toxicology & Storage
Overdose: Symptoms are primarily due to fluid overload and hyperglycemia: Pulmonary edema, dyspnea, rales, jugular venous distension, peripheral edema, severe hyperglycemia, glycosuria, osmotic diuresis leading to dehydration and electrolyte loss, hyperosmolar coma, and in neonates, intracranial hemorrhage.
Storage: Store at room temperature (not exceeding 30°C). Protect from freezing and direct sunlight. Do not use if the container is leaking, damaged, or if the solution is cloudy, discolored, or contains visible particles. The solution is intended for single use only; discard any unused portion. Keep out of reach of children.