Introduction
Dextrose, also known as D-glucose, is a simple monosaccharide and the primary source of energy for cellular metabolism. As a pharmaceutical agent, it is widely used in various clinical settings for nutritional support, treatment of hypoglycemia, and as a vehicle for drug delivery. Dextrose solutions are available in multiple concentrations ranging from 5% to 70% for intravenous administration, as well as in oral formulations.
Mechanism of Action
Dextrose functions as a readily available source of carbohydrate calories. When administered, it increases blood glucose concentrations by providing directly absorbable glucose molecules. Glucose serves as the primary metabolic substrate for energy production through glycolysis and the citric acid cycle. In the brain, which relies almost exclusively on glucose for energy under normal conditions, dextrose administration rapidly restores neuronal function during hypoglycemic episodes.
Indications
- Treatment of hypoglycemia (documented or suspected)
- Source of carbohydrate calories in parenteral nutrition
- Fluid replacement and caloric supplementation in patients unable to maintain adequate oral intake
- As a diluent for intravenous administration of various medications
- Treatment of hyperkalemia (in combination with insulin)
- Management of poisoning by certain drugs (e.g., beta-blockers, calcium channel blockers) when used with insulin
Dosage and Administration
Intravenous Administration:- Hypoglycemia: 10-25 g (20-50 mL of 50% solution) IV push, followed by continuous infusion if needed
- Maintenance therapy: 5-10% solutions at rates based on fluid and caloric requirements
- Hyperkalemia: 25-50 g dextrose with 10 units regular insulin IV
- Hypoglycemia: 15-20 g orally, repeated as needed
- Pediatric patients: 0.5-1 g/kg/dose (2-4 mL/kg of 25% solution)
- Renal impairment: Dose adjustment may be necessary based on fluid status
- Hepatic impairment: Monitor glucose levels closely
Pharmacokinetics
Absorption: Orally administered dextrose is rapidly absorbed in the small intestine via active transport mechanisms. Intravenous administration provides immediate bioavailability. Distribution: Distributed throughout extracellular fluid with minimal protein binding. Metabolism: Metabolized primarily through glycolysis in all tissues, with the liver playing a central role in glucose homeostasis. Elimination: Renal excretion occurs when blood glucose levels exceed the renal threshold (approximately 180 mg/dL).Contraindications
- Known hypersensitivity to dextrose or corn products (as some preparations are derived from corn)
- Intracranial or intraspinal hemorrhage
- Hyperglycemia
- Diabetic ketoacidosis
- Delayed gastric emptying (for concentrated oral solutions)
Warnings and Precautions
- Risk of hyperglycemia and hyperosmolar syndrome with concentrated solutions
- Extravasation may cause tissue necrosis, especially with hypertonic solutions (>10%)
- Monitor fluid balance in patients with cardiac or renal dysfunction
- Use with caution in patients with diabetes mellitus
- Thiamine deficiency may impair glucose metabolism
- Refeeding syndrome risk in malnourished patients
Drug Interactions
- Insulin and oral hypoglycemics: May require adjustment when co-administered with dextrose
- Corticosteroids: May antagonize glucose-lowering effects
- Beta-blockers: May mask hypoglycemia symptoms
- Thiazide diuretics: May increase blood glucose levels
- Phenytoin: Dextrose solutions may precipitate phenytoin
Adverse Effects
Common:- Hyperglycemia
- Hypersomolar syndrome
- Venous irritation or thrombophlebitis
- Fluid overload
- Hypokalemia (with insulin coadministration)
- Hyperglycemic hyperosmolar nonketotic coma
- Tissue necrosis from extravasation
- Refeeding syndrome
- Anaphylactic reactions (rare)
Monitoring Parameters
- Blood glucose levels (frequent monitoring during infusion)
- Serum electrolytes (particularly potassium)
- Fluid balance and body weight
- Signs of infection at infusion site
- Serum osmolarity with concentrated solutions
- Liver and renal function tests during prolonged therapy
Patient Education
- Understand the signs and symptoms of both hypoglycemia and hyperglycemia
- For diabetic patients: Regular self-monitoring of blood glucose when receiving dextrose therapy
- Report any pain, redness, or swelling at the infusion site
- Maintain regular follow-up with healthcare provider
- For oral formulations: Take as directed and don't exceed recommended dosage
- Understand that dextrose therapy is a medical treatment, not a nutritional supplement for healthy individuals
References
1. American Diabetes Association. Standards of Medical Care in Diabetes. Diabetes Care. 2023;46(Suppl 1):S1-S291. 2. Lexicomp Online. Dextrose Monograph. Wolters Kluwer Clinical Drug Information. 2023. 3. Trissel LA. Handbook on Injectable Drugs. 20th ed. American Society of Health-System Pharmacists; 2018. 4. Mirtallo J, Canada T, Johnson D, et al. Safe practices for parenteral nutrition. JPEN J Parenter Enteral Nutr. 2004;28(6):S39-S70. 5. FDA prescribing information for various dextrose preparations. 6. Mechanick JI, et al. Clinical practice guidelines for the perioperative nutritional, metabolic, and nonsurgical support of the bariatric surgery patient. Obesity. 2013;21 Suppl 1:S1-S27.