Introduction
Glucose, also known as dextrose, is a simple monosaccharide and the primary energy source for most living organisms. As a pharmaceutical agent, it is classified as a carbohydrate caloric agent and is essential for maintaining normal cellular function. Pharmaceutical-grade glucose is used therapeutically to treat hypoglycemia, provide energy supplementation, and as a vehicle for drug delivery in various clinical settings.
Mechanism of Action
Glucose serves as the fundamental metabolic substrate for cellular energy production. After administration, glucose undergoes glycolysis to produce pyruvate, which enters the Krebs cycle to generate adenosine triphosphate (ATP) through oxidative phosphorylation. In the brain, glucose is the primary energy source and is essential for maintaining neurological function. When administered intravenously, glucose provides immediate substrate for ATP production, while oral administration allows for absorption through sodium-glucose cotransporters in the intestinal mucosa.
Indications
- Treatment of hypoglycemia (documented or suspected)
- Nutritional support in patients unable to maintain adequate oral intake
- Fluid and electrolyte replacement therapy
- As a vehicle for intravenous drug administration
- Treatment of hyperkalemia (in combination with insulin)
- Management of dehydration and ketosis in diabetic ketoacidosis (as part of comprehensive therapy)
Dosage and Administration
Hypoglycemia treatment:- Oral: 15-20 grams immediately, repeat in 15 minutes if needed
- Intravenous: 10-25 grams (20-50 mL of D50W) administered push
- IV infusion: 5-10% dextrose solutions at rates based on clinical needs
- Total parenteral nutrition: Component of nutritional formulations
- Pediatric patients: 0.5-1 g/kg IV for hypoglycemia
- Renal impairment: Dose adjustment typically not required
- Hepatic impairment: Monitor closely for fluid overload
Pharmacokinetics
Absorption: Orally administered glucose is rapidly absorbed in the small intestine via active transport mechanisms. Bioavailability approaches 100% for pharmaceutical preparations. Distribution: Distributed throughout total body water with a volume of distribution approximately 0.2 L/kg. Readily crosses the placenta and enters breast milk. Metabolism: Primarily metabolized through glycolysis and subsequent oxidative pathways in all tissues, particularly the liver, muscle, and brain. Elimination: Renal excretion is minimal (<0.5%) in normoglycemic states. Elimination half-life is approximately 15-20 minutes when administered intravenously.Contraindications
- Known hypersensitivity to glucose or corn-derived products
- Hyperglycemia or diabetic ketoacidosis without appropriate insulin coverage
- Intracranial or intraspinal hemorrhage
- Delayed gastric emptying (for oral administration)
Warnings and Precautions
- Risk of hyperglycemia with excessive administration
- Monitor for hypokalemia with high-dose infusions
- Use with caution in patients with cardiac or renal insufficiency due to fluid overload risk
- Peripheral vein irritation and thrombophlebitis may occur with concentrated solutions
- Refeeding syndrome risk in malnourished patients
Drug Interactions
- Insulin: Potentiates hypoglycemic effects
- Corticosteroids: May antagonize glucose-lowering effects
- Beta-blockers: May mask hypoglycemic symptoms
- Thiazide diuretics: May cause hyperglycemia
- Phenytoin: May decrease insulin secretion
Adverse Effects
Common:- Hyperglycemia
- Hypokalemia
- Fluid overload
- Venous irritation (with concentrated solutions)
- Hyperosmolar hyperglycemic state
- Hypokalemia-induced arrhythmias
- Refeeding syndrome
- Extravasation injury with hypertonic solutions
Monitoring Parameters
- Blood glucose levels (frequent monitoring during infusion)
- Serum electrolytes (particularly potassium)
- Fluid balance and body weight
- Signs of venous irritation or infiltration
- Neurological status in patients with hypoglycemia
- Renal function in patients receiving prolonged therapy
Patient Education
- Recognize symptoms of hypoglycemia (sweating, trembling, confusion)
- Understand proper administration techniques for home glucose therapy
- Monitor blood glucose levels as directed by healthcare provider
- Report signs of fluid overload (swelling, shortness of breath)
- Store glucose products according to manufacturer instructions
- Carry medical identification if prone to hypoglycemia
References
1. American Diabetes Association. Standards of Medical Care in Diabetes. Diabetes Care. 2023;46(Suppl 1) 2. Lexicomp Online. Glucose monograph. Wolters Kluwer Clinical Drug Information. 2023 3. Micromedex Solutions. Dextrose drug information. IBM Watson Health. 2023 4. Traub SL, et al. Basic Skills in Interpreting Laboratory Data. 7th ed. ASHP; 2022 5. Moghissi ES, et al. American Association of Clinical Endocrinologists and American Diabetes Association consensus statement on inpatient glycemic control. Endocr Pract. 2009;15(4):353-369 6. FDA prescribing information for various dextrose injection products