The document provides detailed information on dextrose solutions, including dosage equivalence, indications for use, and preparation guidelines for both parenteral and oral forms. It highlights various concentrations available and their specific applications, such as energy source, fluid replacement, and management of conditions like hypoglycemia and hyperkalemia. Additionally, it outlines common side effects, contraindications, and precautionary measures when administering dextrose solutions.

1. Dextrose solution (GW)
Alaa F. Hassan (MSc. Pharmacology)
Drug Information Centre/ Al-Mahmoudiya G. Hospital
Doses equivalence & conversion
 75 g anhydrous glucose eq. to glucose BP 82.5g (1)
 Oral liquid containing 250mg/ml & tablet containing glucose 4g/tab. (1)
 Buccal gel tube of 40% oral gel containing 10g/tube (1)
 IV solution available as (GW) 2.5%, 5% & 10%, (HT) 15%, 20%, 30 %, 40% 50% & 70%
(2, 4); note thatref. 4 classify sol.>5% as HT.
Available in our Hosp. Anhydrous glucose conc.
5% 500ml 50mg/ml
10% 500ml 100mg/ml
20% 50ml 200mg/ml
50% 20ml 500mg/ml
pH value 3.5-6.5, stored at 20-25°C (3)
Indication & doses-only parenteral
Indication (3) Concentrations
Energy source & fluid replacement (peripheral inf.) 2.5%, 5%, 10% (3, 4)
Energy source (CV inf. As TPN) 10%-70% (3, 4)
Insulin induced hypoglycaemia 25%, 50%
Neonates & infant acute symptomatic episodes of
hypoglycaemia
25%
Adj. management of hyperkalaemia 25% or 50%
As IV diluent for drugs adm. 2.5%-10%
Hypoglycaemia
 Preterm & term neonates’ 200mg/kg slow IV inj. Followed by 3-6mg/kg/min inf.
(2ml/kg GW 10%) (2)
 Infant ≤6month 250-500mg/kg/dose (1-2ml HT 25%) (3-4)
 Neonates 500mg/kg/hr as GW 10% IV inf., initial dose 250mg/kg/5min may be required
for severe hypoglycaemia (associated with loss of consciousness&/seizures) (1)
 Children>1month (6months) 500mg-1g/kg IV inj./inf. (5-10ml/kg GW 10% or 2-4ml
HT 25%) into large vein through large gauge needle (1-3)
 Adult 10000-25000mg (40-100ml HT 25% or 20-50ml HT 50%) repeated as needed (3)
 children & adult 20-50ml HT 50% at rate of 3ml/min , maintenance dose of GW 10% (4)

2. Hyperkalaemia
 500mg/kg (2ml HT 25%) with soluble insulin 0.1U/kg repeated as needed (unlabelled)
(3)
 Neonates 500mg-1g/kg (2.5-5ml/kg HT 20%) with soluble insulin 0.3-0.6U/kg/hr (2)
 Children >1month 500mg-1g/kg (2.5-5ml/kg HT 20%) with soluble insulin 0.05-
0.2U/kg/hr (2)
 Adult 25000mg (50ml HT 50%) with soluble insulin 10U/5min repeated as needed
(unlabelled) (3)
Persistent cyanosis combined with propranolol & followed by morphine
If (blood glucose < 3mmol/l) Children 200mg/kg as GW 10% IV inf. /10 min (1)
Energy source (nutritional support), carbohydrate/calorie &/fluid replacement
Mixed with amino acid &/ sterile water for inj. (SWFI) with dose adjustment for individual pt.
requirement (1, 3)
Children & Adult 2.5%, 5% & 10% sol. via peripheral line or 10%-70% sol. Through large CV
line (typically mixed with TPN) (4)
Diabetic ketoacidosis (1)
Insulin secreting islet cell adenoma & varicose veins (off-label) (4)
Common Side effects, contraindications, precautions
 Febrile reaction (3, 4), fever&/chills (1, 4)
 Electrolyte & fluid imbalances-dilution of serum electrolyte conc.,
overhydration/congested state, polyuria & pulmonary oedema (1, 3, 4)
 Acidosis & alkalosis (3)
 Rash & hypersensitivity (anaphylaxis, difficult breathing, periorbital/facial &/ laryngeal
oedema, pruritus, sneezing & urticaria)(3, 4) , local reaction & pain (1, 4)
 Hypertension, heart failure (4), venous thrombosis & phlebitis (1-4)
 Delirium tremens with dehydration, anuria(3, 4)
 Diabetic coma with excessive blood sugar while used in caution with pt. have
subclinical/overt diabetes or receiving corticosteroids, hepatic coma (3, 4)
 Heart failure (4), intracranial/intraspinal haemorrhage (3, 4)
 Corn&/corns’ product allergy, drug hypersensitivity (3, 4)
 Glycosuria is associated with rate of adm., while 0.5g/kg/hr not causes glycosuria; an inf.
at rate of 0.8g/kg/hr when 95% of the solution is retained will cause glycosuria (3)
 Excessive&/rapid adm. Will result in hyperosmolar syndrome, (generally used with
extreme caution in new born/very low birth weight infant= hypo-/hyperglycaemia),
characterized with ↑ serum Osmolarity, mental confusion, loss of consciousness &
possible intracerebral haemorrhage (3, 4)

3. Also fatty liver infiltration, acute respiratory failure & hypermetabolic pt. difficult
weaning from respirator (3), besides resulting in sig. hypokalaemia & hypophosphatemia
(3).While prolong administration of glucose without electrolyte is associated with
hyponatraemia & electrolyte imbalance (1)
 Slow iv inf. /5min suggested for conc. not >25% (2), When higher conc. >5% to be given
via peripheral vein, adm. Slowly preferably through small bore needle into large vein to
minimize irritation (3, 4), use umbilical/central venous catheter for sol. Conc.>10% after
appropriate dilution (1, 2) , > 12.5% (5), or an inf. via CV line for conc. not >25% or 30%
(considered irritant to central vein) (2)
 HT 50% sol. should be only administered in emergency; avoid sudden withdrawal, adm.
GW 5% or 10% infusion after the HT inj. To avoid rebound hypoglycaemia (2-4)
 1 manufacturer state the use final filter during adm. Of all parenteral sol. When possible
(3)
 Causes pseudoagglutination of RBCs when adm. simultaneously with whole blood (3, 4)
 Do not use plastic bags in series connection, pressurize bag to increase flow rate nor use
vented IV adm. Set (results in air embolism) (3,4)
 Some sol. Contains Aluminium, in pt. with impaired renal fx. , toxicity is expected
(Premature neonates are at particular risk-their immature kidneys & requirement of
calcium + phosphate) (pt. with impaired renal fx. Receiving parenteral Al >4-5mcg/day
are at risk for CNS or bone toxicity) (3)
Preparation of other conc. From GW 10% 500ml +HT 50% (2)
Volume removed
from GW 10% (ml)
Volume of HT 50% to
be added (ml)
Final conc. Final vol. (ml)
31.25 31.25 12.5% 500
62.5 62.5 15% 500
93.75 93.75 17.5% 500
187.5 187.5 25% 500
Volume req. HT 50%= (% change [higher conc. – lower conc.] * final volume) /40 (5)
If you need to add NaCl 0.9% to the made 500ml bottle, remove 15ml prepared solution & add
15ml NaCl 30% (2)
References
1. British National Formulary for Children. V3.1.6 updated 28th Sep. 2022 [Android apk]
2. Guy’s & St Thomas’ NHS Foundation Trust - Paediatric Formulary. First Ed. Updated 27th
April 2020 [Android apk]
3. Elsevier’s 2032 Intravenous Medications, A handbook for nurses and health professionals.
Thirty-nine Ed. V3.6.14 [Android apk]
4. McGraw-Hill - I.V Drug Handbook. V3.0.82 2009-2010 [Android apk]
5. Neonatal Guidelines And Drug Doses 2015 [Android apk]