Intravenous sugar solution explained

Dailymedid:Dextrose_solution
Routes Of Administration:Intravenous
Atc Prefix:B05
Atc Suffix:BA03
Chemspiderid:none
Unii:5SL0G7R0OK
Synonyms:dextrose solution, glucose solution

Intravenous sugar solution, also known as dextrose solution, is a mixture of dextrose (glucose) and water.[1] It is used to treat low blood sugar or water loss without electrolyte loss. Water loss without electrolyte loss may occur in fever, hyperthyroidism, high blood calcium, or diabetes insipidus. It is also used in the treatment of high blood potassium, diabetic ketoacidosis, and as part of parenteral nutrition. It is given by injection into a vein.[2]

Side effects may include irritation of the vein in which it is given, high blood sugar, and swelling.[2] Excess use may result in low blood sodium and other electrolyte problems.[2] Intravenous sugar solutions are in the crystalloid family of medications.[3] They come in a number of strengths including 5%, 10%, and 50% dextrose.[2] While they may start out hypertonic they become hypotonic solutions as the sugar is metabolised.[4] Versions are also available mixed with saline.[5]

Dextrose solutions for medical use became available in the 1920s and 1930s.[6] [7] It is on the World Health Organization's List of Essential Medicines.[8]

Medical uses

Administering a 5% sugar solution peri- and postoperatively usually achieves a good balance between starvation reactions and hyperglycemia caused by sympathetic activation. A 10% solution may be more appropriate when the stress response from the reaction has decreased, after approximately one day after surgery. After more than approximately two days, a more complete regimen of total parenteral nutrition is indicated.

In patients with hypernatremia and euvolemia, free water can be replaced using either 5% D/W or 0.45% saline.

In patients with fatty-acid metabolism disorder (FOD), 10% solution may be appropriate upon arrival to the emergency room.

Side effects

Intravenous glucose is used in some Asian countries as a pick-me-up, for "energy", but is not part of routine medical care in the United States where glucose solution is a prescription drug. Asian immigrants to the United States are at risk of infection if they seek intravenous glucose treatment. It may be had at storefront clinics catering to Asian immigrants, despite having no more effect than drinking sugared water. The procedure is commonly called "ringer".[9]

Concentrated dextrose solutions should not be administered subcutaneously or intramuscularly, as they can cause cell death via dehydration and subsequent necrosis.

Types

Types of glucose/dextrose include:

The percentage is a mass concentration, so a 5% glucose/dextrose solution contains 50 g/L of glucose/dextrose (5 g per 100 ml). This usage is imprecise but widely used, as discussed at Mass concentration (chemistry) § Usage in biology.

Glucose provides energy 4 kcal/gram, so a 5% glucose solution provides 0.2 kcal/ml. If prepared from dextrose monohydrate, which provides 3.4 kcal/gram, a 5% solution provides 0.17 kcal/ml.[11]

Notes and References

  1. Web site: Dextrose. The American Society of Health-System Pharmacists. 8 January 2017. live. https://web.archive.org/web/20170118042122/https://www.drugs.com/monograph/dextrose.html. 18 January 2017.
  2. Book: British national formulary : BNF 69. 2015. British Medical Association. 9780857111562. 683–684. 69.
  3. Book: David SS . Clinical Pathways in Emergency Medicine. 2016. Springer. 9788132227106. 62. en. live. https://web.archive.org/web/20170116170118/https://books.google.ca/books?id=JnxBDAAAQBAJ&pg=PA62. 16 January 2017.
  4. Book: Waldmann C, Soni N, Rhodes A . Oxford Desk Reference: Critical Care. 2008. OUP Oxford. 9780199229581. 142. en. live. https://web.archive.org/web/20170116170011/https://books.google.ca/books?id=eLqMpXfAlEcC&pg=PA142. 16 January 2017.
  5. Book: WHO Model Formulary 2008 . 2009 . 9789241547659 . ((World Health Organization)) . Stuart MC, Kouimtzi M, Hill SR . 10665/44053 . World Health Organization . World Health Organization . 491.
  6. Book: Skipper A . Dietitian's Handbook of Enteral and Parenteral Nutrition. 2012. Jones & Bartlett Publishers. 9780763742904. 283. en. live. https://web.archive.org/web/20170116170010/https://books.google.ca/books?id=f8gjJOPJlowC&pg=PA283. 16 January 2017.
  7. Book: Nelms M, Sucher K . Nutrition Therapy and Pathophysiology. 2015. Cengage Learning. 9781305446007. 89. en. live. https://web.archive.org/web/20170116165726/https://books.google.ca/books?id=RGlvCgAAQBAJ&pg=PT121. 16 January 2017.
  8. Book: ((World Health Organization)) . World Health Organization model list of essential medicines: 21st list 2019 . 2019 . 10665/325771 . World Health Organization . World Health Organization . Geneva . WHO/MVP/EMP/IAU/2019.06. License: CC BY-NC-SA 3.0 IGO . free .
  9. News: Jiha Ham. A Life Upended After an IV Glucose Treatment Popular Among Asian Immigrants. 21 March 2015. The New York Times. 20 March 2015. Although many doctors warn Asian immigrants in New York that the effects of injecting glucose differ little from drinking sugary water, many Asians, especially of older generations, still use the intravenous solution. In their homelands, it is commonly prescribed by doctors as a method to cure colds, fevers and sometimes an upset stomach.. live. https://web.archive.org/web/20150322034910/http://www.nytimes.com/2015/03/21/nyregion/despite-warnings-asian-immigrants-rely-on-glucose-injections-as-a-cure-for-ailments.html. 22 March 2015.
  10. http://emedicine.medscape.com/article/241094-treatment eMedicine > Hypernatremia: Treatment & Medication
  11. http://health.csusb.edu/dchen/368%20stuff/TPN%20calculation.htm Calculating Parenteral Feedings