Dextrose Monohydrate

Dextrose is a form of glucose (sugar) used as a caloric source in intravenous fluids, a treatment for low blood sugar (hypoglycemia), and a component in specialized solutions for anticoagulation and calculi dissolution.

The dosage of Dextrose is highly individualized based on the patient's age, weight, clinical condition, and fluid/electrolyte balance.

• For Acute Hypoglycemia: The standard adult dose is 10 to 25 grams of Dextrose (typically 20 to 50 mL of a 50% solution) administered slowly via a large peripheral vein or central line. This may be repeated based on follow-up blood glucose monitoring.
• For Maintenance Fluid (Hydration): Dextrose 5% (D5W) is often infused at rates of 50 to 125 mL per hour, depending on the patient’s size and hydration status.
• For Hyperkalemia (High Potassium): 25 to 50 grams of Dextrose is usually given alongside 10 units of regular insulin to facilitate the intracellular shift of potassium.
• For Calculi Dissolution: Solutions are typically used for continuous or intermittent bladder irrigation as directed by a urologist, often involving 30 to 60 mL of specialized solution multiple times per day.

Pediatric dosing requires extreme precision to avoid fluid overload or dangerous spikes in blood sugar.

• Neonatal Hypoglycemia: 200 to 500 mg/kg (2 to 5 mL/kg of a 10% Dextrose solution) is the standard emergency dose.
• Infants and Children: For acute hypoglycemia, 0.5 to 1 gram/kg (using 10% or 25% concentrations) is common. High concentrations like D50W are generally avoided in small children due to the risk of vein irritation and brain hemorrhage.

Renal Impairment

Patients with kidney disease are at high risk for fluid overload. Healthcare providers must monitor 'ins and outs' (fluid intake vs. urine output) closely. Dextrose levels may need to be reduced if the patient is unable to excrete the water volume associated with the sugar infusion.

Hepatic Impairment

In patients with severe liver disease (cirrhosis), the liver's ability to store and release glycogen is impaired. These patients may require more frequent Dextrose infusions but must be monitored for the development of cerebral edema (brain swelling).

Elderly Patients

Older adults often have reduced cardiac and renal reserve. Dosing should start at the lower end of the range to prevent heart failure exacerbations or pulmonary edema (fluid in the lungs).

Dextrose is almost exclusively administered by healthcare professionals in a clinical setting when given intravenously.

• IV Administration: High concentrations (above 10%) should ideally be administered through a central venous catheter to prevent thrombophlebitis (vein inflammation).
• Oral Use: If using Dextrose tablets or gels at home for hypoglycemia, follow the '15-15 Rule': consume 15 grams of Dextrose, wait 15 minutes, and re-check blood sugar. Repeat if levels remain below 70 mg/dL.
• Storage: IV bags should be stored at room temperature (25°C/77°F) and protected from extreme heat or freezing. Do not use the solution if it is discolored or contains particles.

In a hospital setting, Dextrose is usually given as a continuous infusion. If an infusion is interrupted, your nurse or doctor will restart it as soon as possible. For home-use oral Dextrose, a 'missed dose' is not applicable as it is used on an as-needed basis for low blood sugar symptoms.

An overdose of Dextrose (hyperglycemia) can lead to a condition called hyperosmolar hyperglycemic state (HHS).

• Symptoms: Extreme thirst, frequent urination, confusion, blurred vision, and in severe cases, seizures or coma.
• Emergency Measures: If an overdose occurs, the infusion is stopped immediately. Insulin is administered to lower blood sugar, and isotonic fluids (like Normal Saline) are given to correct dehydration and electrolyte imbalances.

> Important: Follow your healthcare provider's dosing instructions. Do not adjust your dose or stop an infusion without medical guidance, as sudden cessation can lead to 'rebound hypoglycemia'.

Most side effects associated with Dextrose are related to the concentration of the sugar and the volume of fluid administered.

• Injection Site Irritation: Patients often report a warm sensation, stinging, or redness at the site of the IV. This is common with D5W and very common with higher concentrations like D50W.
• Glycosuria: Sugar appearing in the urine. This happens when the blood sugar level rises too quickly for the kidneys to reabsorb it. It may feel like an increased urge to urinate shortly after the infusion starts.
• Fluid Retention: Mild swelling (edema) in the hands or ankles due to the water content of the IV fluid.

Dextrose is generally safe when used appropriately, but it is a potent metabolic agent. Patients must be aware that Dextrose is not 'just sugar water'—it significantly impacts fluid balance, insulin production, and electrolyte levels. According to the FDA, Dextrose solutions should be used with caution in patients with known subclinical or overt diabetes mellitus, as it can precipitate severe hyperglycemia.

No FDA black box warnings for Dextrose. It is one of the most widely used and well-tolerated substances in clinical medicine when administered under professional supervision.

• Allergic Reactions / Anaphylaxis Risk: Most Dextrose is derived from corn. Patients with a severe corn allergy may experience anaphylactic reactions. Always inform your provider of any food or grain allergies before receiving an infusion.

• Blood Products (Coadministration): Dextrose solutions without electrolytes (like D5W) must NEVER be infused through the same tubing as whole blood or packed red blood cells. The lack of electrolytes causes the red cells to swell and clump (pseudoagglutination), which can lead to fatal transfusion reactions.

• Corticosteroids (e.g., Prednisone, Dexamethasone): These medications naturally increase blood sugar levels. When used with Dextrose, they can cause extreme hyperglycemia that is difficult to control even with insulin.
• Insulin: While often used together, insulin directly opposes the effect of Dextrose. Close monitoring is required to prevent rapid swings between high and low blood sugar.

Dextrose must NEVER be used in the following circumstances:

• Severe Hyperglycemia: If blood sugar is already dangerously high (e.g., in Diabetic Ketoacidosis), adding more Dextrose will worsen the condition and increase the risk of coma.
• Corn Allergy: Since most medical-grade Dextrose is derived from corn starch, patients with a documented anaphylactic allergy to corn products should avoid Dextrose infusions unless no alternative exists and they are under extreme supervision.
• Intracranial or Intraspinal Hemorrhage: In the setting of a 'brain bleed' or acute stroke, high blood sugar can worsen brain swelling (edema) and increase the area of brain damage. Dextrose is generally avoided in these patients unless they are also hypoglycemic.
• Delirium Tremens (with Dehydration): If the patient is severely dehydrated and in alcohol withdrawal, Dextrose without electrolytes can worsen the metabolic state.

Dextrose is classified as FDA Pregnancy Category C (under the old system, though still used in clinical practice). It is widely used during labor and delivery to provide energy to the mother and prevent ketosis. However, if the mother has Gestational Diabetes, high-concentration Dextrose can cause the fetus to produce excess insulin, leading to severe hypoglycemia in the newborn immediately after birth. A 2022 study in the American Journal of Obstetrics and Gynecology highlighted that careful glucose management during labor is essential for neonatal safety.

Dextrose is a natural component of breast milk (as lactose is broken down into glucose and galactose). Intravenous Dextrose given to a mother does not pose a risk to the nursing infant. It is considered compatible with breastfeeding.

Dextrose is a life-saving medication for neonates (newborns), who have very small glycogen stores. However, children are much more sensitive to 'osmotic shifts'. Using D50W in a child can cause the blood to become too 'thick' (hyperosmolar), which can lead to brain bleeds (intraventricular hemorrhage). Pediatric concentrations are usually limited to 10% or 25%.

Dextrose acts as a direct metabolic substrate. Once it enters the cell via GLUT transporters, it is phosphorylated by the enzyme hexokinase to form glucose-6-phosphate. This molecule then enters the glycolytic pathway to produce pyruvate, which is then converted into Acetyl-CoA for the citric acid cycle (Krebs cycle). This process generates NADH and FADH2, which power the electron transport chain to produce ATP. In its role as a Calcium Chelating Activity [MoA], the Dextrose in anticoagulant solutions provides the energy needed for the sodium-potassium pump in red blood cell membranes, maintaining cell integrity during storage.

The onset of action for IV Dextrose in treating hypoglycemia is nearly instantaneous (less than 1 minute). The duration of effect depends on the patient's underlying metabolic rate and insulin levels but typically lasts 30 to 60 minutes. Dextrose also has an osmotic effect; high concentrations draw water out of the cells and into the bloodstream, which can temporarily increase blood pressure and reduce brain swelling (though this is more common with Mannitol).