Why drip glucose? Glucose solution: instructions for use for intravenous infusions.

Active ingredient: glucose;

1 ml of the drug contains glucose monohydrate 0.4 g in terms of anhydrous glucose;

excipients: 0.1 M hydrochloric acid solution, sodium chloride, water for injection.

Pharmacodynamics. Glucose provides substrate replenishment of energy costs. With the introduction of hypertonic solutions into a vein, intravascular osmotic pressure increases, the flow of fluid from tissues into the blood increases, metabolic processes accelerate, the antitoxic function of the liver improves, the contractile activity of the heart muscle increases, diuresis increases. With the introduction of a hypertonic glucose solution, redox processes are enhanced, glycogen deposition in the liver is activated.

Pharmacokinetics. After intravenous administration, glucose with the blood flow enters the organs and tissues, where it is included in the metabolic processes. Glucose stores are stored in the cells of many tissues in the form of glycogen. Entering the process of glycolysis, glucose is metabolized to pyruvate or lactate, under aerobic conditions, pyruvate is completely metabolized to carbon dioxide and water with the formation of energy in the form of ATP. The end products of the complete oxidation of glucose are excreted by the lungs and kidneys.
Pharmaceutical specifications

Basic physical and chemical properties: transparent colorless or slightly yellowish liquid.

Hypoglycemia.

Glucose solution 40% is administered intravenously (very slowly), adults - 20-40-50 ml per injection. If necessary, administered drip, at a rate of up to 30 drops / min (1.5 ml / kg / h). Dose for adults with intravenous drip - up to 300 ml per day. The maximum daily dose for adults is 15 ml / kg, but not more than 1000 ml per day.

Use during pregnancy or lactation

Glucose infusions in pregnant women with normoglycemia can lead to the fetus causing it. The latter is important to consider, especially when fetal distress is or is already due to other perinatal factors.

The drug is used for children only as directed and under medical supervision.

The drug should be used under the control of blood sugar and electrolyte levels.

It is not recommended to prescribe a glucose solution in the acute period of severe, with acute cerebrovascular accident, since the drug can increase damage to brain structures and worsen the course of the disease (except in cases of correction).

disorders of the endocrine system and metabolism: hyperglycemia, hypokalemia, acidosis;

violations of the urinary system:, glucosuria;

disorders of the digestive tract:,;

general body reactions: hypervolemia, allergic reactions (fever, skin rashes, angioedema, shock).

In the event of an adverse reaction, the administration of the solution should be stopped, the patient's condition should be assessed and assistance should be provided.

Glucose solution 40% should not be administered in the same syringe with hexamethylenetetramine, since glucose is a strong oxidizing agent. It is not recommended to mix in one syringe with alkaline solutions: with general anesthetics and hypnotics, as their activity decreases, with solutions of alkaloids; inactivates streptomycin, reduces the effectiveness of nystatin.

Under the influence of thiazide diuretics and furosemide, glucose tolerance decreases. Insulin promotes the entry of glucose into peripheral tissues, stimulates the formation of glycogen, the synthesis of proteins and fatty acids. Glucose solution reduces the toxic effect of pyrazinamide on the liver. The introduction of a large volume of glucose solution contributes to the development of hypokalemia, which increases the toxicity of simultaneously used digitalis preparations.

Glucose solution 40% is contraindicated in patients with: intracranial and intraspinal hemorrhage, with the exception of conditions associated with hypoglycemia; severe dehydration, including alcohol; hypersensitivity to the components of the drug; anuria; diabetes mellitus and other conditions accompanied by hyperglycemia; glucose-galactose malabsorption syndrome. The drug should not be administered simultaneously with blood products.

With an overdose of the drug, hyperglycemia, glucosuria, increased osmotic blood pressure (up to the development of hyperglycemic coma), hyperhydration and electrolyte imbalance develop. In this case, the drug is canceled and insulin is prescribed at the rate of 1 unit for every 0.45-0.9 mmol of blood glucose until a blood glucose level of 9 mmol / l is reached. Blood glucose levels should be reduced gradually. Simultaneously with the appointment of insulin, an infusion of balanced salt solutions is carried out.

If necessary, symptomatic treatment is prescribed.

Glucose enhances redox processes in the body, improves the antitoxic function of the liver, enhances the contractile activity of the myocardium, and is a source of easily digestible carbohydrates.

Pharmacodynamic properties of 5%, 10%, 20% and 40% dextrose solutions are similar to those of glucose, the main energy source of cellular metabolism.

5% dextrose solution is an isotopic solution with an osmolarity of about 277 mOsm/l. The caloric intake of a 5% dextrose solution is 200 kcal/l.

10% dextrose solution is a hypertonic solution with an osmolarity of about 555 mOsm/l. The caloric intake of a 10% dextrose solution is 400 kcal/L.

20% dextrose solution is a hypertonic solution with an osmolarity of about 1110 mOsm/l. The caloric intake of a 20% dextrose solution is 680 kcal/l.

40% dextrose solution is a hypertonic solution with an osmolarity of about 2220 mOsm / l. The caloric intake of a 40% dextrose solution is 1360 kcal/L.

As part of parenteral nutrition, 5%, 10%, 20% and 40% dextrose solutions are administered as a carbohydrate source (alone or as part of parenteral nutrition if necessary).

5% and 10% dextrose solutions allow you to fill the lack of fluid without the simultaneous introduction of ions.

20% dextrose solution provides the maximum amount of calories in the minimum amount of liquid.

40% dextrose solution allows you to restore the concentration of glucose in the blood during hypoglycemia with the introduction of a minimum amount of liquid, increases the osmotic pressure of the blood, increases diuresis.

Dextrose, entering the tissues, is phosphorylated, turning into glucose-6-phosphate, which is actively involved in many parts of the body's metabolism.

When using dextrose solutions to dilute and dissolve parenteral drugs, the pharmacodynamic properties of the solution will depend on the substance added.

Glucose is metabolized in two different ways: anaerobic and aerobic.

Dextrose, breaking down into pyruvic or lactic acid (anaerobic glycolysis), is metabolized to carbon dioxide and water with the release of energy.

When using a dextrose solution to dilute and dissolve parenterally administered drugs, the pharmacokinetic properties of the solution will depend on the substance added.

5% glucose solution:

For dilution and dissolution of parenterally administered drugs.

10% glucose solution:

As a carbohydrate source (alone or as part of parenteral nutrition if needed);

For rehydration in case of fluid loss, especially in patients with a high need for carbohydrates;

For dilution and dissolution of parenterally administered drugs;

For the prevention and treatment of hypoglycemia.

20% and 40% glucose solutions:

As a source of carbohydrates (alone or as part of parenteral nutrition if necessary), especially in cases where it is necessary to limit fluid intake;

Hypoglycemia.

Isotonic glucose solution 5%:

decompensated diabetes mellitus; other known forms of glucose intolerance (eg, metabolic stress); hyperosmolar coma; hyperglycemia and hyperlactatemia; the introduction of the solution during the first 24 hours after a head injury; hypersensitivity to the components of the drug; use in patients with a known intolerance to corn or corn products (when receiving dextrose from corn); contraindications to any drugs added to the glucose solution.

Hypertonic glucose solution 10%:

decompensated diabetes mellitus and diabetes insipidus; other known forms of glucose intolerance (eg, metabolic stress); hyperosmolar coma; hyperglycemia, hyperlactatemia; hemodilution and extracellular overhydration or hypervolemia; severe renal failure (with oliguria or anuria); decompensated heart failure; generalized edema (including pulmonary and cerebral edema) and cirrhosis of the liver with ascites; the introduction of the solution during the first 24 hours after a head injury; hypersensitivity to the components of the drug; use in patients with a known intolerance to corn or corn products (when receiving dextrose from corn); contraindications to any drugs added to the glucose solution.

Hypertonic glucose solutions 20% and 40% (optional):

intracranial hemorrhage and hemorrhage in the spinal cord, children's age (for solutions over 20%).

Diabetes mellitus, intracranial hypertension, hyponatremia, childhood.

Dextrose solution 5% during pregnancy, it is usually used as a hydrator and a vehicle when using other drugs (in particular oxytocin).

Dextrose solution 5% and 10% can be safely used during pregnancy and during breastfeeding, provided that the electrolyte balance and fluid balance are controlled and are within the physiological norm. If glucose is administered intravenously to a woman in labor, then the concentration of glucose in her blood should not exceed 11 mmol / l.

Feeding during infusion try not to interrupt.

Purpose 20% and 40% dextrose solutions during pregnancy and breastfeeding is possible only on prescription and under the supervision of a physician, if the intended benefit to the mother outweighs the potential risk to the fetus or infant.

If dextrose solution is added to the medicinal product, the properties of the medicinal product and its use during pregnancy and during breastfeeding are considered separately.

Intravenously (drip). The drug is usually administered into a peripheral or central vein.

The concentration and dose of the administered solution depend on the age, body weight and clinical condition of the patient.

The use of the drug should be carried out under regular medical supervision. Clinical and biological parameters, in particular blood glucose concentrations, as well as fluid and electrolyte balance, should be carefully monitored.

In adults with a normal metabolism, the daily dose of glucose administered should not exceed 4-6 g / kg, i.e. about 250-450 g (with a decrease in metabolic rate, the daily dose is reduced to 200-300 g), while the daily volume of fluid administered is 30-40 ml / kg.

children for parenteral nutrition, along with fats and amino acids, 6 g of glucose / kg / day is administered on the first day, and subsequently up to 15 g / kg / day.

Insertion rate: in a normal state of metabolism, the maximum rate of administration for adults is 0.25-0.5 g / kg / h (with a decrease in metabolic rate, the rate of administration is reduced to 0.125-0.25 g / kg / h). In children, the rate of glucose administration should not exceed 0.5 g/kg/h.

For complete assimilation of dextrose administered in large doses, short-acting insulin is simultaneously prescribed at the rate of 1 IU of insulin per 4-5 g of dextrose.

With total parenteral nutrition, the administration of glucose should always be accompanied by the administration of a sufficient amount of amino acid solutions, an emulsion of lipids, electrolytes, vitamins and trace elements.

Patients with diabetes glucose is administered under the control of its content in the blood and urine.

For adults: 500-3000 ml per day.

For children, including newborns:

With a body weight of 0-10 kg - 100 ml / kg per day;

With a body weight of 10-20 kg - 1000 ml + additional 50 ml for each kg of body weight over 10 kg per day;

With a body weight of more than 20 kg - 1500 ml + additional 20 ml for each kg of body weight over 20 kg per day.

Rate and volume of infusion depend on the age, body weight, clinical condition and metabolism of the patient, as well as on concomitant therapy. In children, they should be determined by the attending physician with experience in the use of intravenous drugs in this category of patients.

The threshold for glucose utilization in the body must not be exceeded to avoid hyperglycemia, therefore the maximum dose of dextrose varies from 5 mg / kg / min for adults and 10-18 mg / kg / min for newborns and children, depending on age and total body weight.

The recommended dose when used to dilute and dissolve parenterally administered drugs is usually 50-250 ml per dose of the administered drug, however, the required volume should be determined based on the instructions for use of the added drugs. In this case, the dose and rate of administration of the solution are determined by the properties and dosing regimen of the diluted drug.

10% glucose solution:

Children and teenagers: the rate and volume of infusion depend on the age, body weight, clinical condition and metabolism of the patient, as well as on concomitant therapy. They should be determined by a physician experienced in the use of intravenous drugs in children.

* The rate, volume of infusion and duration of treatment depend on the age, body weight, clinical condition and metabolism of the patient, as well as on concomitant therapy. They should be determined by a physician experienced in the use of intravenous drugs in children.

Note: Maximum volumes within recommended doses should be administered within 24 hours to avoid hemodilution.

The maximum infusion rate should not exceed the patient's glucose utilization threshold, as this may lead to hyperglycemia. Depending on the clinical condition of the patient, the rate of administration may be reduced to reduce the risk of osmotic diuresis.

When using the drug for dilution and dissolution of drugs for infusion administration, the required volume is determined on the basis of the instructions for use of the added drugs.

20% glucose solution:

The introduction of a 20% glucose solution is carried out only through the central vein. The rate of administration of the solution is up to 30-40 drops / min (1.5-2 ml / min). The maximum daily dose for adults is 500 ml.

40% glucose solution:

The use of the drug should be carried out under regular medical supervision.

The dosage regimen depends on the age, weight and clinical condition of the patient. Clinical and biological parameters should be carefully monitored, in particular blood glucose, electrolytes and fluid balance.

A 40% glucose solution is injected intravenously at a rate of up to 30 drops / min (1.5 ml / min).

The maximum daily dose for adults is 250 ml.

After reaching the required concentration of glucose in the blood, the patient is transferred to the introduction of 5% or 10% glucose solutions.

Adverse reactions (HP ) are grouped by systems and organs in accordance with the MedDRA dictionary and the WHO HP HP classification: very often (≥ 1/10), often (≥ 1/100 to<1/10), нечасто (≥ 1/1000 до <1/100), редко (≥ 1/10000 до <1/1000), очень редко (<1/10000), частота неизвестна - (частота не может быть определена на основе имеющихся данных).

From the side of the immune system

Frequency unknown: anaphylactic reactions, hypersensitivity.

From the side of metabolism and nutrition

Frequency unknown: violations of water and electrolyte balance (hypokalemia, hypomagnesemia and hypophosphatemia), hyperglycemia, hemodilution, dehydration, hypervolemia.

From the side of the vessels

Frequency unknown: venous thrombosis, phlebitis.

From the skin and subcutaneous tissues

Frequency unknown: increased sweating.

From the side of the kidneys and urinary tract

Frequency unknown: polyuria.

General disorders and disorders at the injection site

Frequency unknown: chills, fever, injection site infection, injection site irritation, extravasation, injection site tenderness.

Laboratory- instrumentaldata

Frequency unknown: glucosuria.

Adverse reactions may also be associated with the drug that was added to the solution. The likelihood of other adverse reactions depends on the properties of the particular drug being added.

If adverse reactions occur, the administration of the solution should be discontinued.

Symptoms

Prolonged infusion administration of the drug can lead to hyperglycemia, glucosuria, hyperosmolarity, osmotic diuresis and dehydration. Rapid infusion can create fluid accumulation in the body with hemodilution and hypervolemia, and when the body's ability to oxidize glucose is exceeded, rapid administration can cause hyperglycemia. There may also be a decrease in the content of potassium and inorganic phosphate in the blood plasma.

When using dextrose solution for infusion to dilute and dissolve other drugs for intravenous administration, the clinical signs and symptoms of overdose may be related to the properties of the drugs used.

Treatment

If symptoms of an overdose appear, the administration of the solution should be suspended, the patient's condition should be assessed, short-acting insulin should be administered, and, if necessary, supportive symptomatic therapy should be carried out.

The combined use of catecholamines and steroids reduces the absorption of dextrose (glucose).

When mixed with other drugs, it is necessary to visually control them for incompatibility.

For dilution or dissolution of other drugs, the drug should be used only if there are instructions for dilution with a dextrose solution in the instructions for use for this drug. In the absence of information on compatibility, the drug should not be mixed with other drugs.

Before adding any drug, you need to make sure that it is soluble and stable in water in the pH range of the drug. After adding a compatible medicinal product to the preparation, the resulting solution should be administered immediately.

Medicinal products with known incompatibilities should not be used.

With the introduction of dextrose solutions through the same infusion system as for blood transfusion, there is a risk of hemolysis and thrombosis.

Since patients with diabetes mellitus, renal insufficiency or who are in acute critical condition, the tolerance of glucose (dextrose) may be impaired, their clinical and biological parameters should be carefully monitored, in particular the concentration of electrolytes in the blood plasma, including magnesium or phosphorus, concentration of glucose in the blood. In the presence of hyperglycemia, the rate of administration of the drug should be adjusted or short-acting insulin should be prescribed.

Usually, glucose is completely absorbed by the body (it is not normally excreted by the kidneys), so the appearance of glucose in the urine may be a pathological sign.

In the case of prolonged administration or use of dextrose in high doses, it is necessary to control the concentration of potassium in the blood plasma and, if necessary, administer additional potassium to avoid hypokalemia.

In episodes of intracranial hypertension, careful monitoring of blood glucose levels is necessary.

The use of dextrose solutions can lead to hyperglycemia. Therefore, they are not recommended to be administered after an acute ischemic stroke, since hyperglycemia is associated with an increase in ischemic brain damage and prevents recovery.

Particularly careful clinical monitoring is required at the beginning of intravenous administration of the drug.

For rehydration therapy, carbohydrate solutions should be used in combination with electrolyte solutions to avoid electrolyte imbalance (hyponatremia, hypokalemia).

It is necessary to control the concentration of glucose and electrolytes in the blood, water balance, as well as the acid-base state of the body.

Before use, the solution should be inspected. Use only a clear solution without visible inclusions and in the absence of damage to the packaging. Enter immediately after connecting to the infusion system.

The solution should be administered using sterile equipment in compliance with the rules of asepsis and antisepsis.

To avoid air embolism, air should be evacuated from the infusion set with a solution.

Do not connect containers in series to avoid air embolism, which may occur due to the suction of air from the first container before the completion of the solution from the second container.

Administering intravenous solutions contained in soft plastic containers at elevated pressure to increase the flow rate may lead to air embolism if residual air in the container is not completely removed prior to administration.

The use of an intravenous system with a gas outlet can lead to air embolism when the gas outlet is open. Soft plastic containers should not be used with such systems. Substances to be added may be administered prior to infusion or during infusion through the injection site (provided there is a dedicated injection port). The addition of other drugs to the solution or a violation of the administration technique can cause fever due to the possible ingestion of pyrogens. With the development of adverse reactions, the infusion should be stopped immediately.

When adding other drugs before parenteral administration, it is necessary to check the isotonicity of the resulting solution. Complete and thorough mixing under aseptic conditions is a must. Solutions containing additional substances should be used immediately, their storage is prohibited.

When introducing additional nutrients, the osmolarity of the resulting mixture should be determined before the start of the infusion. The resulting mixture must be administered through a central or peripheral venous catheter, depending on the final osmolarity.

The compatibility of additionally administered drugs must be assessed before they are added to the solution (similar to the use of other parenteral solutions). Assessment of the compatibility of additionally administered drugs with the drug is the responsibility of the doctor. It is necessary to check the resulting solution for color change and / or the appearance of a precipitate, insoluble complexes or crystals.

You should read the instructions for use of the added drugs.

From a microbiological point of view, the diluted preparation should be used immediately. The exception is dilutions prepared under controlled and aseptic conditions. After preparation of the solution, the terms and conditions of its storage until administration are the responsibility of the user and should be no more than 24 hours at a temperature of 2 to 8 ° C.

Children

In newborns, especially those born prematurely or born with low body weight, the risk of developing hypo- or hyperglycemia is increased, therefore, during the period of intravenous administration of dextrose solutions, careful monitoring of blood glucose concentrations is necessary to avoid long-term undesirable consequences. Hypoglycemia in newborns can lead to prolonged seizures, coma, and brain damage. Hyperglycemia has been associated with intraventricular hemorrhage, delayed bacterial and fungal infections, retinopathy of prematurity, necrotizing enterocolitis, bronchopulmonary dysplasia, prolonged hospitalization, and mortality.

To avoid potentially fatal overdose of intravenous drugs in neonates, particular attention must be paid to the route of administration.

When using a syringe pump for intravenous administration of drugs to newborns, the container with the solution should not be left attached to the syringe. When using an infusion pump, before removing the system from the pump or disconnecting it, it is necessary to close all clamps of the system, regardless of the presence of a device in the system that prevents the free flow of fluid.

Intravenous infusion devices and other drug administration equipment should be monitored regularly.

If the drug contains dextrose derived from corn, the drug is contraindicated in patients with a known intolerance to corn or corn products, because. the following manifestations of hypersensitivity are possible: anaphylactic reactions, chills and fever.

For drugs in containers:

Containers should be disposed of after a single use.

Each unused dose should be discarded.

Do not reconnect partially used containers.

Not applicable (due to the use of the drug exclusively in the hospital).

Solution for infusion, 5%, 10%, 20%, 40%.

250 and 500 ml containers made of multilayer polymer film complete with multilayer polymer tubes and infusion ports.

Each container, along with instructions for use, is placed in an individual bag of polymer and combined materials.

10-90 containers are placed in a bag of polymer and combined materials, along with an equal number of instructions for use, or 10-90 individual bags with containers are placed in a bag of polymer and combined materials (only for hospitals).

At temperatures from 5 to 30 °C.

Keep out of the reach of children.