Dextrose 20% Inj, 500ml
It is used to treat low blood sugar. Some products are used to add fluid to the body after fluid loss, to mix with certain drugs that are given as an injection, or to add calories to a TPN.
Drug Class
Fluid, electrolyte, and nutrient replenisher; Caloric agent
Pharmacologic Class
Carbohydrate; Monosaccharide
Pregnancy Category
Category C
FDA Approved
Jan 1970
DEA Schedule
Not Controlled
Overview
What is this medicine?
Dextrose 20% Injection is a sterile sugar solution given through a vein (intravenously). It provides calories and helps raise blood sugar levels. It's used when you can't eat or need extra energy, or to treat low blood sugar. It helps your body get the energy it needs to function.
How to Use This Medicine
To use this medication correctly, follow your doctor's instructions and carefully read all accompanying information. Administer the medication as directed, which typically involves intravenous infusion over a specified period.
If you need to store this medication at home, consult with your doctor, nurse, or pharmacist to determine the appropriate storage method.
In the event that you miss a dose, contact your doctor promptly to receive guidance on the next steps to take.
If you need to store this medication at home, consult with your doctor, nurse, or pharmacist to determine the appropriate storage method.
In the event that you miss a dose, contact your doctor promptly to receive guidance on the next steps to take.
Lifestyle & Tips
- No specific lifestyle changes are required while receiving Dextrose 20% Injection, as it is administered in a controlled medical setting.
- Your healthcare provider will monitor your blood sugar and fluid levels closely to ensure safe and effective treatment.
Available Forms & Alternatives
Available Strengths:
- Dextrose 5% Inj, 1000ml
- Dextrose 5% Inj, 250ml
- Dextrose 5% Inj, 100ml
- Dextrose 5% Inj, 50ml
- Dextrose 5%/nacl 0.2% Inj, 1000ml
- Dextrose 5%/nacl 0.45% Inj, 1000ml
- D5w/nacl 0.9% Inj, 1000ml
- Dextrose 50% Injection Ftv 25x50ml
- Dextrose 5% Inj, 500ml
- Dextrose 70% Inj, 2000ml
- Dextrose 5%/nacl 0.45% Inj, 500ml
- Dextrose 50% Inj, 50ml
- Dextrose 10% Inj, 500ml
- Dextrose 10% Inj, 250ml
- Dextrose 5% Inj, 25ml
- Dextrose 5% Pgbk Inj, 100ml
- Dextrose 5%/nacl 0.3% Inj, 1000ml
- Dextrose 5% Inj, 150ml
- Dextrose 5%/nacl 0.45% Inj, 250ml
- Dextrose 5%/nacl 0.3% Inj, 500ml
- Dextrose 30% Inj, 500ml
- Dextrose 20% Inj, 500ml
- Dextrose 70% Inj, 500ml
- Dextrose 10% Inj, 1000ml
- Dextrose 5%/nacl 0.3% Inj, 250ml
Dosing & Administration
Adult Dosing
Standard Dose:
Highly individualized based on patient's metabolic needs, fluid status, and clinical condition. For caloric support, typically administered as a continuous intravenous infusion at rates providing 0.5 to 1.5 g/kg/day of dextrose. For persistent hypoglycemia (after initial bolus), continuous infusion rates may range from 0.1 to 0.4 g/kg/hour (e.g., 35-140 mL/hour of D20 for a 70kg adult).
Dose Range:
25 - 150 mg
Condition-Specific Dosing:
caloricSupport:
Individualized based on total parenteral nutrition (TPN) requirements.
persistentHypoglycemia:
After initial bolus, continuous infusion to maintain euglycemia.
fluidReplacement:
Used with caution, primarily for caloric contribution rather than sole fluid replacement.
Pediatric Dosing
Neonatal:
Not typically used as initial fluid due to high osmolarity. May be used in specific cases for persistent hypoglycemia or as part of TPN, at rates providing 4-8 mg/kg/min of glucose (e.g., 1.2-2.4 mL/kg/hour of D20 for 4-8 mg/kg/min). Close monitoring of blood glucose is critical.
Infant:
Highly individualized. For caloric support or persistent hypoglycemia, rates typically range from 5-10 mg/kg/min (e.g., 1.5-3 mL/kg/hour of D20). Close monitoring of blood glucose and electrolytes is essential.
Child:
Highly individualized. For caloric support or persistent hypoglycemia, rates typically range from 5-10 mg/kg/min (e.g., 1.5-3 mL/kg/hour of D20). Close monitoring of blood glucose and electrolytes is essential.
Adolescent:
Highly individualized. For caloric support or persistent hypoglycemia, rates typically range from 5-10 mg/kg/min (e.g., 1.5-3 mL/kg/hour of D20). Close monitoring of blood glucose and electrolytes is essential.
Dose Adjustments
Renal Impairment:
Mild:
Use with caution; monitor fluid balance, electrolytes, and blood glucose closely.
Moderate:
Use with caution; monitor fluid balance, electrolytes, and blood glucose closely to avoid fluid overload and electrolyte disturbances.
Severe:
Use with caution; monitor fluid balance, electrolytes, and blood glucose closely to avoid fluid overload and electrolyte disturbances. Dosage adjustments are not for dextrose metabolism but for fluid management.
Dialysis:
Considerations for fluid and electrolyte balance are paramount. Dextrose may be used, but close monitoring of blood glucose and fluid status is required.
Hepatic Impairment:
Mild:
No specific adjustment typically needed, but monitor blood glucose.
Moderate:
Use with caution; monitor blood glucose and electrolytes closely due to potential for impaired glucose metabolism.
Severe:
Use with caution; monitor blood glucose and electrolytes closely due to potential for impaired glucose metabolism and fluid/electrolyte imbalances.
Pharmacology
Mechanism of Action
Dextrose is a monosaccharide that provides a source of calories and raises blood glucose levels. It is readily metabolized by the body's tissues, providing energy and sparing protein. It also contributes to fluid volume and can induce diuresis depending on concentration and infusion rate.
Pharmacokinetics
Absorption:
Bioavailability:
100% (intravenous administration)
Tmax:
Immediate (upon infusion)
FoodEffect:
Not applicable (IV administration)
Distribution:
Vd:
Approximately total body water (0.6 L/kg)
ProteinBinding:
Negligible
CnssPenetration:
Yes (glucose is actively transported into the brain)
Elimination:
HalfLife:
Not applicable (continuously metabolized)
Clearance:
Rapid (consumed by metabolism)
ExcretionRoute:
Carbon dioxide (exhaled) and water (renal, insensible losses)
Unchanged:
0% (metabolized)
Pharmacodynamics
OnsetOfAction:
Rapid (within minutes of infusion)
PeakEffect:
Dependent on infusion rate and patient's metabolic demand
DurationOfAction:
Dependent on infusion rate and patient's metabolic demand
Confidence:
Medium
Safety & Warnings
Side Effects
Urgent Side Effects: Seek Medical Help Right Away
While rare, some people may experience severe and potentially life-threatening side effects when taking this medication. If you notice any of the following symptoms, contact your doctor or seek immediate medical attention:
Signs of an allergic reaction, such as:
+ Rash
+ Hives
+ Itching
+ Red, swollen, blistered, or peeling skin with or without fever
+ Wheezing
+ Tightness in the chest or throat
+ Trouble breathing, swallowing, or talking
+ Unusual hoarseness
+ Swelling of the mouth, face, lips, tongue, or throat
Severe dizziness or fainting
Signs of fluid and electrolyte problems, including:
+ Mood changes
+ Confusion
+ Muscle pain or weakness
+ Fast or abnormal heartbeat
+ Severe dizziness or fainting
+ Increased thirst
+ Seizures
+ Feeling very tired or weak
+ Decreased appetite
+ Unable to pass urine or changes in urine production
+ Dry mouth
+ Dry eyes
+ Severe stomach upset or vomiting
Blue or gray discoloration of the skin, lips, nail beds, fingers, or toes
Fever or chills
Shortness of breath, sudden weight gain, or swelling in the arms or legs
* Pain and irritation at the injection site
Other Possible Side Effects
Like all medications, this drug can cause side effects. Many people may not experience any side effects or may only have mild ones. If you have any side effects that bother you or do not go away, contact your doctor for advice.
Not all possible side effects are listed here. If you have questions or concerns about side effects, talk to your doctor. You can also report side effects to the FDA at 1-800-332-1088 or online at https://www.fda.gov/medwatch.
While rare, some people may experience severe and potentially life-threatening side effects when taking this medication. If you notice any of the following symptoms, contact your doctor or seek immediate medical attention:
Signs of an allergic reaction, such as:
+ Rash
+ Hives
+ Itching
+ Red, swollen, blistered, or peeling skin with or without fever
+ Wheezing
+ Tightness in the chest or throat
+ Trouble breathing, swallowing, or talking
+ Unusual hoarseness
+ Swelling of the mouth, face, lips, tongue, or throat
Severe dizziness or fainting
Signs of fluid and electrolyte problems, including:
+ Mood changes
+ Confusion
+ Muscle pain or weakness
+ Fast or abnormal heartbeat
+ Severe dizziness or fainting
+ Increased thirst
+ Seizures
+ Feeling very tired or weak
+ Decreased appetite
+ Unable to pass urine or changes in urine production
+ Dry mouth
+ Dry eyes
+ Severe stomach upset or vomiting
Blue or gray discoloration of the skin, lips, nail beds, fingers, or toes
Fever or chills
Shortness of breath, sudden weight gain, or swelling in the arms or legs
* Pain and irritation at the injection site
Other Possible Side Effects
Like all medications, this drug can cause side effects. Many people may not experience any side effects or may only have mild ones. If you have any side effects that bother you or do not go away, contact your doctor for advice.
Not all possible side effects are listed here. If you have questions or concerns about side effects, talk to your doctor. You can also report side effects to the FDA at 1-800-332-1088 or online at https://www.fda.gov/medwatch.
Seek Immediate Medical Attention If You Experience:
- Unusual thirst or increased urination (signs of high blood sugar)
- Fatigue or confusion
- Swelling in your hands, feet, or ankles (signs of fluid overload)
- Difficulty breathing or shortness of breath
- Pain, redness, or swelling at the injection site
Before Using This Medicine
Before Taking This Medication: Important Information to Share with Your Doctor
It is essential to inform your doctor about the following:
Any allergies you have, including allergies to this medication, its components, or other substances, such as foods or drugs. Be sure to describe the allergic reaction you experienced, including any symptoms that occurred.
Certain health conditions, including:
+ Bleeding in the brain or spine
+ Severe dehydration
+ Severe liver problems
+ Difficulty urinating
This list is not exhaustive, and it is crucial to discuss all your health problems with your doctor.
Additionally, provide your doctor and pharmacist with a comprehensive list of all the medications you are taking, including:
Prescription medications
Over-the-counter (OTC) medications
Natural products
Vitamins
It is vital to verify that it is safe to take this medication with all your other medications and health conditions. Never start, stop, or change the dose of any medication without first consulting your doctor.
It is essential to inform your doctor about the following:
Any allergies you have, including allergies to this medication, its components, or other substances, such as foods or drugs. Be sure to describe the allergic reaction you experienced, including any symptoms that occurred.
Certain health conditions, including:
+ Bleeding in the brain or spine
+ Severe dehydration
+ Severe liver problems
+ Difficulty urinating
This list is not exhaustive, and it is crucial to discuss all your health problems with your doctor.
Additionally, provide your doctor and pharmacist with a comprehensive list of all the medications you are taking, including:
Prescription medications
Over-the-counter (OTC) medications
Natural products
Vitamins
It is vital to verify that it is safe to take this medication with all your other medications and health conditions. Never start, stop, or change the dose of any medication without first consulting your doctor.
Precautions & Cautions
It is essential to inform all your healthcare providers, including doctors, nurses, pharmacists, and dentists, that you are taking this medication. Regular blood tests will be necessary, as directed by your doctor, to monitor your condition. Discuss any concerns or questions you have with your doctor.
This medication may contain aluminum, which can increase the risk of aluminum toxicity with long-term use. This risk is higher if you have kidney problems or are a premature infant. Your doctor will need to monitor you closely to minimize this risk.
In some cases, this medication may be mixed with parenteral nutrition (PN). However, PN has been associated with serious complications, including blood clots in the lungs, infections, high blood sugar, and liver problems. In rare instances, these complications can be fatal. If you have any questions or concerns about PN, discuss them with your doctor.
When used in newborns, this medication requires careful monitoring. Your doctor will need to assess the potential benefits and risks of using this medication in this population.
If you are pregnant, planning to become pregnant, or breastfeeding, inform your doctor. They will help you weigh the benefits and risks of using this medication to ensure the best possible outcome for you and your baby.
This medication may contain aluminum, which can increase the risk of aluminum toxicity with long-term use. This risk is higher if you have kidney problems or are a premature infant. Your doctor will need to monitor you closely to minimize this risk.
In some cases, this medication may be mixed with parenteral nutrition (PN). However, PN has been associated with serious complications, including blood clots in the lungs, infections, high blood sugar, and liver problems. In rare instances, these complications can be fatal. If you have any questions or concerns about PN, discuss them with your doctor.
When used in newborns, this medication requires careful monitoring. Your doctor will need to assess the potential benefits and risks of using this medication in this population.
If you are pregnant, planning to become pregnant, or breastfeeding, inform your doctor. They will help you weigh the benefits and risks of using this medication to ensure the best possible outcome for you and your baby.
Overdose Information
Overdose Symptoms:
- Severe hyperglycemia (very high blood sugar) leading to dehydration, osmotic diuresis, confusion, and potentially hyperosmolar hyperglycemic state (HHS) or coma.
- Fluid overload (hypervolemia) leading to edema, pulmonary edema, and heart failure.
- Electrolyte imbalances (e.g., hypokalemia, hypophosphatemia).
What to Do:
Immediate medical attention is required. Management includes discontinuing the infusion, administering insulin to lower blood glucose, diuretics to manage fluid overload, and correcting electrolyte imbalances. Call 911 or your local emergency number immediately. For poison control, call 1-800-222-1222.
Drug Interactions
Major Interactions
- Insulin (pharmacodynamic antagonism if not carefully managed, requires dose adjustment of insulin)
- Diuretics (especially loop diuretics, can affect electrolyte balance, particularly potassium and phosphate, requiring close monitoring)
Moderate Interactions
- Corticosteroids (can increase blood glucose levels, requiring closer monitoring of glucose)
Monitoring
Baseline Monitoring
Blood Glucose
Rationale: To establish baseline and guide initial infusion rate.
Timing: Prior to initiation of therapy.
Serum Electrolytes (Na, K, Cl, Mg, Phos)
Rationale: To assess baseline electrolyte status and identify potential imbalances.
Timing: Prior to initiation of therapy.
Renal Function (BUN, Creatinine)
Rationale: To assess kidney function, which impacts fluid and electrolyte balance.
Timing: Prior to initiation of therapy.
Fluid Status (Weight, I&O)
Rationale: To assess baseline hydration and guide fluid management.
Timing: Prior to initiation of therapy.
Routine Monitoring
Blood Glucose
Frequency: Every 1-6 hours initially, then daily or as clinically indicated once stable.
Target: 70-180 mg/dL (individualized based on patient condition)
Action Threshold: Values outside target range; adjust infusion rate or administer insulin/glucose as needed.
Serum Electrolytes (Na, K, Cl, Mg, Phos)
Frequency: Daily or every 2-3 days, or as clinically indicated.
Target: Normal physiological ranges
Action Threshold: Significant deviations from normal; supplement or adjust fluid/electrolyte therapy.
Fluid Balance (Intake & Output, Daily Weight)
Frequency: Daily
Target: Appropriate fluid balance, stable weight
Action Threshold: Significant positive or negative fluid balance, rapid weight changes; adjust fluid rate.
Signs of Fluid Overload (e.g., edema, dyspnea)
Frequency: Continuously
Target: Absence of signs
Action Threshold: Presence of signs; reduce infusion rate, administer diuretics if indicated.
Symptom Monitoring
- Signs of hyperglycemia (e.g., polyuria, polydipsia, fatigue, blurred vision, dehydration)
- Signs of fluid overload (e.g., peripheral edema, pulmonary edema, dyspnea, crackles)
- Signs of electrolyte imbalance (e.g., muscle weakness, cramps, arrhythmias, confusion)
- Signs of phlebitis or irritation at infusion site (e.g., pain, redness, swelling)
Special Patient Groups
Pregnancy
Category C. Generally considered safe when indicated for fluid, caloric, or electrolyte replacement, but close monitoring of maternal blood glucose is crucial to avoid hyperglycemia, which can be associated with adverse fetal outcomes (e.g., macrosomia, neonatal hypoglycemia).
Trimester-Specific Risks:
First Trimester:
No specific increased risk identified beyond general hyperglycemia risks.
Second Trimester:
Monitor for hyperglycemia; uncontrolled maternal hyperglycemia can affect fetal growth.
Third Trimester:
Monitor for hyperglycemia; uncontrolled maternal hyperglycemia can affect fetal growth and lead to neonatal hypoglycemia post-delivery.
Lactation
L1 (Compatible with breastfeeding). Dextrose is a natural component of breast milk and is generally considered safe for use during lactation when administered appropriately. Monitor infant for signs of hyperglycemia if maternal intake is excessive, though unlikely with therapeutic use.
Infant Risk:
Low risk to infant.
Pediatric Use
Dosing is highly individualized based on weight, age, metabolic needs, and clinical condition. Neonates and infants are particularly susceptible to fluid and glucose imbalances. Close monitoring of blood glucose, fluid balance, and electrolytes is essential to prevent hyperglycemia, hypoglycemia, and fluid overload.
Geriatric Use
Use with caution in elderly patients due to increased susceptibility to fluid overload, electrolyte imbalances, and impaired glucose tolerance. Start with lower infusion rates and monitor blood glucose, fluid status, and electrolytes closely.
Clinical Information
Clinical Pearls
- Dextrose 20% is a hypertonic solution (~680 mOsm/L). It should ideally be administered via a central venous catheter to minimize the risk of vein irritation, phlebitis, and extravasation, especially for prolonged infusions.
- Rapid infusion of Dextrose 20% can lead to hyperglycemia, osmotic diuresis, and fluid shifts, potentially causing dehydration or electrolyte disturbances.
- Always monitor blood glucose levels frequently, particularly in diabetic patients, critically ill patients, or those receiving high infusion rates, to prevent hyperglycemia or rebound hypoglycemia.
- Electrolyte imbalances, such as hypokalemia, hypophosphatemia, and hypomagnesemia, can occur as glucose is metabolized and shifts electrolytes intracellularly. Supplementation may be required.
- Dextrose solutions are not suitable for primary fluid replacement in dehydrated patients without adequate electrolyte supplementation, as they do not contain sufficient electrolytes to replace losses.
- Ensure patency of the IV line and observe for signs of infiltration or phlebitis at the infusion site.
Alternative Therapies
- Oral glucose (for conscious patients with mild to moderate hypoglycemia)
- Glucagon (for severe hypoglycemia when IV access is not available)
- Other parenteral nutrition components (e.g., lipid emulsions, amino acid solutions for caloric and protein support)
Cost & Coverage
Average Cost:
Price varies widely by supplier, volume, and contract. Typically inexpensive. per 500ml bag
Generic Available:
Yes
Insurance Coverage:
Generally covered by most insurance plans as a necessary medical supply for inpatient or outpatient use.
General Drug Facts
If your symptoms or health problems persist or worsen, it is essential to contact your doctor for further guidance. To ensure safe use, never share your medication with others, and do not take medication prescribed for someone else. Store all medications in a secure location, out of reach of children and pets, to prevent accidental ingestion. Dispose of unused or expired medications properly. Unless instructed to do so by a healthcare professional, do not flush medications down the toilet or pour them down the drain. If you are unsure about the proper disposal method, consult your pharmacist for advice. Many communities have drug take-back programs, which your pharmacist can help you locate. Some medications may come with an additional patient information leaflet; check with your pharmacist to see if this applies to your prescription. If you have any questions or concerns about your medication, discuss them with your doctor, nurse, pharmacist, or other healthcare provider. In the event of a suspected overdose, immediately contact your local poison control center or seek emergency medical attention. Be prepared to provide information about the medication taken, the amount, and the time it was taken to ensure prompt and effective treatment.