Dextrose + Sodium Chloride

Usage

Dextrose + Sodium Chloride injection is a sterile, nonpyrogenic solution administered intravenously for fluid and electrolyte replenishment and caloric supply. It is prescribed for treating conditions like dehydration, hypoglycemia, and providing a source of calories when oral intake is not possible. It also serves as a vehicle for administering compatible IV medications. Its pharmacological classifications include: fluid expander, electrolyte replenisher, and carbohydrate source. The mechanism of action involves providing a source of glucose for energy and correcting fluid and electrolyte imbalances.

Alternate Names

Dextrose and Sodium Chloride Injection, USP; Dextrose-Saline; D/S (although this abbreviation requires specific concentration details); D5NS (for 5% dextrose in 0.9% Sodium Chloride). Brand names vary depending on the manufacturer. Examples include, but aren’t limited to, products marketed by Baxter and others.

How It Works

Pharmacodynamics: Dextrose provides a readily available energy source, raising blood glucose levels. Sodium chloride replenishes extracellular fluid and maintains osmotic pressure.

Pharmacokinetics: Dextrose is rapidly metabolized to carbon dioxide and water. Sodium chloride dissociates into sodium and chloride ions, which are distributed throughout the extracellular fluid. Elimination primarily occurs through renal excretion, with some sodium regulation through aldosterone.

Mode of Action: Dextrose increases blood glucose levels, while sodium chloride restores electrolyte balance. There is no receptor binding, enzyme inhibition, or neurotransmitter modulation associated with this solution. It is metabolized through glycolysis and eliminated through renal excretion.

Dosage

Standard Dosage

Adults: Dosage is determined by a physician based on individual patient needs. Typical range is 500–3000 mL/24 hours.

Children: Dosage is based on weight and clinical condition. A common range is 20–100 mL/kg/24 hours. Careful monitoring for hyperglycemia and hypoglycemia is crucial, particularly in neonates and low birth weight infants.

Special Cases:

• Elderly Patients: Dosage adjustments based on organ function and fluid balance are necessary.
• Patients with Renal Impairment: Reduced dosages and close monitoring of fluid and electrolyte balance are critical.
• Patients with Hepatic Dysfunction: Adjustments are typically not required as dextrose metabolism doesn’t primarily occur in the liver.
• Patients with Comorbid Conditions: Individualized dosing based on specific conditions like diabetes mellitus and cardiovascular disease is necessary.

Clinical Use Cases:

Dosage in these settings is patient-specific and guided by clinical status and lab values:

• Intubation: Used to maintain hydration and electrolyte balance.
• Surgical Procedures: Pre-, intra-, and postoperative fluid management.
• Mechanical Ventilation: To maintain hydration.
• Intensive Care Unit (ICU) Use: Fluid and electrolyte management.
• Emergency Situations: Rapid fluid resuscitation in hypovolemic shock.

Dosage Adjustments: Dose modifications are based on patient factors like renal/hepatic function, metabolic disorders, and fluid balance.

Side Effects

Common Side Effects:

Fever, infection at the injection site, venous thrombosis, phlebitis, extravasation, and hypervolemia.

Rare but Serious Side Effects:

Severe allergic reactions (anaphylaxis), pulmonary edema, electrolyte imbalances (e.g., hyponatremia, hypernatremia), and cerebral edema.

Long-Term Effects:

With prolonged use, monitor for electrolyte imbalances and fluid overload.

Adverse Drug Reactions (ADR):

Anaphylaxis, severe electrolyte disturbances.

Contraindications

Hypersensitivity to dextrose or sodium chloride, clinically significant hyperglycemia. Use caution in patients with congestive heart failure, severe renal insufficiency, edema with sodium retention, and known allergy to corn or corn products.

Drug Interactions

May interact with corticosteroids, corticotropin, and diuretics. Monitor glucose and electrolyte levels when using concurrently with other drugs affecting glycemic control or electrolyte balance.

Pregnancy and Breastfeeding

Consult a physician before administering to pregnant or breastfeeding women. While it’s generally safe, fetal/neonatal monitoring for hyperglycemia and hypoglycemia may be necessary.

Drug Profile Summary

• Mechanism of Action: Provides fluids, electrolytes, and calories; supports electrolyte balance.
• Side Effects: Injection site reactions, fluid overload, electrolyte imbalances.
• Contraindications: Hypersensitivity, hyperglycemia, severe dehydration.
• Drug Interactions: Corticosteroids, corticotropin, diuretics.
• Pregnancy & Breastfeeding: Consult a physician before use.
• Dosage: Variable, depending on the patient’s condition and age.
• Monitoring Parameters: Electrolytes (sodium, potassium, chloride), blood glucose, renal function, fluid balance.

Popular Combinations

Combined with potassium chloride for patients needing potassium supplementation.

Precautions

Monitor fluid balance, electrolyte levels, and blood glucose, especially in patients with renal/hepatic impairment, diabetes, or cardiovascular disease. Adjust dose as needed. Exercise caution when administering to patients receiving corticosteroids or corticotropin.

FAQs (Frequently Asked Questions)

Q1: What is the recommended dosage for Dextrose + Sodium Chloride?

A: Dosage is individualized based on patient age, weight, and clinical condition. Adults typically receive 500-3000 mL/24 hours; children 20-100 mL/kg/24 hours.

Q2: How should Dextrose + Sodium Chloride be administered?

A: Strictly intravenous administration using sterile equipment.

Q3: What are the signs of an adverse reaction?

A: Difficulty breathing, swelling, severe rash, chest pain, dizziness, or seizures.

Q4: Can Dextrose + Sodium Chloride be used in patients with diabetes?

A: Use with caution; monitor blood glucose closely.

Q5: What are the key electrolytes to monitor during infusion?

A: Sodium, potassium, and chloride.

Q6: Can this solution be mixed with other medications?

A: Compatibility should be checked before admixing any medication.

Q7: Is it necessary to adjust the dosage for elderly patients?

A: Yes, adjustments are usually needed based on kidney function and overall health status.

Q8: What are the storage recommendations for Dextrose + Sodium Chloride?

A: Store at room temperature, away from excessive heat and light. Do not freeze.

Q9: Are there specific considerations for administering to neonates?

A: Yes, careful monitoring of blood glucose is critical due to the risk of hypoglycemia or hyperglycemia. Infusion rates should be adjusted based on glucose tolerance.