Dextrose administration

Metabolic stress, infection, corticosteroids, pancreatitis, diabetes mellitus, peritoneal dialysis, excessive dextrose administration Abrupt dextrose withdrawal, excessive insulin Excess dextrose administration... 

Moursi M, Rising C L, Zelenock G B et al 1987 Dextrose administration exacerbates acute renal ischemic damage in anesthetized dogs. Archives of Surgery 122 ... 

Iodized Salt. Iodized table salt has been used to provide supplemental iodine to the U.S. population since 1924, when producers, in cooperation with the Michigan State Medical Society (24), began a voluntary program of salt iodization in Michigan that ultimately led to the elimination of iodine deficiency in the United States. More than 50% of the table salt sold in the United States is iodized. Potassium iodide in table salt at levels of 0.006% to 0.01% KI is one of two sources of iodine for food-grade salt approved by the U.S. Food and Dmg Administration. The other, cuprous iodide, is not used by U.S. salt producers. Iodine may be added to a food so that the daily intake does not exceed 225 p.g for adults and children over four years of age. Potassium iodide is unstable under conditions of extreme moisture and temperature, particularly in an acid environment. Sodium carbonate or sodium bicarbonate is added to increase alkalinity, and sodium thiosulfate or dextrose is added to stabilize potassium iodide. Without a stabilizer, potassium iodide is oxidized to iodine and lost by volatilization from the product. Potassium iodate, far more stable than potassium iodide, is widely used in other parts of the world, but is not approved for use in the United States. 

Combined electrolyte solutions are available for oral and IV administration. The IV solutions contain various electrolytes and dextrose. The amount of electrolytes, given as milliequivalents per liter (mEq/L), also varies. The IV solutions are used to replace fluid and electrolytes that have been lost and to provide calories by means of their carbohydrate content. Examples of IV electrolyte solutions are dextrose 5% with 0.9% NaCl, lactated Ringer s injection, Plasma-Lyte, and 10% Travert (invert sugar—a combination of equal parts of fructose and dextrose) and Electrolyte No. 2. 

Hyperglycemia is the most common metabolic complication. A too rapid infuson of amino add-carbohydrate mixtures may result in hyperglycemia, glycosuria, mental confuson, and loss of consciousness Blood glucose levels may be obtained every 4 to 6 hours to monitor for hyperglycemia and guide the dosage of dextrose and insulin (if required). To minimize these complications the primary health care provider may decrease the rate of administration, reduce the dextrose concentration, or administer insulin. 

To prevent a rebound hypoglycemic reaction from the sudden withdrawal of TPN containing a concentrated dose of dextrose, the rate of administration is slowly reduced or the concentration of dextrose gradually decreased. If TPN must be abruptly withdrawn, a solution of 5% or 10% dextrose is begun to gradually reduce the amount of dextrose administered. 

In patients with peritonitis, hypovolemia is often accompanied by acidosis, so large volumes of a solution such as lac-tated Ringers may be required initially to restore intravascular volume. Maintenance fluids should be instituted (after intravascular volume is restored) with 0.9% sodium chloride and potassium chloride (20 mEq/L) or 5% dextrose and 0.45% sodium chloride with potassium chloride (20 mEq/L). The administration rate should be based on estimated daily fluid loss through urine and nasogastric suction, including 0.5 to 1.0 L for insensible fluid loss. Potassium would not be included routinely if the patient is hyperkalemic or has renal insufficiency. Aggressive fluid therapy often must be continued in the postoperative period because fluid will continue to sequester in the peritoneal cavity, bowel wall, and lumen. 

Hepatic steatosis usually is a result of excessive administration of carbohydrates and/or lipids, but deficiencies of carnitine, choline, and essential fatty acids also may contribute. Hepatic steatosis can be minimized or reversed by avoiding overfeeding, especially from dextrose and lipids.35,38 Carnitine is an important amine that transports long-chain triglycerides into the mitochondria for oxidation, but carnitine deficiency in adults is extremely rare and is mostly a problem in premature infants and patients receiving chronic dialysis. Choline is an essential amine required for synthesis of cell membrane components such as phospholipids. Although a true choline deficiency is rare, preliminary studies of choline supplementation to adult patients PN caused reversal of steatosis. 

Factors that can predispose patients to developing metabolic bone disease include deficiencies of phosphorus, calcium, and vitamin D vitamin D and/or aluminum toxicity amino acids and hypertonic dextrose infusions chronic metabolic acidosis corticosteroid therapy and lack of mobility.35,39 Calcium deficiency (due to decreased intake or increased urinary excretion) is one of the major causes of metabolic bone disease in patients receiving PN. Provide adequate calcium and phosphate with PN to improve bone mineralization and help to prevent metabolic bone disease. Administration of amino acids and chronic metabolic acidosis also appear to play an important role. Provide adequate amounts of acetate in PN admixtures to maintain acid-base balance. 

Few tablets intended for oral administration are totally soluble in aqueous media, but if such a product is needed, then soluble excipients are employed. These include dextrose, lactose, mannitol, and sodium chloride, with the last of these sometimes acting as its own lubricant. Urea may also be used, but due to its known pharmacological effects, it is less desirable than the other soluble compounds cited. 

Commonly administered LVPs include such products as Lactated Ringers Injection USP, Sodium Chloride Injection USP (0.9%), which replenish fluids and electrolytes, and Dextrose Injection USP (5%), which provides fluid plus nutrition (calories), or various combinations of dextrose and saline. In addition, numerous other nutrient and ionic solutions are available for clinical use, the most popular of which are solutions of essential amino acids or lipid emulsions. These solutions are modified to be hypertonic, isotonic, or hypotonic to aid in maintaining both fluid, nutritional, and electrolyte balance in a particular patient according to need. Indwelling needles or catheters are required in LVP administration. Care must be taken to avoid local or systemic infections or thrombophlebitis owing to faulty injection or administration technique. 

Patient case A patient s daily nutritional requirements have been estimated to be 100 g protein and 2,000 total kcal. The patient has a central venous access and reports no history of hyperlipidemia or egg allergy. The patient is not fluid restricted. The PN solution will be compounded as an individualized regimen using a single-bag, 24-hour infusion of a 2-in-1 solution with intravenous fat emulsion (IVFE) piggybacked into the PN infusion line. Determine the total PN volume and administration rate by calculating the macronutrient stock solution volumes required to provide the desired daily nutrients. The stock solutions used to compound this regimen are 10% crystalline amino acids (CAA), 70% dextrose, and 20% IVFE. 

Rapid correction of hyperkalemia requires administration of drugs that shift potassium intracellularly (e.g., insulin and dextrose, sodium bicarbonate, or albuterol). 

The characteristics of the fluid to be injected will also influence the choice of parenteral routes. The drug must be compatible with other fluids (e.g., saline, dextrose, Ringer s lactate) with which it may be combined for administration to the patient, as well as with the components of the blood itself. 

IV administration - Do not exceed 1.5 mL/min of a 10% concentration (or its equivalent), except in cases of severe eclampsia with seizures. Dilute IV infusion solutions to a concentration of 20% or less prior to IV administration. The most commonly used diluents are 5% dextrose injection and 0.9% sodium chloride Injection. 

Initial dose - 1 to 2 mEq/kg/min given over 1 to 2 minutes followed by 1 mEq/kg every 10 minutes of arrest. If base deficit is known, give calculated dose of 0.3 X kg X base deficit. If only 7.5% or 8.4% sodium bicarbonate is available, dilute 1 1 with 5% dextrose in water before administration. 

IV filters Some in-line IV filters also absorb nitroglycerin avoid these filters. Hemolysis/Pseudoagglutination Do not administer solutions containing dextrose without electrolytes through the same administration set as blood because this may result in pseudoagglutination or hemolysis. 

Administration - The loading dose of aminophylline can be given by very slow IV push or, more conveniently, may be infused in a small guantity (usually 100 to 200 mL) of 5% Dextrose Injection or 0.9% Sodium Chloride Injection. Do not exceed the rate of 25 mg/min. Thereafter, maintenance therapy can be administered by a large volume infusion to deliver the desired amount of drug each hour. Aminophylline is compatible with most commonly used IV solutions. Oral therapy should be substituted for intravenous aminophylline as soon as adeguate improvement is achieved. 

Do not administer esomeprazole IV concomitantly with any other medications through the same IV site and/or tubing. Always flush the IV line with 0.9% sodium chloride injection, lactated Ringer s injection, or 5% dextrose injection, both prior to and after administration of esomeprazole IV. 

IV administration - Administer over approximately 30 minutes. Reconstitute with 50 or 100 ml of a compatible IV fluid. Cefepime is compatible at concentrations of 1 to 40 mg/mL with 0.9% Sodium Chloride Injection, 5% and 10% Dextrose Injection, M/6 Sodium Lactate Injection, 5% Dextrose and 0.9% Sodium Chloride Injection, Lactated Ringers and 5% Dextrose Injection, Normosol-R or Normosol-M in 5% Dextrose injection. 

IM administration Reconstitute cefepime with the following diluents Sterile Water for Injection, 0.9% Sodium Chloride, 5% Dextrose Injection, 0.5% or 1 % lidocaine hydrochloride, or Sterile Bacteriostatic Water for Injection with parabens or benzyl alcohol. 

Do not add additives or other medications to IV moxifloxacin or infuse simultaneously through the same IV line. If the same IV line is used for sequential infusion of other drugs, or if the piggyback method of administration is used, flush the line before and after infusion of moxifloxacin IV with a compatible solution. Moxifloxacin IV is compatible with the following IV solutions at ratios from 1 10 to 10 1 0.9% sodium chloride injection, IM sodium chloride injection, 5% dextrose injection, sterile water for injection, 10% dextrose for injection, Lactated Ringer s for injection. 

IV administration Administer over a period of 30 to 120 minutes. Do not use IV infusion bag in series connections. Do not introduce additives into this solution. Do not administer concomitantly with another drug administer each drug separately. Compatible IV solutions 5% dextrose injection, 0.9% sodium chloride injection lactated Ringer s injection. 

C. Hypoglycaemia may occur as gluconeogenesis is reduced in the liver. 10% dextrose by central venous administration is needed, usually with extra potassium. 

Tonicity agents are added to injectable preparations to prevent osmotic shock at the site of injection upon administration, and thereby reduce local irritation. Typical excipients used for tonicity adjustment include saline, glycerin, mannitol, dextrose, and trehalose. Tonicity is a colligative property that depends primarily on the number of dissolved particles in solution. Hence, the amount of tonicity agent to be added depends on the specific formulation. Typically, osmolality of 280 to 320mOsm is considered iso-osmotic. 

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