Saline 0.18%/dextrose

A. Wright, and J. Hecker, Long term stability of heparin in dextrose saline intravenous fluids. Int. J. Pharmacol. Pract. 3 253-255, 1995. 

An early Phase I clinical evaluation indicated dose-related nephrotoxicity and this has led to much caution in dosage (19). At least one death from kidney failure has been reported. Maintaining adequate diuresis with 5% dextrose/saline may reduce the risk of nephrotoxicity. 

The majority of early treatment regimes used excessively high doses of EDTA, administered by rapid intravenous infusion, and this resulted in a number of cases of serious nephrotoxicity. The general rule today is that a patient should not receive more than 3 g of EDTA or DTPA within a 24 hour time period this corresponds to —40 mg ( — 150 pmol) of EDTA kg of body weight for a 70 kg subject. In practice a dose of 1 g day of either EDTA or DTPA would be more usual this corresponds to —50 and —30 pmol kg , respectively. The agent is administered by intravenous infusion, in a vehicle such as 5% dextrose-saline, over a period of several hours. 

Das Gupta, V. Stewart, K.R. Stability of cefuroxime sodium in some aqueous buffered solutions and intravenous admixtures. J.Clin.Hosp.Pharm., 1986, 11, 47-54 [5% dextrose saline stability-indicating simultaneous degradation products cefazolin (IS)]... 

Elliott, G.T. McKenzie, M.W. Curry, S.H. Pieper, J.A. Quinn, S.L. Stability of cimetidine hydrochloride in admixtures after microwave thawing. Am.J.Hosp.Pharm., 1983, 40, 1002—1006 [stabilily-indicat-ing 5% dextrose saline]... 

Waugh, W.N. Trissel, L.A. Stella, V.J. Stability, compatibility, and plasticizer extraction of taxol (NSC-125973) injection diluted in infusion solutions and stored in various containers. Am.J.Hosp.Pharm., 1991, 48, 1520-1524 [stability-indicating simultaneous degradation products injections 5% dextrose saline]... 

These include dextrose, saline, and lactated Ringer s solution. 

VII. Formulations. Norepinephrine bitartrate is rapidly oxidized on exposure to air it must be kept in its airtight ampule until immediately before use. If the solution appears brown or contains a precipitate, do not use it. The stock solution must be diluted in 5% dextrose or 5% dextrose-saline for infusion usually, a 4-mg ampule is added to 1 L of fluid to provide 4 mcg/mL of solution. 

Septicaemia from prolonged intravenous infusions is a well-known complication and it has therefore been generally accepted that infusion sets should not be used longer than 24 hours (maximum 48 hours). Intravenous systems used for over 48 hours have been shown to increase the risk of contamination by 15% as compared with systems in use for less than 48 hours (3%) (12 ). Four cases of septicaemia in children receiving Lv. infusion (5% dextrose-saline) have been observed, all caused by Pseudomonas cepacia contamination (13 ). The isolated strains were sensitive to sulfonamides, co-trimoxazole and chloramphenicol,- but resistant to gentamicin, polymyxin B and other antibiotics. One patient died after a long and comphcated post-operative period. The other 3 recovered after chloramphenicol therapy within 2 weeks. 

Cytembena is a hydrolytic product of the crotonolactones. These have been shown to be effective against a wide range of animal tumours and have been tried in phase I studies against such tumours as adenocarcinoma. It is prepared as a white powder which is soluble in distilled water, physiological saline or dextrose saline and can be given slowly into a freely running intravenous solution. 

Energy substrates include dextrose solutions and fat emulsion. Solutions used to supply energy and fluid include dextrose (glucose) in water or sodium chloride, alcohol in dextrose, and IV fat emulsion. Dextrose is a carbohydrate used to provide a source of calories and fluid. Alcohol (as alcohol in dextrose) also provides calories. Dextrose is available in various strengths (or percent of the carbohydrate) in a fluid, which may be water or sodium chloride (saline). Dextrose and dextrose in alcohol are available in various strengths (or percent of the carbohydrate and percent of the alcohol) in water. Dextrose solutions also are available with electrolytes, for example, Plasma-Lyte 56 and 5% Dextrose. Calories provided by dextrose and dextrose and alcohol solutions are listed in Table 58-1. 

Sodium is essential for the maintenance of normal heart action and in the regulation of osmotic pressure in body cells. Sodium, as sodium chloride (NaCl), may be given IV. A solution containing 0.9% NaCl is called normal saline, and a solution containing 0.45% NaCl is called half-normal saline. Sodium also is available combined with dextrose, for example, dextrose 5% and sodium chloride 0.9%. 

Parenteral product should be mixed with saline instead of dextrose diluents... 

Change to hypotonic saline or dextrose 5% in water to correct free water deficit once intravascular replete ° Primarily water depletion... 

Hypotonic solution such as dextrose 5% and 1/2 normal saline or similar fluid... 

In patients presenting with acute adrenal crisis who have not been diagnosed previously with adrenal insufficiency, immediate treatment with injectable hydrocortisone and intravenous saline and dextrose solutions should be initiated prior to confirmation of the diagnosis because of the life-threatening nature of this condition. Determine and correct the underlying cause of the acute adrenal crisis (e.g., infection). 

Promptly correct volume depletion, dehydration, and hypoglycemia with large volumes of intravenous normal saline and 5% dextrose (about 2-3 L). 

Vigorous intravenous hydration with dextrose 5% in water with half-normal saline at 3 L/m2 per day to maintain a urine output of 100 mL/m2 per hour or more is necessary, unless the patient presents with acute renal dysfunction. Alkalinization of the urine to a pH of 7.0 or more with 50 to 100 mEq/L of sodium bicarbonate has been used to promote uric acid solubility for excretion. This measure is controversial because xanthine and hypoxanthine are less soluble at alkaline pH, potentially leading to crystallization, especially during and after allopurinol therapy32 (see Fig. 96-6). Medications that increase serum... 

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. 

Large-volume parenterals designed to provide fluid (water), calories (dextrose solutions), electrolytes (saline solutions), or combinations of these materials have been described. Several other specialized LVP and sterile solutions are also used in medicine and will be described here, even though two product classes (peritoneal dialysis and irrigating solutions) are not parenteral products. 

Streptokinase 1.5 million units in 50 mL of normal saline or 5% dextrose in water IV over 60 minutes. 

Crystalloids consist of electrolytes (e.g., Na+, Cl-, K1) in water solutions, with or without dextrose. Lactated Ringer s solution may be preferred because it is unlikely to cause the hyperchloremic metabolic acidosis seen with infusion of large amounts of normal saline. 

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