Since the tolerance of glucose (dextrose) may be impaired in patients with diabetes mellitus, renal insufficiency or in an acute critical condition, their clinical and biological parameters, in particular the concentration of electrolytes in blood plasma, including magnesium or phosphorus, should be closely monitored, concentration of glucose in the blood. In the presence of hyperglycemia, the rate of administration of the drug should be adjusted orinsulin short-acting (subcutaneously 4-5 units at the rate of 1 unit of short-acting insulin for 4-5 g of dextrose).
In case of prolonged administration or use of dextrose in high doses, it is necessary to monitor the potassium concentration in the blood plasma and, if necessary, to introduce potassium additionally to avoid hypokalemia.
In episodes of intracranial hypertension, a careful control of the concentration of glucose in the blood is necessary.
The use of dextrose solutions can lead to hyperglycemia. Therefore, they are not recommended for administration after acute ischemic stroke, since hyperglycemia is associated with increased ischemic damage to the brain and prevents recovery.
Particularly careful clinical monitoring is required at the beginning of intravenous administration of the drug.
The drug should be administered under regular medical supervision. Clinical and biological parameters, in particular the concentration of glucose in the blood should be carefully monitored.
When hyperglycemia occurs, it is necessary to change the rate of infusion or to introduce short-acting insulin, and, if necessary, enter potassium parenterally.
In connection with the risk of unwanted osmotic diuresis, it is necessary to select a low flow rate.
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, the 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 directly after connecting to the infusion system.
The solution should be administered with the use of sterile equipment in compliance with the rules of aseptic and antiseptic.
To avoid air embolism, remove air from the infusion system with a solution.
Do not join the containers sequentially to avoid air embolism, which may occur due to sucking air from the first container until the solution is completed from the second container.
The supply of intravenous solutions contained in soft plastic containers,under increased pressure to increase the flow rate can lead to air embolism, if the residual air in the container is not completely removed before administration.
The use of the system for intravenous administration with a gas outlet can lead to air embolism with an open gassing. Soft plastic containers with such systems should not be used.
Adding substances can be administered before infusion or during infusion through the injection site (port for drug administration).
Adding other medications to the solution or disturbing the technique of administration can cause fever due to the possible entry of pyrogens into the body.
If unwanted reactions develop, the infusion should be stopped immediately.
When adding other medications before parenteral administration, it is necessary to check the isotonicity of the resulting solution. Complete and thorough mixing in aseptic conditions is mandatory.
Solutions containing additional substances should be applied immediately, their storage is prohibited.
With the introduction of additional nutrients, the osmolarity of the resulting mixture should be determined before the infusion begins.The resulting mixture must be administered through a central or peripheral venous catheter, depending on the final osmolarity.
Similarly to the use of other parenteral solutions, the compatibility of the additionally administered drugs should be assessed before they are added to the solution.
Assessment of the compatibility of additional drugs with the drug is within the competence of the doctor.
It is necessary to check the resulting solution for discoloration and / or the appearance of a precipitate, insoluble complexes or crystals.
It is necessary to follow the recommendations for the dilution of the added medicines in accordance with the instructions for their use.
From a microbiological point of view, the diluted drug should be applied immediately. The exception is dilutions prepared in controlled and validated aseptic conditions. Otherwise, after the preparation of the solution, the terms and conditions of its storage prior to the introduction are the responsibility of the user.
The drug contains dextrose, obtained from corn. The use of the drug is contraindicated in patients with a known intolerance to corn or corn products.the following manifestations of hypersensitivity are possible: anaphylactic reactions, hypersensitivity, chills and fever.
Usually, glucose is fully absorbed by the body (normally not excreted by the kidneys), so the appearance of glucose in the urine can be a pathological sign.
Children and teens
In newborns, especially preterm or low birth weight, the risk of developing hypoglycemic or hyperglycemia is increased, so careful monitoring of blood glucose levels is necessary during intravenous dextrose solutions to avoid long-term adverse effects.
Hypoglycemia in newborns can lead to prolonged seizures, coma and brain damage.
Hyperglycemia is associated with intraventricular hemorrhage, delayed bacterial and fungal infectious diseases, retinopathy of prematurity, necrotizing enterocolitis, bronchopulmonary dysplasia, prolonged hospitalization and mortality.
To avoid potentially lethal overdose of intravenous medications in newborns, special attention should be paid to the method of administration.When using a newborn syringe pump for intravenous administration, the container with the solution must not be left attached to the syringe. When using an infusion pump, before removing the system from the pump or switching it off, all the system clamps must be closed, regardless of the presence of a device that prevents free-flowing fluid.
Devices for intravenous infusion and other equipment for the administration of drugs should be monitored regularly.