10% solution: carbohydrate source as monotherapy or if required, in parenteral nutrition; prevention and treatment of hypoglycaemia; irrigation in states of water loss and dehydration in patients with high carbohydrate demand; dilution of compatible medicinal products. 20% solution: carbohydrate deficiency, energy deficiencies, hypoglycaemia (eg after overdose of insulin), parenteral nutrition.
Composition:
1 ml of a 10% solution contains 100 mg of glucose; 1 ml of a 20% solution contains 200 mg of glucose.
Action:
Glucose - the basic energy substrate - is consumed by all body tissues. In neural cells, the oxidation of this compound covers 30% of the energy requirement. It reduces the need for fat metabolism, prevents ketonemia and acidosis by increasing the amount of glycogen in the liver. It also works diuretic. When administered parenterally, it widens coronary vessels, increases the strength of myocardial contraction. It is metabolized in tissues and partially deposited in the form of glycogen in the liver. 10-40% Glucose solutions are hypertonic fluids in relation to blood. 100 ml of a 10% solution provides 40 kcal (167 kJ), the osmolarity is 555 mosmol / l. 100 ml of a 20% solution provides 80 kcal (344.5 kJ), the osmolarity is 1110 mosmol / l.
Contraindications:
10% solution: decompensated diabetes and diabetes insipidus; hyperosmolar coma; hemodilution and extracellular transmission or hypervolaemia; hyperglycemia and elevated lactate in the blood; severe renal failure (with oliguria / anuria); decompensated heart failure; generalized edema (including pulmonary edema and brain edema) and liver cirrhosis with ascites; other known glucose intolerance states (such as situations of metabolic stress). 20% solution: diabetes; hypotonic dehydration; overhydration; hypokalaemia; hyperglycemia; hyperosmia; anuria; intracranial bleeding. The 20% solution should not be added to peripheral vessels.
Precautions:
Exercise caution and special supervision when infusing a large volume of fluid in patients with excessive hydration, heart failure, respiratory failure and renal failure. Patients with diabetes mellitus, renal insufficiency or critically ill may have impaired glucose tolerance, clinical and biological parameters, especially plasma electrolytes, including magnesiumemia or phosphatase and glycemia, should be monitored particularly closely. If hyperglycaemia occurs, modify the infusion rate or give insulin. In the event of prolonged administration or a high dose of Glucose, caution should be exercised to avoid hypokalaemia, by monitoring plasma concentrations of potassium and, if necessary, by supplementing its deficiency. During the first 24 hours after head injury, infusion of glucose-containing solutions is contraindicated and blood glucose levels should be carefully monitored during episodes of intracranial hypertension. The use of glucose solutions after acute ischemic stroke is not recommended because hyperglycaemia has an effect on ischemic brain damage and impairs remedial processes. Use caution in hyponatraemia. The product should not be administered using the same kit as whole blood, because haemolysis and agglutination may occur. Do not use plastic containers in serial connections - such use can cause air embolism caused by residual air drawn from the first container before delivery from the second container is completed. At the beginning of each intravenous infusion, clinical parameters should be monitored.
Pregnancy and lactation:
A 10% solution can be safely used during pregnancy and lactation, provided that the electrolyte and fluid balance is controlled and maintained in the physiological standards. When adding the drug to the solution, its type and use during pregnancy and lactation should be considered separately. 20% solution should be used with caution during pregnancy due to the possibility of hyperglycaemia, hyperinsulinemia and fetal acidosis, followed by hypoglycaemia and jaundice in the newborn.
Side effects:
Too fast administration may result in circulatory insufficiency, pulmonary edema and peripheral edema. Glucose solution, administered as the only liquid, may cause hypo-osmolarity and electrolyte disturbances. Long-term administration of glucose solutions makes it necessary to supplement intracellular electrolytes: potassium, Magnesium, phosphates. Hypertonic solutions may lead to dehydration, hyperglycaemia and glucosuria, and after discontinuation of the infusion for secondary hypoglycaemia. During the administration, vein irritation and thrombophlebitis at the injection site may occur. Solutions of glucose at concentrations above 15% administered to peripheral vessels damage their endothelium, causing inflammation of the veins and inflammatory changes. In addition (frequency unknown): allergic reactions, sweating, chills, febrile reactions, fever, infection at the injection site.
Dosage:
Intravenously, depending on the indications, hydration status, electrolyte concentration in the blood and energy requirements of the body, patient's age, body weight and clinical condition, through the peripheral or central vein. 10% solution. Adult and elderly patients with an average body weight of 70 kg; usually 500 - 3000 ml / day (7 - 40 ml / kg / day) in an intravenous infusion at a rate of 5 mg / kg / min (3 ml / kg / h). Dilution of medicinal products showing compliance: 50 - 250 ml / dose. Children and adolescents: o. 0 - 10 kg 100ml / kg / day; about mc. 10 - 20 kg 1000ml + 50ml / kg over 10kg / day; o mc.> 20kg 1500ml + 20ml / kg over 20kg / day. Feeding speed: newborns and premature babies 6-11 ml / kg / h (10-18 mg / kg / min); children 1-3 years: 5 - 8 ml / kg / h (9-14 mg / kg / min); children 4 - 6 years: 5 - 7 ml / kg / h (8 - 11 mg / kg / min); children 7-10 years: 4 - 7 ml / kg / h (7 - 11 mg / kg / min); children> 11 years: 4 ml / kg / h (7 - 8.5 mg / kg / min). Dilution of medicinal products showing compliance: 50 - 100 ml / dose. 20% solution through the central vein - at a rate of up to 40 drops / min. Maximum dose 1.5ml / kg The maximum rate of administration should not exceed the patient's ability to oxidize glucose, as this may result in hyperglycaemia. Serve without time limits, depending on the clinical condition of the patient. Depending on the clinical condition of the patient, the recommended rate of administration may be reduced in order to reduce the risk of unwanted osmotic diuresis.
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