Drugs List

Therapeutic Indications

Uses

Treatment of dehydration with acidosis and carbohydrate deficiency

Administration

For administration by intravenous infusion.

Rapid infusion should be avoided.

Intravenous glucose should not be administered concurrently with blood through the same infusion set as haemolysis and clumping may occur.

Contraindications

Cardiac arrhythmias
Head trauma
Hyperglycaemic coma
Hypervolaemia
Lactic acidosis
Respiratory alkalosis
Severe hepatic impairment

Precautions and Warnings

Children under 3 months
Peripheral oedema
Cardiac impairment
Diabetes mellitus
Eclampsia
Hepatic impairment
Hyperaldosteronism
Hypertension
Hypophosphataemia
Impaired carbohydrate tolerance
Pre-eclampsia
Pregnancy
Pulmonary oedema
Renal impairment
Severe malnutrition
Thiamine deficiency

Potassium deficient patients should receive potassium supplements
Avoid circulatory overload
Avoid rapid infusion rates
Do not give blood products in same intravenous line
Monitor acid-base balance
Monitor blood or urinary glucose
Monitor ECG prior to and during treatment in existing cardiac abnormalities
Monitor fluid and electrolyte status
Monitor plasma potassium in patients at risk of hyperkalaemia
Monitor for signs of mental confusion or loss of consciousness

Insulin production may be affected by prolonged use of intravenous glucose for parenteral nutrition.

Thiamine is required for glucose metabolism and in administration of glucose may result in thiamine deficiency (e.g. Wernicke's encephalopathy).

Pregnancy and Lactation

Pregnancy

Use with caution.

Intravenous glucose administered during pregnancy may result in considerable foetal insulin production. This causes an increased risk of rebound hypoglycaemia in the neonate.

Infusions should not exceed 5-10g of glucose/hour during labour or Caesarean section.

Safety of sodium lactate compound infusion during pregnancy has not been established, but its use is not considered to constitute a hazard, as long as the electrolyte and fluid balance is controlled.

The use of all medication in pregnancy should be avoided whenever possible; particularly in the first trimester. Non-drug treatments should also be considered. When essential, a medication with the best safety record over time should be chosen, employing the lowest effective dose for the shortest possible time. Polypharmacy should be avoided. Teratogens taken in the pre-embryonic period, often quoted as lasting until 14-17 days post-conception, are believed to have an all-or-nothing effect. Where drugs have a short half-life, and when the date of conception is certain, this may allow women to be reassured where drug exposure has occurred within this time frame. Further advice may be available from the UK National Teratology Information Service (NTIS) and through ToxBase, available via password on the internet ( www.toxbase.org ) or if this is unavailable at the backup site ( www.toxbasebackup.org ).

Lactation

Safety of sodium lactate compound infusion during lactation has not been established, but its use is not considered to constitute a hazard as long as the electrolyte and fluid balance is controlled.

Neonates, infants born prematurely, those with low birth weight, those with an unstable gastrointestinal function or who have serious illnesses may require special consideration. For any infant, if a drug is prescribed to the nursing mother, it should be at the lowest practical dose and for the shortest time. When drug administration is unavoidable and breastfeeding is to continue, minimisation of exposure of the infant to the drug may sometimes be achieved by timing the maternal doses to just after a feeding episode. Infants exposed to drugs via breast milk should be monitored for unusual signs or symptoms. Interactions between the drug received by the infant from the mother's milk and medication prescribed for the infant should also be considered, for example, when the drug given to the infant may prevent metabolism of the drug received via breast milk.
Specialist advice is available from the UK Drugs in Lactation Advisory Service at https://www.midlandsmedicines.nhs.uk/content.asp?section=6&subsection=17&pageIdx=1

Side Effects

Anaphylactoid reaction
Bradycardia
Breathing difficulties
Bronchospasm
Chest pain
Chest tightness
Convulsions
Cough
Erythema
Fluid and electrolyte disturbances
Heat and redness (injection site)
Hyperphosphataemia
Hypokalaemia
Hypomagnesaemia
Hypophosphataemia
Inflammation (injection site)
Itching
Local pain (injection site)
Nasal congestion
Periorbital oedema
Pruritus
Quincke's oedema
Rash
Sneezing
Tachycardia
Thrombophlebitis (injection site)
Thrombosis of vascular access sites
Urticaria

Presentation

Intravenous infusion containing glucose 5 % and half strength sodium lactate compound solution.

Drugs List

Therapeutic Indications

Uses

Treatment of dehydration with acidosis and carbohydrate deficiency

Dosage

The rate and volume of infusion depends on the requirements of the individual patient and the judgement of the physician. Dosage should be based on the age, weight and clinical condition of the patient.

Elderly

Administration

For administration by intravenous infusion.

Rapid infusion should be avoided.

Intravenous glucose should not be administered concurrently with blood through the same infusion set as haemolysis and clumping may occur.

Contraindications

Cardiac arrhythmias
Head trauma
Hyperglycaemic coma
Hypervolaemia
Lactic acidosis
Respiratory alkalosis
Severe hepatic impairment

Precautions and Warnings

Children under 3 months
Peripheral oedema
Cardiac impairment
Diabetes mellitus
Eclampsia
Hepatic impairment
Hyperaldosteronism
Hypertension
Hypophosphataemia
Impaired carbohydrate tolerance
Pre-eclampsia
Pregnancy
Pulmonary oedema
Renal impairment
Severe malnutrition
Thiamine deficiency

Potassium deficient patients should receive potassium supplements
Avoid circulatory overload
Avoid rapid infusion rates
Do not give blood products in same intravenous line
Monitor acid-base balance
Monitor blood or urinary glucose
Monitor ECG prior to and during treatment in existing cardiac abnormalities
Monitor fluid and electrolyte status
Monitor plasma potassium in patients at risk of hyperkalaemia
Monitor for signs of mental confusion or loss of consciousness

Insulin production may be affected by prolonged use of intravenous glucose for parenteral nutrition.

Thiamine is required for glucose metabolism and in administration of glucose may result in thiamine deficiency (e.g. Wernicke's encephalopathy).

Pregnancy and Lactation

Pregnancy

Use with caution.

Intravenous glucose administered during pregnancy may result in considerable foetal insulin production. This causes an increased risk of rebound hypoglycaemia in the neonate.

Infusions should not exceed 5-10g of glucose/hour during labour or Caesarean section.

Safety of sodium lactate compound infusion during pregnancy has not been established, but its use is not considered to constitute a hazard, as long as the electrolyte and fluid balance is controlled.

The use of all medication in pregnancy should be avoided whenever possible; particularly in the first trimester. Non-drug treatments should also be considered. When essential, a medication with the best safety record over time should be chosen, employing the lowest effective dose for the shortest possible time. Polypharmacy should be avoided. Teratogens taken in the pre-embryonic period, often quoted as lasting until 14-17 days post-conception, are believed to have an all-or-nothing effect. Where drugs have a short half-life, and when the date of conception is certain, this may allow women to be reassured where drug exposure has occurred within this time frame. Further advice may be available from the UK National Teratology Information Service (NTIS) and through ToxBase, available via password on the internet ( www.toxbase.org ) or if this is unavailable at the backup site ( www.toxbasebackup.org ).

Lactation

Safety of sodium lactate compound infusion during lactation has not been established, but its use is not considered to constitute a hazard as long as the electrolyte and fluid balance is controlled.

Neonates, infants born prematurely, those with low birth weight, those with an unstable gastrointestinal function or who have serious illnesses may require special consideration. For any infant, if a drug is prescribed to the nursing mother, it should be at the lowest practical dose and for the shortest time. When drug administration is unavoidable and breastfeeding is to continue, minimisation of exposure of the infant to the drug may sometimes be achieved by timing the maternal doses to just after a feeding episode. Infants exposed to drugs via breast milk should be monitored for unusual signs or symptoms. Interactions between the drug received by the infant from the mother's milk and medication prescribed for the infant should also be considered, for example, when the drug given to the infant may prevent metabolism of the drug received via breast milk.
Specialist advice is available from the UK Drugs in Lactation Advisory Service at https://www.midlandsmedicines.nhs.uk/content.asp?section=6&subsection=17&pageIdx=1

Side Effects

Anaphylactoid reaction
Bradycardia
Breathing difficulties
Bronchospasm
Chest pain
Chest tightness
Convulsions
Cough
Erythema
Fluid and electrolyte disturbances
Heat and redness (injection site)
Hyperphosphataemia
Hypokalaemia
Hypomagnesaemia
Hypophosphataemia
Inflammation (injection site)
Itching
Local pain (injection site)
Nasal congestion
Periorbital oedema
Pruritus
Quincke's oedema
Rash
Sneezing
Tachycardia
Thrombophlebitis (injection site)
Thrombosis of vascular access sites
Urticaria

Overdosage

It is strongly recommended that the UK National Poisons Information Service be consulted on cases of suspected or actual overdose where there is doubt over the degree of risk or about appropriate management.

The following number will direct the caller to the relevant local centre (0844) 892 0111

Information may be obtained if you have access to ToxBase the primary clinical toxicology database of the National Poisons Information Service. This is available via password on the internet ( www.toxbase.org ) or if this is unavailable at the backup site ( www.toxbasebackup.org ).

Further Information

Last Full Review Date: March 2013

Reference Sources

British National Formulary, 64th Edition (2012) Pharmaceutical Press, London.

Summary of Product Characteristics: Glucose 5 % in half strength Hartmann's Solution as Steriflex No.42 and freeflex. Fresenius Kabi Limited. August 2006.

Summary of Product Characteristics: Compound Sodium Lactate Intravenous Infusion. B. Braun. June 2012
Summary of Product Characteristics: Compound Sodium Lactate Solution for Infusion. Baxter Healthcare Ltd. March 2006.
Summary of Product Characteristics: Hartmann's Solution. Fresenius Kabi Ltd. March 2010.

Summary of Product Characteristics: Glucose 10 % w/v Solution for Infusion. Baxter Healthcare Ltd. February 2010
Summary of Product Characteristics: Glucose Infusion BP 5 %. Fresenius Kabi Ltd. April 2000
Summary of Product Characteristics: Glucose Intravenous Infusion 10 %. Fresenius Kabi Ltd. September 2009
Summary of Product Characteristics: Glucose 20 % IV Infusion BP, as Steriflex No.31 and freeflex. Fresenius Kabi Ltd. February 2009
Summary of Product Characteristics: Glucose Infusion BP 40 % as Steriflex No.33 and freeflex. Fresenius Kabi Ltd. April 2006
Summary of Product Characteristics: Glucose Infusion BP 50 % as Steriflex No.34 and freeflex. Fresenius Kabi Ltd. February 2009