Drugs List

Therapeutic Indications

Uses

Carbohydrate depletion
Cerebral oedema
Diluent, vehicle or excipient
Fluid replacement
Hypoglycaemic coma
Reduction of intracranial pressure
Severe hypoglycaemia

Administration

For administration by intravenous infusion.

Rapid infusion or very prolonged large volumes of intravenous glucose given too quickly may cause water intoxication. Infusion over a long period of time can cause dehydration.

Contraindications

Intraspinal haemorrhage
Acute cardiac failure
Anuria
Delirium tremens with dehydration
Hyperglycaemia
Hyperglycaemic coma
Intracranial haemorrhage
Ischaemic cerebrovascular accident
Metabolic acidosis
Pulmonary oedema

Precautions and Warnings

Children under 18 years
Elderly
Recent trauma
Sepsis
Severe traumatic brain injury
Shock
Cardiac impairment
Diabetes mellitus
Hypervolaemia
Hypophosphataemia
Impaired carbohydrate tolerance
Malnutrition
Pregnancy
Renal impairment
Severe dehydration
Thiamine deficiency

Not all available brands are licensed for all indications
Avoid circulatory overload
Avoid rapid infusion rates
Do not give blood products in same intravenous line
May cause hyponatraemia
Monitor acid-base balance
Monitor blood or urinary glucose
Monitor fluid and electrolyte status
Consider hyponatraemia in all patients with drowsiness/confusion/seizures
May cause anaphylactic / anaphylactoid reactions
Monitor for signs of mental confusion or loss of consciousness
Discontinue if hypersensitivity reactions occur
Prolonged use in parenteral nutrition may affect insulin production

The administration of glucose without adequate levels of thiamine may precipitate overt deficiency states e.g. Wernicke's encephalopathy.

Hyponatraemia can develop into acute hyponatraemic encephalopathy characterised by headache, nausea, seizures, lethargy, coma, cerebral oedema and death. Children, elderly, women, postoperative patients, patients with hypoxia and patients with central nervous system disease or psychogenic polydipsia are at particular risk for this complication.

Refeeding severely malnourished patients may result in the refeeding syndrome that is characterised by the shift of potassium, phosphorus and magnesium intracellularly as the patient becomes anabolic. Thiamine deficiency and fluid retention may also develop. Careful monitoring and slowly increasing nutrient intakes while avoiding over feeding can prevent these complications.

Solutions containing glucose should be used with caution, if at all, in patients with known allergy to corn.

Pregnancy and Lactation

Pregnancy

Use intravenous glucose with caution in pregnancy.

Intrapartum maternal intravenous glucose infusion may result in foetal insulin production, with an associated risk of foetal hyperglycaemia and metabolic acidosis, as well as rebound hypoglycaemia in the neonate.

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

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 to 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

Intravenous glucose is considered safe for use in breastfeeding.

Glucose and its metabolites are excreted in human breast milk, but no effects on the breastfed newborns/infants are anticipated at therapeutic doses.

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
Chills
Dehydration
Fluid and electrolyte disturbances
Glycosuria
Heat and redness (injection site)
Hyperglycaemia
Hyperphosphataemia
Hypersensitivity reactions
Hypervolaemia
Hypokalaemia
Hypomagnesaemia
Hyponatraemia
Hyponatraemic encephalopathy
Hypophosphataemia
Local infection at injection site
Local pain (injection site)
Oedema
Osmotic diuresis
Phlebitis
Pulmonary congestion
Pyrexia
Rash
Shivering
Sweating
Thrombophlebitis (injection site)
Thrombosis of vascular access sites
Venous irritation
Venous thrombosis

Presentation

Intravenous infusions of glucose with strengths greater than 5%.

Drugs List

Therapeutic Indications

Uses

Carbohydrate depletion
Cerebral oedema
Diluent, vehicle or excipient
Fluid replacement
Hypoglycaemic coma
Reduction of intracranial pressure
Severe hypoglycaemia

Dosage

Intravenous infusions of glucose with strengths 10% or greater are hypertonic solutions.

Adults

Children

Administration

For administration by intravenous infusion.

Rapid infusion or very prolonged large volumes of intravenous glucose given too quickly may cause water intoxication. Infusion over a long period of time can cause dehydration.

Contraindications

Intraspinal haemorrhage
Acute cardiac failure
Anuria
Delirium tremens with dehydration
Hyperglycaemia
Hyperglycaemic coma
Intracranial haemorrhage
Ischaemic cerebrovascular accident
Metabolic acidosis
Pulmonary oedema

Precautions and Warnings

Children under 18 years
Elderly
Recent trauma
Sepsis
Severe traumatic brain injury
Shock
Cardiac impairment
Diabetes mellitus
Hypervolaemia
Hypophosphataemia
Impaired carbohydrate tolerance
Malnutrition
Pregnancy
Renal impairment
Severe dehydration
Thiamine deficiency

Not all available brands are licensed for all indications
Avoid circulatory overload
Avoid rapid infusion rates
Do not give blood products in same intravenous line
May cause hyponatraemia
Monitor acid-base balance
Monitor blood or urinary glucose
Monitor fluid and electrolyte status
Consider hyponatraemia in all patients with drowsiness/confusion/seizures
May cause anaphylactic / anaphylactoid reactions
Monitor for signs of mental confusion or loss of consciousness
Discontinue if hypersensitivity reactions occur
Prolonged use in parenteral nutrition may affect insulin production

The administration of glucose without adequate levels of thiamine may precipitate overt deficiency states e.g. Wernicke's encephalopathy.

Hyponatraemia can develop into acute hyponatraemic encephalopathy characterised by headache, nausea, seizures, lethargy, coma, cerebral oedema and death. Children, elderly, women, postoperative patients, patients with hypoxia and patients with central nervous system disease or psychogenic polydipsia are at particular risk for this complication.

Refeeding severely malnourished patients may result in the refeeding syndrome that is characterised by the shift of potassium, phosphorus and magnesium intracellularly as the patient becomes anabolic. Thiamine deficiency and fluid retention may also develop. Careful monitoring and slowly increasing nutrient intakes while avoiding over feeding can prevent these complications.

Solutions containing glucose should be used with caution, if at all, in patients with known allergy to corn.

Pregnancy and Lactation

Pregnancy

Use intravenous glucose with caution in pregnancy.

Intrapartum maternal intravenous glucose infusion may result in foetal insulin production, with an associated risk of foetal hyperglycaemia and metabolic acidosis, as well as rebound hypoglycaemia in the neonate.

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

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 to 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

Intravenous glucose is considered safe for use in breastfeeding.

Glucose and its metabolites are excreted in human breast milk, but no effects on the breastfed newborns/infants are anticipated at therapeutic doses.

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
Chills
Dehydration
Fluid and electrolyte disturbances
Glycosuria
Heat and redness (injection site)
Hyperglycaemia
Hyperphosphataemia
Hypersensitivity reactions
Hypervolaemia
Hypokalaemia
Hypomagnesaemia
Hyponatraemia
Hyponatraemic encephalopathy
Hypophosphataemia
Local infection at injection site
Local pain (injection site)
Oedema
Osmotic diuresis
Phlebitis
Pulmonary congestion
Pyrexia
Rash
Shivering
Sweating
Thrombophlebitis (injection site)
Thrombosis of vascular access sites
Venous irritation
Venous thrombosis

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: September 2018

Reference Sources

Summary of Product Characteristics: Glucose 10% w/v solution for infusion. Baxter Healthcare Ltd. Revised March 2016.
Summary of Product Characteristics: Glucose 20% w/v solution for infusion. Hameln Pharmaceuticals Ltd. Revised May 2016.
Summary of Product Characteristics: Glucose 20% w/v solution for infusion. Baxter Healthcare Ltd. Revised May 2016.
Summary of Product Characteristics: Glucose Intravenous Infusion BP 30% w/v. B. Braun Melsungen AG. Revised June 2018.
Summary of Product Characteristics: Glucose 50% w/v Concentrate for solution for infusion. Baxter Healthcare Ltd. Revised May 2016.
Summary of Product Characteristics: Glucose 50% w/v solution for infusion. Hameln Pharmaceuticals Ltd. Revised June 2018.
Summary of Product Characteristics: Glucose 70% Concentrate for solution for infusion. Baxter Healthcare Ltd. Revised May 2016.

NICE Evidence Services Available at: www.nice.org.uk Last accessed: 02 August 2018