Drugs List

Therapeutic Indications

Uses

Fluid replacement
Sodium depletion
Source of energy in parenteral nutrition

Administration

The administration is performed by intravenous infusion.

Contraindications

Diabetic hyperosmolar coma
Fluid retention
Recent head trauma
Cardiac failure
Hepatic cirrhosis with ascites
Hyperemesis gravidarum
Hyperlactataemia
Hypervolaemia
Hypochloraemia
Hyponatraemia
Recent ischaemic cerebrovascular accident
Severe hyperglycaemia
Severe renal impairment
Uncontrolled diabetes mellitus

Precautions and Warnings

Children under 18 years
Debilitation
Elderly
Obesity
Peripheral oedema
Predisposition to hypokalaemia
Restricted sodium intake
Severe sepsis
Breastfeeding
Cardiac disorder
Cardiac impairment
Diabetes mellitus
Eclampsia
Electrolyte imbalance
Gastrointestinal disorder
Glucose-galactose malabsorption syndrome
Hepatic cirrhosis
Hepatic impairment
Hyperaldosteronism
Hypernatraemia
Hypertension
Malnutrition
Metabolic alkalosis
Pre-eclampsia
Pregnancy
Renal impairment
Syndrome of Inappropriate Antidiuretic Hormone secretion
Thiamine deficiency
Thyrotoxicosis

Sodium content of formulation may be significant
Not all available brands are licensed for all age groups
Potassium deficient patients should receive potassium supplements
Contains glucose
Avoid rapid infusion rates
Child under 17 years: Treatment to be initiated/supervised by a specialist
Rapid infusion of hypertonic sodium chloride may cause circulatory overload
Diabetic control may need adjustment
Monitor blood glucose periodically
Monitor children closely for signs and symptoms of hyponatraemia
Monitor fluid and electrolyte status
Monitor fluid balance
Treating severely undernourished patients may cause refeeding syndrome
Consider dose reduction in renal impairment
Consider reducing dose in elderly
Avoid prolonged use

Glucose intravenous infusions are usually isotonic solutions. However, glucose containing fluids can become extremely physiologically hypotonic due to rapid glucose metabolization. Intravenous administration of glucose can cause electrolyte disturbances like hypo- or hyperosmotic hyponatraemia.

During the catabolic phase of the response to illness or injury, there is an increase in antidiuretic hormone, cortisol, and aldosterone secretion, especially if there has been any reduction in blood or extracellular fluid volume. In consequence, retention of sodium and water and loss of potassium occurs. This should be taken into consideration when administering a hypotonic solution.

Solutions containing glucose should not be used routinely after ischaemic stroke, unless specifically required, as hyperglycaemia has been implicated in increasing cerebral ischaemic damage and impairing recovery.

Pregnancy and Lactation

Pregnancy

Use sodium chloride and glucose with caution during pregnancy.

The manufacturer advises caution if sodium chloride and glucose is used during pregnancy. Maternal hyperglycaemia in the perinatal period should be avoided to prevent the induction of reflex neonatal hypoglycaemia. Caution should be exercised when administering to pregnant women during labour, particularly if administered with oxytocin, due to the risk of hyponatraemia.

Lactation

Use sodium chloride and glucose with caution during breastfeeding.

The manufacturer advises caution if sodium chloride and glucose is used when breastfeeding. The manufacturer states that potential risks and benefits should be considered for each patient before initiation of treatment. The presence of sodium chloride and glucose in human breast milk is unknown. Effects on exposed infants are unknown.

Side Effects

Anaphylactic reaction
Chills
Electrolyte disturbances
Hyperglycaemia
Hypersensitivity reactions
Hypokalaemia
Hypomagnesaemia
Hyponatraemia
Hypophosphataemia
Infusion-related symptoms
Local pain (injection site)
Oedema
Over-hydration
Phlebitis
Pruritus
Pyrexia
Rash
Thrombophlebitis
Thrombosis (injection site)
Venous irritation
Vesicles

Presentation

Infusions containing sodium chloride and glucose.

Drugs List

Therapeutic Indications

Uses

Fluid replacement
Sodium depletion
Source of energy in parenteral nutrition

Dosage

The dosage must be determined by the physician and is dependant upon the age, weight and clinical condition of the patient.

Solutions containing sodium chloride 0.18% and glucose 4% should not generally be used for fluid replacement in children because of the risk of hyponatraemia.

The infusion rate should not exceed the patient's glucose oxidation capacities in order to avoid hyperglycaemia.

Adults

Children

Administration

The administration is performed by intravenous infusion.

Contraindications

Diabetic hyperosmolar coma
Fluid retention
Recent head trauma
Cardiac failure
Hepatic cirrhosis with ascites
Hyperemesis gravidarum
Hyperlactataemia
Hypervolaemia
Hypochloraemia
Hyponatraemia
Recent ischaemic cerebrovascular accident
Severe hyperglycaemia
Severe renal impairment
Uncontrolled diabetes mellitus

Precautions and Warnings

Children under 18 years
Debilitation
Elderly
Obesity
Peripheral oedema
Predisposition to hypokalaemia
Restricted sodium intake
Severe sepsis
Breastfeeding
Cardiac disorder
Cardiac impairment
Diabetes mellitus
Eclampsia
Electrolyte imbalance
Gastrointestinal disorder
Glucose-galactose malabsorption syndrome
Hepatic cirrhosis
Hepatic impairment
Hyperaldosteronism
Hypernatraemia
Hypertension
Malnutrition
Metabolic alkalosis
Pre-eclampsia
Pregnancy
Renal impairment
Syndrome of Inappropriate Antidiuretic Hormone secretion
Thiamine deficiency
Thyrotoxicosis

Sodium content of formulation may be significant
Not all available brands are licensed for all age groups
Potassium deficient patients should receive potassium supplements
Contains glucose
Avoid rapid infusion rates
Child under 17 years: Treatment to be initiated/supervised by a specialist
Rapid infusion of hypertonic sodium chloride may cause circulatory overload
Diabetic control may need adjustment
Monitor blood glucose periodically
Monitor children closely for signs and symptoms of hyponatraemia
Monitor fluid and electrolyte status
Monitor fluid balance
Treating severely undernourished patients may cause refeeding syndrome
Consider dose reduction in renal impairment
Consider reducing dose in elderly
Avoid prolonged use

Glucose intravenous infusions are usually isotonic solutions. However, glucose containing fluids can become extremely physiologically hypotonic due to rapid glucose metabolization. Intravenous administration of glucose can cause electrolyte disturbances like hypo- or hyperosmotic hyponatraemia.

During the catabolic phase of the response to illness or injury, there is an increase in antidiuretic hormone, cortisol, and aldosterone secretion, especially if there has been any reduction in blood or extracellular fluid volume. In consequence, retention of sodium and water and loss of potassium occurs. This should be taken into consideration when administering a hypotonic solution.

Solutions containing glucose should not be used routinely after ischaemic stroke, unless specifically required, as hyperglycaemia has been implicated in increasing cerebral ischaemic damage and impairing recovery.

Pregnancy and Lactation

Pregnancy

Use sodium chloride and glucose with caution during pregnancy.

The manufacturer advises caution if sodium chloride and glucose is used during pregnancy. Maternal hyperglycaemia in the perinatal period should be avoided to prevent the induction of reflex neonatal hypoglycaemia. Caution should be exercised when administering to pregnant women during labour, particularly if administered with oxytocin, due to the risk of hyponatraemia.

Lactation

Use sodium chloride and glucose with caution during breastfeeding.

The manufacturer advises caution if sodium chloride and glucose is used when breastfeeding. The manufacturer states that potential risks and benefits should be considered for each patient before initiation of treatment. The presence of sodium chloride and glucose in human breast milk is unknown. Effects on exposed infants are unknown.

Side Effects

Anaphylactic reaction
Chills
Electrolyte disturbances
Hyperglycaemia
Hypersensitivity reactions
Hypokalaemia
Hypomagnesaemia
Hyponatraemia
Hypophosphataemia
Infusion-related symptoms
Local pain (injection site)
Oedema
Over-hydration
Phlebitis
Pruritus
Pyrexia
Rash
Thrombophlebitis
Thrombosis (injection site)
Venous irritation
Vesicles

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: November 2021

Reference Sources

Summary of Product Characteristics: Sodium Chloride 0.18% Glucose 4.0% IV infusion. Fresenius Kabi Ltd. Revised May 2016.

Summary of Product Characteristics: Sodium Chloride 0.18% Glucose 10% IV infusion. Fresenius Kabi Ltd. Revised September 2009.

Summary of Product Characteristics: Sodium Chloride 0.45% Glucose 2.5% IV infusion. Baxter Healthcare Ltd. Revised March 2019.

Summary of Product Characteristics: Sodium Chloride 0.45% Glucose 5.0% IV infusion. Fresenius Kabi Ltd. Revised September 2009.

Summary of Product Characteristics: Sodium Chloride 0.9% Glucose 5.0% IV infusion. Fresenius Kabi Ltd. Revised May 2016.

NICE Evidence Services Available at: www.nice.org.uk Last accessed: 15 November 2021