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Insulin Reaction(trade name)
Pregnancy Category: C
ClassificationTherapeutic: caloric sources
Intravenous: Lower-concentration (2.5–11.5%) injection provides hydration and calories.Higher concentrations (up to 70%) treat hypoglycemia and in combination with amino acids provide calories for parenteral nutrition.50%—treatment of hypoglycemia (hyperinsulinemia or insulin shock). Oral: Corrects hypoglycemia in conscious patients.
Provision of calories.
Prevention and treatment of hypoglycemia.
Absorption: Well absorbed following oral administration.
Distribution: Widely distributed and rapidly utilized.
Metabolism and Excretion: Metabolized to carbon dioxide and water. When renal threshold is exceeded, dextrose is excreted unchanged by the kidneys.
Time/action profile (effects on blood sugar in diabetic patients)
Contraindicated in: Allergy to corn or corn products; Hypertonic solution (>5%) should not be given to patients with CNS bleeding or anuria or who are at risk of dehydration.
Use Cautiously in: Known diabetic patients (frequent lab assessment necessary to quantitate appropriate doses); Neonates (excess/rapid infusion of solutions >10% may ↑ risk of intracerebral hemorrhage); Chronic alcoholics or severely malnourished patients (administration requires initial pretreatment with thiamine).
Adverse Reactions/Side Effects
- inappropriate insulin secretion (long-term use)
Fluid and Electrolyte
- fluid overload
- local pain/irritation at IV site (hypertonic solution)
Drug-Drug interactionWill alter requirements for insulin or oral hypoglycemic agents in diabetic patients.
Route/DosageHydration (as 5% solution)
Intravenous (Adults and Children) 0.5–0.8 g/kg/hr.Hypoglycemia
Oral (Adults and Children) Conscious patients—10–20 g, may repeat in 10–20 min.
Intravenous (Adults) 20–50 mL of 50% solution infused slowly (3 mL/min).
Intravenous (Infants > 6 mo and Children) 0.5–1 g/kg/dose (maximum of 25 g/dose) (as 25% dextrose).
Intravenous (Infants ≤ 6 mo and Neonates) 0.25–0.50 g/kg/dose (maximum of 25 g/dose) (as 25% dextrose);.
Availability (generic available)
Oral gel: 40% in 15-g, 30-g, and 45–g tubesOTC
Chewable tablets: 4 g, 5 gOTC
Solution for injection: 2.5%, 5%, 10%, 20%, 25%, 30%, 40%, 50%, 60%, 70%In combination with: sodium chloride, other electrolytes, and amino acids.
- Assess the hydration status of patients receiving IV dextrose. Monitor intake and output and electrolyte concentrations. Assess patient for dehydration or edema.
- Assess nutritional status, function of gastrointestinal tract, and caloric needs of patient.
- Diabetic patients and patients receiving hypertonic dextrose solution (>5%) should have serum glucose, potassium, and phosphate monitored regularly.
- Monitor IV site frequently for phlebitis and infection.
- Lab Test Considerations: May cause an ↑ serum glucose level.
Potential Nursing DiagnosesDeficient fluid volume (Indications)
Imbalanced nutrition: less than body requirements (Indications)
Excess fluid volume (Adverse Reactions)
- Dextrose solution alone does not contain enough calories to sustain an individual for a prolonged period. Dextrose contains 3.4 kcal/g. D5W contains 170 cal/liter and D10W contains 340 cal/liter.
- Oral: Concentrated dextrose gels and chewable tablets may be used in the treatment of hypoglycemia in conscious patients. The dose should be repeated if symptoms persist and serum glucose has not increased by at least 20 mg/dL within 20 min. May be followed by more complex carbohydrates.
- Intravenous: Hypertonic dextrose solution (>10%) should be administered IV into a central vein. For emergency treatment of hypoglycemia, administer slowly into a large peripheral vein to prevent phlebitis or sclerosis of the vein. Assess IV site frequently. Rapid infusions may cause hyperglycemia or fluid shifts. When hypertonic solution is discontinued, taper solution and administer D5W or D10W to prevent rebound hypoglycemia.
- Patients requiring prolonged infusions of dextrose should have electrolytes added to the dextrose solution to prevent water intoxication and maintain fluid and electrolyte balance.
- Additive Incompatibility: whole blood
- Explain the purpose of dextrose administration to patient.
- Instruct diabetic patient on the correct method for self–blood glucose monitoring.
- Advise patient on when and how to administer dextrose products for hypoglycemia.
- Correction and maintenance of adequate hydration status and normal serum glucose levels.
- Maintenance of adequate caloric intake.
in·su·lin re·ac·tion(insŭ-lin re-akshŭn)
Very low levels of blood sugar, which result from misdosage of insulin.