Prismasol

Anhydrous Dextrose is a sterile, nonpyrogenic monosaccharide used in various clinical applications, including calculi dissolution, anticoagulation, and as a radiographic contrast agent vehicle. It plays a vital role in metabolic support and specialized irrigation procedures.

The dosage of Anhydrous Dextrose is highly individualized based on the patient's age, weight, clinical condition, and the specific therapeutic goal.

• For Calculi Dissolution (Irrigation): Healthcare providers typically use a 5% to 10% solution for continuous or intermittent irrigation of the bladder or renal pelvis. The flow rate is usually adjusted to 30-60 mL per hour, depending on patient tolerance and the size of the stone. Treatment may continue for several days until the calculi are sufficiently dissolved.
• For Caloric Support (IV): Dosage is calculated based on the patient's daily energy requirements. A standard rate might involve 2-4 mg/kg/minute of dextrose to maintain metabolic stability without causing excessive hyperglycemia.
• For Acute Hypoglycemia: 10 to 25 grams (40 to 100 mL of a 25% solution or 20 to 50 mL of a 50% solution) may be administered intravenously as a slow bolus.

Anhydrous Dextrose is approved for pediatric use, but dosing must be extremely precise to avoid osmotic shifts and electrolyte imbalances.

• Neonates and Infants: Dosing is strictly weight-based, often starting at 4-8 mg/kg/minute. High-concentration solutions (above 12.5%) should generally not be infused through peripheral veins in infants due to the risk of tissue damage.
• Children: For hypoglycemia, 0.5 to 1 gram/kg is a common starting dose. For irrigation, pediatric use is rare and must be monitored by a pediatric urologist.

Renal Impairment

Patients with impaired kidney function require careful monitoring. While dextrose itself is not toxic to the kidneys, the fluid volume and the risk of osmotic diuresis can strain renal reserves. Dose reductions in the rate of infusion are often necessary to prevent fluid overload.

Hepatic Impairment

In patients with severe liver disease, the ability to store glucose as glycogen or convert lactate to glucose may be impaired. Frequent blood glucose monitoring is required, and doses may need to be adjusted to prevent both hypoglycemia and hyperglycemia.

Elderly Patients

Geriatric patients are more susceptible to fluid overload and glucose intolerance. Healthcare providers typically start at the lower end of the dosing range and titrate slowly while monitoring cardiac and renal markers.

Anhydrous Dextrose is almost exclusively administered by healthcare professionals in a clinical setting.

• Intravenous Infusion: Must be administered through a sterile catheter. High concentrations (hypertonic solutions) should be infused into a large central vein to minimize the risk of vein irritation (thrombophlebitis).
• Irrigation: Administered via a urinary catheter (Foley or nephrostomy tube). It is vital to maintain aseptic technique to prevent urinary tract infections.
• Storage: Solutions should be stored at room temperature (20°C to 25°C) and protected from excessive heat and freezing. Do not use the solution if it is discolored or contains particulate matter.

In a hospital setting, missed doses are rare as infusions are controlled by pumps. If an irrigation or infusion is interrupted, contact your nurse or doctor immediately. Do not attempt to 'double the rate' to catch up, as this can cause dangerous spikes in blood sugar.

Signs of Anhydrous Dextrose overdose (hyperglycemia) include extreme thirst, frequent urination, confusion, blurred vision, and a sweet, fruity breath odor (ketoacidosis). In severe cases, it can lead to hyperosmolar hyperglycemic state (HHS), characterized by profound dehydration and coma.

Emergency Measures: If an overdose is suspected, the infusion must be stopped immediately. Treatment involves the administration of insulin to lower blood sugar and appropriate fluid and electrolyte replacement to correct dehydration.

> Important: Follow your healthcare provider's dosing instructions. Do not adjust your dose or stop an infusion without medical guidance.

When administered intravenously or via irrigation, some side effects occur frequently as the body adjusts to the glucose load:

• Injection Site Reaction: Redness, swelling, or a warm feeling at the site of the IV. This usually resolves shortly after the infusion rate is adjusted or the site is changed.
• Increased Urination (Polyuria): As the body processes the sugar, the kidneys may excrete more water, leading to more frequent trips to the bathroom.
• Thirst: A natural response to the osmotic effects of dextrose in the bloodstream.

• Hyperglycemia

Anhydrous Dextrose must be used with extreme caution in patients with known glucose intolerance or diabetes mellitus. Because it is a direct source of glucose, it can rapidly elevate blood sugar levels, necessitating frequent monitoring and potential insulin administration. Furthermore, the osmolarity of the solution is a critical safety factor; hypertonic solutions can cause significant tissue damage if they leak out of the vein (extravasation).

No FDA black box warnings for Anhydrous Dextrose. Clinical practice, however, treats the risk of peripheral vein damage from hypertonic solutions with the same level of gravity as a boxed warning.

• Allergic Reactions: Patients with a known allergy to corn or corn products should be monitored closely, as most medical-grade dextrose is derived from corn starch.

While Anhydrous Dextrose is a naturally occurring sugar, it should not be mixed in the same IV line with certain medications:

• Blood for Transfusion: Dextrose solutions should never be administered through the same infusion set as whole blood or red blood cells. The dextrose can cause the red cells to clump (pseudoagglutination) or burst (hemolysis).
• Ceftriaxone (in Neonates): Mixing ceftriaxone with calcium-containing dextrose solutions can lead to fatal precipitates in the lungs and kidneys of newborns.

• Insulin: While often used together, insulin directly opposes the blood-sugar-raising effect of dextrose. Dosage must be precisely balanced to avoid dangerous swings.

Anhydrous Dextrose must NEVER be used in the following circumstances:

1. 1Hyperglycemic Crisis: Including Diabetic Ketoacidosis (DKA) or Hyperosmolar Hyperglycemic State (HHS), where blood sugar is already dangerously high.
2. 2Severe Dehydration (without electrolytes): Using dextrose without accompanying electrolytes in a severely dehydrated patient can cause water to shift into the brain cells, leading to cerebral edema (brain swelling).
3. 3Intracranial or Intraspinal Hemorrhage: High glucose levels can worsen brain damage following a stroke or bleed.
4. 4Known Corn Allergy

Anhydrous Dextrose is generally considered safe during pregnancy when used appropriately (FDA Category C, though often treated as Category B in clinical practice). It is a standard component of IV fluids used during labor and delivery. However, excessive glucose during pregnancy can lead to fetal hyperglycemia and neonatal hypoglycemia (where the baby's pancreas overproduces insulin in response to the mother's high sugar, causing a crash after birth). It should only be used if clearly needed and under strict glucose control.

Dextrose is a natural component of breast milk. There are no known risks to the nursing infant when the mother receives dextrose infusions. It does not affect milk production, though the mother's overall nutritional status is important for lactation.

Approved for all pediatric age groups, including neonates. In newborns, dextrose is critical for preventing hypoglycemia, which can cause permanent brain damage. However, the 'glucose infusion rate' (GIR) must be carefully calculated (usually in mg/kg/min) to avoid over-taxing the infant's metabolic system. Pediatric patients are at a much higher risk for fluid and electrolyte shifts.

Anhydrous Dextrose ($C_6H_{12}O_6$) is a dextrorotatory isomer of glucose. At the molecular level, it is transported into cells via Glucose Transporters (GLUT). Once inside, it is phosphorylated by hexokinase to form glucose-6-phosphate.

In the context of Calculi Dissolution, the mechanism involves the creation of an acidic environment (pH approx. 4.0-5.0) which increases the solubility of alkaline stones. The Calcium Chelating Activity occurs as the dextrose and associated organic acids in the solution bind to calcium ions, pulling them out of the stone's crystalline matrix. As an Anti-coagulant, it maintains the ATP levels in red blood cells, preventing the release of pro-coagulant cellular factors.

The onset of action for intravenous dextrose is immediate. The duration of the glycemic effect is short (usually 1-2 hours) as the body rapidly moves the sugar into cells or stores it as glycogen. When used for irrigation, the stone dissolution effect is gradual, requiring continuous contact over several days.