Details About Overdose or Poisoning Generic Salt ::  Glucose

Glucose

    

Drug Pharmacology ::

I. Pharmacology. Glucoseis an essential carbohydrate that is used as a substrate for energyproduction within the body. Although many organs use fatty acids as analternative energy source, the brain is totally dependent on glucose asits major energy source; thus, hypoglycemia may cause serious braininjury rapidly. Dextrose administered with insulin shifts potassiumintracellularly and maintains euglycemia for treatment of calciumantagonist poisoning (hyperinsulinemia-euglycemia [HIE] therapy).

Drug Indications ::

Indications

   

Hypoglycemia.

Empiric therapy for patients with stupor, coma, or seizures who may have unsuspected hypoglycemia.

Usedwith an insulin infusion for severe calcium antagonist poisoning (seeCalcium Antagonists), beta-blocker poisoning (see Beta-AdrenergicBlockers), and hyperkalemia (Hyperkalemia and hypokalemia).

Drug Contra-Indications ::

III. Contraindications. Noabsolute contraindications for empiric treatment of comatose patientswith possible hypoglycemia. However, hyperglycemia and (possibly)recent ischemic brain injury may be aggravated by excessive glucoseadministration.

Drug Adverse Effects ::

IV. Adverse effects

   

Hyperglycemia and serum hyperosmolality.

Local phlebitis and cellulitis after extravasation (occurs with concentrations 10%) from the intravenous injection site.

Administrationof a large glucose load may precipitate acute Wernicke-Korsakoffsyndrome in thiamine-depleted patients. For this reason, thiamine (seeThiamine (Thiamin, Vitamin B1)) is given routinely along with glucoseto alcoholic or malnourished patients.

Administrationof large volumes of sodium-free dextrose solutions may contribute tofluid overload, hyponatremia, hypokalemia, and mild hypophosphatemia.

E. Use in pregnancy. FDAcategory C (indeterminate). This does not preclude its acute,short-term use for a seriously symptomatic patient (see Table III–1).

Drug Lab Interactions ::

Drug or laboratory interactions. No known interactions.

Drug Dose Management ::

Dosage and method of administration

   

Asempiric therapy for coma, give 50–100 mL of 50% dextrose (equivalent to25–50 g glucose) slowly (eg, about 3 mL/min) via a secure intravenousline (children, 2–4 mL/kg of 25% dextrose; do not use 50% dextrose in children).

Persistenthypoglycemia (eg, resulting from poisoning by sulfonylurea agent) mayrequire repeated boluses of 25% (for children) or 50% dextrose andinfusion of 5–10% dextrose, titrated as needed. Consider the use ofoctreotide (see Octreotide) in such situations. Note that glucose canstimulate endogenous insulin secretion, which may exacerbate ahyperinsulinemia (resulting in wide fluctuations of blood glucoselevels while treating sulfonylurea poisonings).

Hyperinsulinemia-euglycemiatherapy usually requires an initial dextrose bolus (unless thepatient’s initial blood glucose is > 250 mg/dL) followed by adextrose infusion at a rate of 0.5 g/kg/h using a 5% to 50% dextrosesolution (if > 25% dextrose solution, administer via a central line)as needed to maintain euglycemia while infusing insulin (see Insulin).

Drug Chemical Formulations ::

Formulations

   

Parenteral. Dextrose(d-Glucose) injection, 50%, 50-mL ampules, vials, and prefilledinjector; 25% dextrose, 10-mL syringes; various solutions of 2.5–70%dextrose, some in combination with saline or other crystalloids.

The suggested minimum stocking levelto treat a 70-kg adult for the first 24 hours is four prefilledinjectors (50% and 25%) and four bottles or bags (5% and 10%, 1 L each).

Disclaimer ::

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