Glucose solution, hypertonic

Glucose solutions are suitable for injection or infusion purposes.

A distinction is made between hypotonic and hypertonic glucose solutions.

Hypotonic:

The 5% glucose solution is called "hypotonic" (Souza- Offtermatt 2004).

Hypertonic:

Glucose solution of 10 % or more is called hypertonic solution:

• 10 %: 500 mOsm
• 70 %: 3.500 mOsm (Striebel 2009)
• 20 % = 0.8 kcal / ml
• 40 % = 1.6 kcal / ml (Herold 2020)

• 12 g glucose = 1 BE
• 1 BE raises the BG level by approx. 30 - 50 mg / dl
• Glucose solution:

100 ml glucose 33 % = 33 g glucose = 2.75 BE: causes a BG- increase of about 85 - 140 mg / dl (Bastigkeit 2010).

A glucose solution of ≥ 5 % is poorly tolerated via peripheral veins (Kasper 2015). Striebel (2009) considers up to 10 % glucose solutions via peripheral cannula possible.

For higher-percentage glucose, a central venous catheter should be placed for administration.

This is usually placed either in the subclavian vein or the internal jugular vein, although it is easier to place the catheter in the subclavian vein.

Catheters are easier to place in the subclavian vein and are better tolerated by the patient than in the internal jugular vein, although the risk of pneumothorax is significantly lower when the latter is punctured (Kasper 2015).

Pharmacodynamics (effect)

Glucose can be metabolized in the body to CO2 and H2O or converted to fats as an energy source. Metabolism of glucose is possible in all tissues. Glucose is taken up by the cells together with potassium in an insulin-dependent manner (Striebel 2009).

The supply of hypertonic solutions rapidly increases the osmolarity of the plasma and thus the osmotic pressure, which causes a flow of fluid from the extravascular to the intravascular space. Thus, a high intravascular increase in volume can be achieved by a small volume administration, the so-called small volume resuscitation(Bastigkeit 2010).

In addition, the intravascular increase in volume leads to an increase in myocardial contractility for reasons that are not yet fully understood (Bastigkeit 2010).

The hypertonic glucose solution causes rapid uptake and metabolism in the cells, so that practically only free water is incorporated. Due to its diffusibility in all fluid compartments, only a maximum of 10% of free water can remain in the intravascular space, so that hypertonic glucose solutions would be ineffective as volume replacement therapy (Bastigkeit 2010).

With physiologically hypotonic glucose solutions, serum sodium monitoring is important (Shi 2013).

Indication

• parenteral nutrition (Herold 2020)
• For sclerosing (60 - 80 % glucose. No longer used nowadays as recurrence rates were high [Kauffmann 2013]).
• Hypoglycemia (5 g i.v. [Brendebach 2013])
• carrier solution for electrolyte concentrates or drugs
• hypertonic dehydration
• hypernatremia
• renal failure
• dialysis patients (Bastigkeit 2010)
• Wound healing

In a meta-analysis with randomized controlled trials between 1990 - 2011, it was shown that wound healing of postoperative aseptic wounds with fat liquefaction can be shortened by subcutaneous injection of insulin and 50% glucose, compared to conventional drainage, because 50% glucose solution inhibits bacterial growth, prevents edema in granulation tissue and stimulates granulation tissue growth (Shi 2013).

Glucose 5 - 10% is used for:

• hypertonic dehydration to substitute free water.
• As a solvent for both dilution and drug administration (leads to longer shelf life for a catecholamine solution, for example [Bastigkeit 2010]).
• Glucose 20 - 70 % is used to:cover carbohydrate metabolism (completely or partially)
• parenteral nutrition
• in hypoglycaemia
• in hyperosmotic coma (Bastigkeit 2010)

Dosage and method of administration

For parenteral nutrition, 100 - 400 g glucose / d is infused at a steady infusion rate(Herold 2020)

Adverse effects

• Tissue necrosis in extravasation (Bastigkeit 2010)
• Thrombophlebitis with peripheral administration of high glucose concentrations (Tagalakis 2002)
• Impaired glucose utilization

At the start of total parenteral nutrition, glucose metabolism may be impaired with hyperglycaemia. In this case, a so-called intensified insulin therapy should be carried out and a BG concentration of approx. 80 - 110 (-150) mg / dl should be aimed for. In most cases, this requires ≤ 4 IU insulin / h (Striebel 2009).

To avoid hyperglycemia, it is recommended to increase the glucose concentration gradually:

1st day 10 % ige

2nd - 4th day 20 % ige

5th day 30 % ige

then 40 % (Siewert 2013)

Contraindication

• Patients with liver cirrhosis (hypertonic glucose solution increases portal pressure and pulmonary capillary pressure (PCP) and can lead to variceal bleeding [Hartel 2013]).
• Hyperglycemia
• Shock
• Acidosis
• In heart failure, there is a risk of volume overload [Bastigkeit 2010].

Interactions

Red cell concentrates:

Because red cell concentrates in glucose solutions lead to pseudoagglutination, do not float them in a glucose solution (Paul 2019).

Preparations

Glucose in bottled form or as infusion bags are offered in increments of ten as glucose 5% to glucose 70% and as glucose 33% (Bastigkeit 2010).

For parenteral nutrition, the following are available: e.g. NuTRI- flex R Lipid basal, NuTRI flex basal, Aminomix, Glucoplasm

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