DRUG CARDS - 50% Dextrose
Indications...
-Acute alcoholism (rapid consumption of alcohol> alcohol poisoning) with coma (deliver thiamine prior to D₅₀W - thiamine "moves" glucose to be used to form ATP. No thiamine to move glucose=accumulation of glucose> cell converts glucose into lactic acid> lots of lactic acid can cause cell death) -Hypoglycemia -Coma of unknown cause (Check blood glucose!) -Status epilepticus of uncertain cause (hypoglycemia might be the cause) -Hyperkalemia - with insulin may shift potassium back to the intracellular space
Class...
-Carbohydrate -Caloric agent
Use cautiously with...
-Carbohydrate intolerance -Renal insufficiency -Chronic alcoholism (give thiamine first) -Diabetes
Side effects of D₅₀W on the metabolism...
-Decrease in potassium and magnesium -fluid overload
Contraindications...
-Hypersensitivity to corn or corn products (corn allergy) -Thiamine deficient PTs (may cause Korsakoff's psychosis or Wernicke's encephalopathy) -Intracranial hemorrhage (unless PT is hypoglycemic; hyperglycemia increases the rate of poor outcomes in PTs with ICH)
Side effects of D₅₀W on the cardiovascular system...
-Hypertension -CHF (life threatening) -Pulmonary edema (life threatening)
Mechanism of action...
-Increases blood glucose concentration -Provides calories -Decreases rate of ketone production (no insulin> body can't use sugar>ketones produced> high blood sugar levels) -Osmotic diuretic (high blood glucose surpasses renal threshold> glucose present in nephron> glucose attracts water>polyuria)
Side effects of D₅₀W on the skin...
-irritation -necrosis (cell dehydration?)
Dose...
12.5-25 grams (20-50cc)
How is D₅₀W supplied?
25 grams/50 mL (50% solution)
What should you preform prior to administration?
D-stick (blood glucose reading)
Precaution to consider when administering D₅₀W...
Excessive IV administration may cause fluid volume or solute overload
Side effects of D₅₀W on the genitourinary system...
Osmotic diuresis
How is D₅₀W administered?
Slow IVP (IV push) in a large vein
What should you give prior to D₅₀W administration if alcohol use is suspected?
Thiamine