The Hitchhikers Guide to Parenteral Nutrition Management for Adult
Must maintain guidelines for peripheral lines when Adjusting dextrose concentration in intravenous ... Limit dextrose in TPN to 150 g/day initially.
Dextrose
In peripheral parenteral nutrition solutions the dextrose concentration is centrated dextrose becomes nonfunctional
What is Too Much? A Survey of Pediatric and Neonatal Parenteral
recommends a maximum of 900 mOsm/L for a peripheral line parenteral There was no maximum dextrose concentration for central PNs for 12 hospitals.
Neonatal Parenteral Nutrition
Peripheral PN solutions cannot exceed 12.5% dextrose Maximum is 3 g/kg/d in term infants and 3.5 g/kg/d in preterm infants.
A.S.P.E.N. Clinical Guidelines: Parenteral Nutrition Ordering Order
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Parenteral Nutrition Consultation and Monitoring Service for Adults
MAXIMUM concentration of dextrose will be 10% peripherally and. 35% centrally. 4. At the time of TPN initiation if the patient is not currently on.
Administration of Intravenous Potassium Chloride (KCL) Replacement
normal saline (0.9% sodium chloride) 5% dextrose
Pediatric Guidelines for IV Medication Administration
For peripheral venous administration dilute dextrose to MAX concentration of 12.5%. (1:1 with. NS)preferred. Monitor blood and urine sugar
DEXTROSE injection for intravenous use
Peripheral vein if final dextrose concentration 5% or less and osmolality is less than 900 mOsm/L Limit aluminum to less than 4 mcg/kg/day (5.8
Adult Intravenous Medications Standard and Maximum Allowable
Amiodarone will leach plastic from PVC bag. Maximum daily dose: 2.1 g/day. Peripheral line: Up to 2 mg/mL. (Concentrations over 2 mg/mL administered for.
[PDF] Dextrose - Ashp Publications
Concentrated dextrose should be diluted in compatible parenteral fluids including PN Maximum concentration Peripheral: 12 5 dextrose (except for emergency
[PDF] DEXTROSE injection for intravenous use - Accessdatafdagov
Peripheral vein if final dextrose concentration 5 or less and osmolality is less than 900 mOsm/L Limit aluminum to less than 4 mcg/kg/day (5 8 8 4)
[PDF] 10% Dextrose Injection USP
DESCRIPTION 10 Dextrose Injection USP (concentrated dextrose in water) is a sterile nonpyrogenic hypertonic solution of Dextrose USP in water for
[PDF] What is Too Much? A Survey of Pediatric and Neonatal Parenteral
The maximum dextrose concentration for a central PN ranged from 20- 35 for the other 19 (61 ) hospitals ? Only 12 9 (4/31) of hospitals allow for albumin
Re-evaluating Safe Osmolarity for Peripheral Parenteral Nutrition in
16 août 2021 · Although the accepted maximum glucose concentration for peripheral IV catheters is 12 5 perhaps according to our study results
Glucose infusions into peripheral veins in the - ResearchGate
Recent evidence supports the integrity of peripheral veins with dextrose concentrations as high as 20 No difference in rate of IV loss was noted for infants
[PDF] The Hitchhikers Guide to Parenteral Nutrition Management for Adult
These include the use of Central PN or provision of peripheral protein-sparing IV fluids containing 5 dextrose The anticipated duration of parenteral support
Glucose infusions into peripheral veins in the - Wiley Online Library
1 fév 2010 · A glucose concentration of 15 has generally been regarded as the highest acceptable for use in solutions infused into peripheral veins in
[PDF] ADULT INTRAVENOUS MEDICATIONS
STANDARD AND MAXIMUM ALLOWABLE CONCENTRATIONS GUIDELINES FOR CONTINUOUS OR Peripheral line: Up to 2 mg/mL (Concentrations over 2 BUN glucose
What is the maximum dextrose through a peripheral line?
This requirement means that peripheral PN formulas should contain no more than 5–10% dextrose and 3.5–5% amino acids. Potential complications of peripheral PN include phlebitis, infiltration, or fluid-overload issues.What is the maximum glucose concentration in a peripheral line?
•
Use increased volume with caution in infants where volume overload is a concern. Maximal concentration of glucose in peripheral IV is D12. 5. -If infant requires IV dextrose concentrations >12.5%, insert central venous catheter.Can dextrose 20% be given peripherally?
The solution should not be infused into peripheral veins. Prolonged intravenous infusion of this solution may cause thrombophlebitis extending from the site of infusion.- 50% glucose solution is hypertonic and can cause significant irritation to vessels. Initial boluses can be given via large bore peripheral line however if an ongoing infusion is required a central venous line should be placed.
Brand namesGenerics
Medication error
potential ISMP high-alert medication (dextrose concentrations of 20% or greater) that has an increased risk of causing significant patient harm if it is used in error. (1)Contraindications
and warningsContraindications: Concentrated dextrose solutions should not be used when intracranial hemorrhage is present.
(2) Dextrose injection should not be infused with blood through the same infusion set because red cell pseudoagglutination may occur. (2) Warnings: Significant hyperglycemia and hyperosmolality may occur with rapid infusion of concentrated dextrose solutions. (2)Infusion-related
cautions Infusion of hypertonic dextrose solutions is irritating to veins and can cause phlebitis wheninfused via peripheral vein. Usually, the concentration infused peripherally is limited to 11.5% to 12% dextrose.
(3,20) In peripheral parenteral nutrition solutions, the dextrose concentration is limited to 10% to 12.5%. (21) Abrupt withdrawal of concentrated dextrose solutions may result in hypoglycemia. This may be avoided by gradual decreases in the rate of infusion. (2)If an IV line infusing con-
centrated dextrose becomes nonfunctional, a peripheral IV can be used to infuse a lowerconcentration of dextrose (i.e., D5W, D10W).DosageHypoglycemia: Neonatal hypoglycemia is a metabolic emergency; serious neurological
injury can occur if normal blood glucose is not established. (5) Preterm neonates: 0.1-0.2 g/kg (1-2 mL/kg of 10% dextrose) followed by 6-8 mg/kg/min. (6-8) (See the Comments section.) dextrose or 1-2 mL/kg of 25% dextrose) administered slowly followed by 6-12 mg/kg/min. (5,7-14) Neonates with persistent hypoglycemia may require >12-15 mg/ kg/min. (5,8) For neonatal hypoglycemia, titrate dextrose to achieve blood glucose concentration40-50 mg/dL.
(9,14) If hypoglycemic seizures are present, 0.4 g/kg (4 mL/kg of 10% dextrose) bolus i s recommended by some authors.(8) Infants >6 months and children: 0.5-1 g/kg (5-10 mL/kg of 10% dextrose or2-4 mL/kg of 25% dextrose)
(6,10,15) administered slowly followed by 3-7.5 mg/kg/min. Pediatric resuscitation: 10% dextrose, 5-10 mL/kg; 25% dextrose, 2-4 mL/kg;50% dextrose, 1-2 mL/kg.
(15) Hyperkalemia (with insulin): 0.5-1 g/kg dextrose plus regular insulin 1 unit for every4 dextrose; infuse over 30 minutes to 2 hours.
(4)In 12 premature neonates 24-26
WGA, hyperkalemia was treated with infusions of 0.5 g/kg/hr dextrose with regular insulin 1 unit per dextrose (mean) infused over 29 hours (mean). (16) One study reported safe and effective use of a compounded multicomponent solution containing 3000 mg calcium gluconate, dextrose, 30 units regular i nsulin, and 100 mEq sodium acetate (final volume approximately 556 mL; final dextrose concentration27%) infused at 2 mL/kg/hr for 1 hour followed by 1 mL/kg/hr to treat hyperkalemia in 21 patients. The solution resulted in a dextrose infusion of 0.54 g/kg/h
r for 1 hour then0.27 g/kg/hr until resolution of hyperkalemia.
(17)Dosage adjustment
in organ dysfunction In liver failure, the glucose requirement may be increased due to depletion of glycogen stores.Dextrose
285Dextrose
Maximum dosageManufacturer states that glycosuria may be present at rates >0.5 g/kg/hr (8.3 mg/kg/ min) and that about 95% of dextrose is retained at 0.8 g/kg/hr (13.3 m g/kg/min). (2)15-25 mg/kg/min (0.9-1.5 g/kg/hr) has been given to hyperinsulinemic neonates.
(5,18)AdditivesContains aluminum.
(2)Suitable diluentsConcentrated dextrose should be diluted in compatible parenteral fluids including PN.
Maximum
concentration Peripheral: 12.5% dextrose (except for emergency situations) (4) Central venous lines: Usually 25% dextrose; 50% dextrose in emergencies. (4,15) Resuscitation: 25% in neonates, infants, and children. 50% has been used in adoles- cents and adults. (15)Preparation and
delivery Dilute to desired concentration in compatible electrolyte solution or PN.IV push0.2 g/kg over 1 minute.
(4,12)Too rapid infusion may result in hyperglycemia.
(2) (See theComments section.)
Intermittent infusionOver 30 minutes to 2 hours (treatment of hyperkalemia) (4)Continuous infusion4.5-15 mg/kg/min
(10,18)Other routes of
administration Concentrated solutions are not for sub-Q or IM administration. (2)May be given IO during
resuscitation. (15) CommentsMonitoring: Blood glucose concentrations should be monitored often during treatment for hypoglycemia and hyperkalemia. (12,15) Hyperglycemia causes osmotic fluid shifts that may result in rapid dehydration and intra- ventricular hemorrhage in neonates. (7) Following hyperglycemia, rebound hypoglycemia can occur because of stimulation of insulin secretion. (7,10,12) Osmolarity: 5% dextrose: 252 mOsmol/L; 10% dextrose: 505 mOsm/L (19) ; 25% dextrose:1390 mOsm/L
(20)REFERENCES
1. Institute for Safe Medication Practices. List of high-alert medications in acute care settings. https://www.ismp.org/recommendations/high-alert-
medications-acute-list. Accessed October 11, 2015.2. 50% and 70% Dextrose Injection, USP [prescribing information]. Lake Forest, IL: Hospira Inc; June 2010.
3. AHFS Drug Information [online database]. Dextrose. http://online.lexi.com. Accessed January 12, 2016.
4. Lexicomp Online, Pediatric and Neonatal Lexi-Drugs [online database]. Dextrose. http://onl
ine.lexi.com. January 12, 2016.5. Frankel L, Stevenson DK. Metabolic emergencies of the newborn: hypoxemia and hypoglycemia. Compr Ther. 1987;13(10):14-19.
6. Hegenbarth MA. Preparing for pediatric emergencies: drugs to consider. Pediatrics. 2008;121(2):433-443.
7. Polk DH. Disorders of carbohydrate metabolism. In: Tauesch HW, Ballard RA, eds. Avery's Diseases of the Newborn. 7th ed. Philadelphia, PA:
WB Saunders Company; 1998:1235-1241.
8. Sperling MA. Hypoglycemia. In: Kliegman RM, Stanton BF, St Geme JW, et al., eds. Nelson Textbook of Pediatrics. 20th ed. Philadelphia, PA:
Elsevier Inc; 2016:773-788.e1.
9. Adamkin DH. Postnatal glucose homeostasis in late-preterm and term infants. Pediatrics. 2011;127(3):575-579.
10. LaFranchi S. Hypoglycemia of infancy and childhood. Pediatr Clin North Am. 1987;34(4):961-982.11. Lilien LD, Grajwer LA, Pildes RS. Treatment of neonatal hypoglycemia with continuous intravenous glucose infusion. J Pediatr. 1977;91(5):779-782.
12. Lilien LD, Pildes RS, Srinivasan G, et al. Treatment of neonatal hypoglycemia with minibolus and intraveous glucose infusion. J Pediatr.
1980;97(2):295-298.
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