Management of diabetic ketoacidosis
▶BY INTRAVENOUS INFUSION
▶Child:Glucose 5 %or 10 % should be added to
replacementfluid once blood-glucose concentration
falls below 14 mmol/litre
DOSE EQUIVALENCE AND CONVERSION
▶ 75 g anhydrous glucose is equivalent to Glucose BP
82. 5 g.lCAUTIONSDo not give alone except when there is no
significant loss of electrolytes.prolonged administration
of glucose solutions without electrolytes can lead to
hyponatraemia and other electrolyte disturbances
lINTERACTIONS→Appendix 1 : glucose
lSIDE-EFFECTSChills.electrolyte imbalance.fever.fluid
imbalance.hypersensitivity.local reaction.localised pain
.polyuria.rash.venous thrombosis
lDIRECTIONS FOR ADMINISTRATION
▶With intravenous useInjections containing more than 10 %
glucose can be irritant and should be given into a central
venous line; however, solutions containing up to 12. 5 %
can be administered for a short period into a peripheral
line.
lPRESCRIBING AND DISPENSING INFORMATIONGlucose BP
is the monohydrate but Glucose Intravenous Infusion BP is
a sterile solution of anhydrous glucose or glucose
monohydrate, potency being expressed in terms of
anhydrous glucose.
lEXCEPTIONS TO LEGAL CATEGORY
▶With intravenous usePrescription only medicine restriction
does not apply to 50 % solution where administration is for
saving life in emergency.
lMEDICINAL FORMS
There can be variation in the licensing of different medicines
containing the same drug. Forms available from special-order
manufacturers include: oral solution, solution for injection,
solution for infusion
Solution for infusion
▶Glucose (Non-proprietary)
Glucose anhydrous 200 mg per 1 mlGlucose 20 % solution for
infusion 100 ml vials| 1 vialP£ 5. 00
Glucose anhydrous 500 mg per 1 mlGlucose 50 % solution for
infusion 20 ml ampoules| 10 ampouleP£ 12. 00 DT = £ 12. 00
Glucose 50 % solution for infusion 50 ml vials| 25 vialP£ 50. 00 –
£ 50. 25
Oral solution
▶Rapilose OGTT(Galen Ltd)
Glucose 250 mg per 1 mlRapilose OGTT solution| 300 ml £ 3. 48
Oral gel
▶Dextrogel(Neoceuticals Ltd)
Glucose 400 mg per 1 gramDextrogel 40 % gel| 75 gram £ 7. 16 DT
=£ 7. 16 | 80 gram £ 6. 84
▶GlucoBoost(Ennogen Healthcare Ltd)
Glucose 400 mg per 1 gramGlucoBoost 40 % gel| 75 gram £ 5. 72
DT = £ 7. 16 | 80 gram £ 6. 11
▶GlucoGel(BBI Healthcare Ltd)
Glucose 400 mg per 1 gramGlucoGel 40 % gel original|
75 gramG£ 7. 16 DT = £ 7. 16 | 80 gramG£ 6. 84
▶Rapilose(Galen Ltd)
Glucose 400 mg per 1 gramRapilose 40 % gel| 75 gram £ 5. 49 DT =
£ 7. 16
Infusion
▶Glucose (Non-proprietary)
Glucose anhydrous 50 mg per 1 mlGlucose 5 % infusion 1 litre
Macoflex bags| 1 bagPs
Glucose 5 % infusion 500 ml bags| 1 bagPs
Glucose 5 % infusion 50 ml bags| 1 bagPs
Glucose 5 % infusion 250 ml bags| 1 bagPs
Glucose 5 % infusion 100 ml bags| 1 bagPs
Glucose anhydrous 100 mg per 1 mlGlucose 10 % infusion 500 ml
bags| 1 bagPs
Glucose 10 % infusion 1 litre bags| 1 bagPs
Glucose anhydrous 200 mg per 1 mlSteriflex No. 31 glucose 20 %
infusion 500 ml bags| 1 bagP£ 2. 64
Glucose (as Glucose monohydrate) 300 mg per 1 mlGlucose 30 %
infusion 500 ml polyethylene bottles| 10 bottleP£ 40. 21
Glucose anhydrous 400 mg per 1 mlSteriflex No. 33 glucose 40 %
infusion 500 ml bags| 1 bagP£ 2. 81
Glucose anhydrous 500 mg per 1 mlSteriflex No. 34 glucose 50 %
infusion 500 ml bags| 1 bagP£ 3. 11
Glucose 50 % infusion 500 ml polyethylene bottles| 1 bottleP
£ 5. 10
Glucose anhydrous 700 mg per 1 mlGlucose 70 % concentrate for
solution for infusion 500 ml Viaflex bags| 1 bagPs
Combinations available:Potassium chloride with glucose,
p. 588 .Potassium chloride with glucose and sodium chloride,
p. 588 .Sodium chloride with glucose,p. 590ORAL REHYDRATION SALTS
Disodium hydrogen citrate with
glucose, potassium chloride and
sodium chloride
(Formulated as oral rehydration salts)
lINDICATIONS AND DOSE
Fluid and electrolyte loss in diarrhoea
▶BY MOUTH
▶Child 1–11 months: 1 – 1 ½ times usual feed volume to be
given
▶Child 1–11 years: 200 mL, to be given after every loose
motion
▶Child 12–17 years: 200 – 400 mL, to be given after every
loose motion, dose according tofluid losslDIRECTIONS FOR ADMINISTRATIONReconstitute 1 sachet
with 200 mL of water (freshly boiled and cooled for
infants); 5 sachets reconstituted with 1 litre of water
provide Na+ 60 mmol, K+ 20 mmol, Cl– 60 mmol, citrate
10 mmol, and glucose 90 mmol.
lPRESCRIBING AND DISPENSING INFORMATIONFlavours of
oral powder formulations may include black currant,
citrus, or natural.
lPATIENT AND CARER ADVICEAfter reconstitution any
unused solution should be discarded no later than 1 hour
after preparation unless stored in a refrigerator when it
may be kept for up to 24 hours.
Medicines for Children leaflet: Oral rehydration salts
http://www.medicinesforchildren.org.uk/oral-rehydration-saltslMEDICINAL FORMS
There can be variation in the licensing of different medicines
containing the same drug.
Powder
▶Dioralyte(Sanofi)
Potassium chloride 300 mg, Sodium chloride 470 mg, Disodium
hydrogen citrate 530 mg, Glucose 3.56 gramDioralyte oral powder
sachets citrus| 20 sachetp£ 6. 72
Dioralyte oral powder sachets plain| 20 sachetp£ 6. 72
Dioralyte oral powder sachets blackcurrant| 20 sachetp£ 6. 72Potassium chloride with rice powder,
sodium chloride and sodium citrate
(Formulated as oral rehydation salts)
lINDICATIONS AND DOSE
Fluid and electrolyte loss in diarrhoea
▶BY MOUTH
▶Child 1–11 months: 1 – 1 ½ times usual feed volume to be
given
▶Child 1–11 years: 200 mL, to be given after every loose
motion
▶Child 12–17 years: 200 – 400 mL, to be given after every
loose motion, dose according tofluid lossBNFC 2018 – 2019 Fluid and electrolyte imbalances 591
Blood and nutrition9