Monday, September 29, 2008

Dextrose NM D5NM Normosol-M

Type of solution

hypertonic solution of balanced maintenance
electrolytes and 5% dextrose injection in water for injection

Classification

Nonpyrogenic, parenteral fluid, electrolyte and
nutrient replenisher

Content

Each 100 mL contains dextrose,
hydrous 5 g, sodium chloride, 234 mg, potassium acetate, 128 mg and magnesium
acetate, anhydrous 21 mg. May contain hydrochloric acid for pH adjustment.

Mechanism of actions

When administered intravenously, Normosol-M
and 5% Dextrose Injection provides water and electrolytes (with dextrose as a
readily available source of carbohydrate) for maintenance of daily fluid and
electrolyte requirements, plus minimal carbohydrate calories. The electrolyte
composition approaches that of the principal ions of normal plasma
(extracellular fluid). The electrolyte concentration is hypotonic (112
mOsmol/liter) in relation to the extracellular fluid (280 mOsmol/liter). One
liter provides approximately one-third of theaverage adult daily requirement for
water and principal electrolytes in balanced proportions, with acetate as a
bicarbonate alternate, plus 170 calories from dextrose.
Solutions containing
carbohydrate in the form of dextrose restore blood glucose levels and supply
calories. Carbohydrate in the form of dextrose may aid in minimizing liver
glycogen depletion and exerts a protein-sparing action. Dextrose injected
parenterally undergoes oxidation to carbon dioxide in water.
Sodium chloride
in water dissociates to provide sodium (Na+) and chloride (Cl−) ions. Sodium
(Na+) is the principal cation of the extracellular fluid and plays a large part
in the therapy of fluid and electrolyte disturbances. Chloride (Cl−) has an
integral role in buffering action when oxygen and carbon dioxide exchange occurs
in the red blood cells. The distribution and excretion of sodium (Na+) and
chloride (Cl−) are largely under the control of the kidney which maintains a
balance between intake and output.
Potassium acetate in water dissociates to
provide potassium (K+) and acetate (CH3COO−) ions. Potassium is the chief cation
of body cells (160 mEq/liter of intracellular water). It is found in low
concentration in plasma and extracellular fluids (3.5 to 5.0 mEq/liter) in a
healthy adult and child over 10 days old; 3.5 to 6.0 mEq/liter in a child less
than 10 days old. Potassium plays an important role in electrolyte balance.
Normally about 80 to 90% of the potassium intake is excreted in the urine; the
remainder in the stools and to a small extent, in the perspiration. The kidney
does not conserve potassium well so that during fasting or in patients on a
potassium-free diet, potassium loss from the body continues resulting in
potassium depletion.
Magnesium acetate in water dissociates to provide
magnesium (Mg++) and acetate (CH3COO−) ions. Magnesium is the second most
plentiful cation of the intracellular fluids. It is an important cofactor for
enzymatic reactions and plays an important role in neurochemical transmission
and muscular excitability. Normal plasma concentration ranges from 1.5 to 2.5 or
3.0 mEq per liter. Magnesium is excreted solely by the kidney at a rate
proportional to the plasma concentration and glomerular filtration.
Acetate
anion (CH3COO−), a source of hydrogen ion acceptors, serves as an alternate
source of bicarbonate (HCO3−) by metabolic conversion in the liver. This has
been shown to proceed readily even in the presence of severe liver disease.
Thus, acetate anion exerts a mild systemic antiacidotic action that may be
advantageous during fluid and electrolyte replacement therapy.
Water is an
essential constituent of all body tissues and accounts for approximately 70% of
total body weight. Average normal adult daily requirement ranges from two to
three liters (1.0 to 1.5 liters each for insensible water loss by perspiration
and urine production). Average normal pediatric daily requirements are based on
the child’s weight as described in the table below:

Indications and
Usage for Normosol-M and Dextrose

Normosol-M and 5% Dextrose Injection
(Multiple Electrolytes and 5% Dextrose Injection Type 1, USP) is indicated for
parenteral maintenance of routine daily fluid and electrolyte requirements with
minimal carbohydrate calories from dextrose. Magnesium in the formula may help
to prevent iatrogenic magnesium deficiency in patients receiving prolonged
parenteral therapy.

Contraindications

None known.

How is
Normosol-M and Dextrose Supplied

Normosol-M and 5% Dextrose Injection
(Multiple Electrolytes and 5% Dextrose Injection Type 1, USP) is supplied in
single-dose 500 and 1000 mL flexible plastic containers (List No. 7965).
Exposure of pharmaceutical products to heat should be minimized. Store at 20
to 25°C(68 to 77°F). [See USP Controlled Room Temperature.] Covered by one or
more of the following patents: 4,344,472; 4,368,765.

DOSAGE

Normosol-M and 5% Dextrose Injection is administered by intravenous
infusion. The dose is dependent upon the age, weight and clinical condition of
the patient. A daily total amount of 1500 mL/M2 of body surface will meet the
usual adult daily requirements for water and principal electrolytes in patients
unable to take anything by mouth. The usual daily maintenance amount for an
average adult (70 kg and 1.8 square meters of body surface) is approximately
three liters.
As reported in the literature, the dosage and constant
infusion rate of intravenous dextrose must be selected with caution in pediatric
patients, particularly neonates and low birth weight infants, because of the
increased risk of hyperglycemia/hypoglycemia.
Drug Interactions
Additives may be incompatible. Consult with pharmacist, if available. When
introducing additives, use aseptic technique, mix thoroughly and do not store.
To avoid precipitation of calcium salts that may occur when certain drugs
are added, Normosol-M and 5% Dextrose Injection does not contain calcium.
Parenteral drug products should be inspected visually for particulate matter
or discoloration prior to administration, whenever solution and container
permit. See PRECAUTIONS.

INSTRUCTIONS FOR USE
To Open
Tear outer
wrap at notch and remove solution container. Some opacity of the plastic due to
moisture absorption during the sterilization process may be observed. This is
normal and does not affect the solution quality or safety. The opacity will
diminish gradually.
If supplemental medication is desired, follow directions
below before preparing for administration.
To Add Medication
1. Prepare
additive port.
2. Using aseptic technique and an additive delivery needle of
appropriate length, puncture resealable additive port at target area, inner
diaphragm and inject. Withdraw needle after injecting medication.
3. The
additive port may be protected by covering with an additive cap.
4. Mix
container contents thoroughly.
To Administer
1. Attach administration
set per manufacturer’s instructions.
2. Regulate rate of administration per
institutional policy.
WARNING: Do not use flexible container in series
connections.

Nursing responsibilites

Clinical evaluation and
periodic laboratory determinations are necessary to monitor changes in fluid
balance, electrolyte concentrations, and acid-base balance during prolonged
parenteral therapy or whenever the condition of the patient warrants such
evaluation.
Caution must be exercised in the administration of parenteral
fluids, especially those containing sodium ions, to patients receiving
corticosteroids or corticotropin.
Solutions containing acetate should be
used with caution, as excess administration may result in metabolic alkalosis.
Solutions containing dextrose should be used with caution in patients with
known subclinical or overt diabetes mellitus.
Do not administer unless
solution is clear and container is undamaged. Discard unused portion.
In
very low birth weight infants, excessive or rapid administration of dextrose
injection may result in increased serum osmolality and possible intracerebral
hemorrhage.

2 comments:

qt_reney said...

hello ninz,,,

thankd for the IVF study.. It helps me alot!!! hehe miss yuh..

Best ever,

RENEYc",)

margarett said...

Hi sir! Thanks for this info this s really a big help! You're my savior! Xiexie