Dextrose 5% water D5W

Type of solution

Hypertonic solution

Classification

Generic Name: sodium chloride, sodium lactate, potassium chloride and
calcium chloride

Content

Each 100 mL contains 5 g Dextrose Hydrous, USP*; 600 mg Sodium Chloride,
USP (NaCl); 310 mg Sodium Lactate (C3H5NaO3); 30 mg of Potassium Chloride, USP
(KCl); and 20 mg Calcium Chloride, USP (CaCl2 · 2H20). It contains no
antimicrobial agents. Approximate pH 5.0 (4.0 to 6.5).

Mechanism of action

5% Dextrose in Lactated Ringer's Injection provides electrolytes and
calories, and is a source of water for hydration. It is capable of inducing
diuresis depending on the clinical condition of the patient. This solution also
contains lactate which produces a metabolic alkalinizing effect.
Sodium, the
major cation of the extracellular fluid, functions primarily in the control of
water distribution, fluid balance and osmotic pressure of body fluids. Sodium is
also associated with chloride and bicarbonate in the regulation of the acid-base
equilibrium of body fluid. Potassium, the principal cation of intracellular
fluid, participates in carbohydrate utilization and protein synthesis, and is
critical in the regulation of nerve conduction and muscle contraction,
particularly in the heart.
Chloride, the major extracellular anion, closely
follows the metabolism of sodium, and changes in the acid-base balance of the
body are reflected by changes in the chloride concentration. Calcium, an
important cation, provides the framework of bones and teeth in the form of
calcium phosphate and calcium carbonate. In the ionized form, calcium is
essential for the functional mechanism of the clotting of blood, normal cardiac
function, and regulation of neuromuscular irritability.
Sodium lactate is a
racemic salt containing both the levo form, which is oxidized by the liver to
bicarbonate, and the dextro form, which is converted to glycogen. Lactate is
slowly metabolized to carbon dioxide and water, accepting one hydrogen ion and
resulting in the formation of bicarbonate for the lactate consumed. These
reactions depend on oxidative cellular activity.
Dextrose provides a source
of calories. Dextrose is readily metabolized, may decrease losses of body
protein and nitrogen, promotes glycogen deposition and decreases or prevents
ketosis if sufficient doses are provided

INDICATIONS AND USAGE

Lactated Ringer’s and 5% Dextrose Injection, USP is indicated as a source
of water, electrolytes and calories or as an alkalinizing agent,

CONTRAINDICATIONS

solutions containing dextrose may be contraindicated in patients with known
allergy to corn or corn products.

How supplied

Lactated Ringer’s and 5% Dextrose Injection, USP in VIAFLEX plastic
containers is available as follows:
Code
Size
NDC
2B2073
500 mL
NDC 0338-0125-03
2B2074
1000 mL
NDC 0338-0125-04
Exposure of
pharmaceutical products to heat should be minimized. Avoid excessive heat. It is
recommended the product be stored at room temperature (25°C); brief exposure up
to 40°C does not adversely affect the product
Dose

DOSAGE AND ADMINISTRATION

As directed by a physician. Dosage is dependent upon the age, weight and
clinical condition of the patient as well as laboratory
determinations.
Parenteral drug products should be inspected visually for
particulate matter and discoloration prior to administration whenever solution
and container permit.
All injections in VIAFLEX plastic containers are
intended for intravenous administration using sterile equipment.
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 weight infants, because of the increased risk of
hyperglycemia/hypoglycemia.
Additives may be incompatible. Complete
information is not available. Those additives known to be incompatible should
not be used. Consult with pharmacist, if available. If, in the informed
judgement of the physician, it is deemed advisable to introduce additives, use
aseptic technique. Mix thoroughly when additives have been introduced. Do not
store solutions containing additives

Nursing
responsibilities
1. Suspend container from eyelet
support.
2. Remove plastic protector from outlet
port at bottom of container.
3. Attach
administration set. Refer to complete directions accompanying
set
1. 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.
2. Lactated Ringer’s and 5% Dextrose
Injection, USP should be used with caution. Excess administration may result in
metabolic alkalosis.
3. Caution must be exercised in
the administration of Lactated Ringer’s and 5% Dextrose Injection, USP to
patients receiving corticosteroids or
corticotropin.
4. Lactated Ringer’s and 5% Dextrose
Injection, USP should be used with caution in patients with overt or subclinical
diabetes mellitus
5. If an adverse reaction does
occur, discontinue the infusion, evaluate the patient, institute appropriate
therapeutic countermeasures

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.

Alcoholism or alcohol abuse

Need to know more about alcoholism? Want to know more about alcoholism? worry no more, here is a summary on Alcoholism or alcohol abuse. here are nursing intervention and case presentation of alcoholism, hope it helps.!

Addiction- is a term used to define a state of chronic or recurrent drug intoxication and is characterize by psychological and physical independence as well as tolerance.
Tolerance- occurs as the individual drinks more with less effect
Withdrawal occurs when an individual abruptly stops drinking after alcohol has become a necessity of life to maintain functioning.
Action of Alcohol
-CNS depressants
-loss of inhibition
-relaxation
- rapidly goes into the bloodstream
Overdosage of alcohol
-vomiting
-unconscious
-respiratory depression
Concept of Alcoholism as a disease
Alcohol is known to shorten an individual’s life span by 12 to 15 years unless treatment is received \. Like other chronic illnesses, it has certain observable symptoms.
Alcoholism
- -intoxication between 15-17
- Phases
- Pre-alcoholic- start for the reason of curiosity
- Early alcoholic – every weekend
- Sexually aggressive
- Lack of coordination
Physiologic effects of alcoholism
-gastro intestinal complications
-gastritis, pancreatitis, hepatitis, cirrhosis of the liver, esophageal varices, hemorrhoids, ascites.
-cardiovascular
- hypertension, weakened heart muscles and heart failure, broken blood vessel in the upper check and bloodshot eyes are common
-respiratory tract complications
- prostatitis, interference with voiding, release of sexual inhibition, fetal alcoholism syndrome,
-central nervous system
-depression, resulting in peripheral neuropathy, interference with nerve conduction, gate changes, and nerve palsies, occurs frequently.
-general appearance
-poor nutritional status, deficiency in vitamin A, D, and K, anemia, an increase susceptibility to infection , bruising and bleeding tendency.

Signs and symptoms
-impaired judgement, orientation memory, affect and cognition; impaired speech; behavioral changes and impaired mobility.
Three screening test
- Michigan alcohol screening test (MAST)
- CAGE screening test for alcoholism
- Alcohol use disorders identification test (AUDIT)
- -Blood and urine screening
- Brief drug abuse screening
Two categories of Alcohol related disorders
Alcohol use disorders
-alcohol dependence -3 or more of the 7 symptoms for 12 months
-tolerance withdrawal symptoms, intake alcohol in a larger amount. Persistent desire

-alcohol abuse- do not include tolerance and withdrawal , but has 1 or more symptoms
- recurrent drinking of alcohol due to failure or depression
-continue use despite of persistent

Alcohol induced DISORDERS
- 1.Alcohol intoxication – occurs after a recent ingestion of alcohol and is evidenced by behavioral changes such as impaired social or occupational functioning, fighting or impaired judgment.
S/s
- Modd changes increase verbalization, impaired attention span, irritability, slurred speech, lack of coordination, unsteady gait, impaired memory and stupor or coma.
2. alcohol withdrawal- clients generally experience clinical symptoms of alcohol withdrawal within several hours to a few days after the cessation or reduction of heavily or prolonged alcohol consumption,.
s/s
autonomic hyper activity, increase hand tremor, sleep disturbances, insomnia, nightmares , nausea or vomiting, trancient visual, tactile or auditory hallucinations or illusions, psychomotor agitation, anxiety and grand mal seizures, elevated temperatures in excess of 100*F and pulse in excess of 100 BP, may indicate impeding deliriums tremens
3. alcohol withdrawal delirium.
- delirium may occur 24 to 72 hours after the clients last drink.
s/s
elevation of v/s, accompanies restlessness, tremulousness, agitation and hyper alertness, any nose or quick movements are perceive as greatly exaggerated, shadows are misinterpreted, and illusions and hallucinations frequently occurs, the clients speech is incoherent.
4. alcohol induced persisting dementia
-individuals who experience a prolong, chronic, dependence on alcohol amy develop alcoholic dementia
s/s
severe loss of intellectual ability that interferes with social or occupational functioning and impaired memory, judgment, an abstract thinking. Permanent brain damage and occur in sever cases.
5. alcohol induced persisting amneistic disorder
- individuals who drink large amount of alcohol in a long period of time
2 CNS disorders associated
-korsakoffs psychosis – deficiency in vitamin B12 and thiamine
s/s
disorientation and confabulation
-wernickes encephalopathy- inflammatory hemorrhage degenerative
s/s diplopia and double vision

pharmacologic intervention
*disulfiram (antabuse) interferes with the breakdown of alcohol-
Client having serious heart disease, diabetes, epilepsy, liver impairment or mental illness is contraindicated
client must not have ingested alcohol for at leat 12 hours to prevent toxic reaction such as sever nausea and vomiting, hypotension headaches.
*Naltrexone (revia) treat alcoholism because it reduce client’s cravings for alcohol.
Contraindicated in patients with hepatitis or liver failure.
*thiamine – prevent or treat wernicke encephalopathy and Korsakoff.
*lorazepam (ativan) – for alcohol withdrawal syndrome.
\
NURSING ACTIONS
- Provide safety for clients as they may exhibit clinical symptoms of overdose, intoxication or withdrawal
- Encourage client for therapy
- Encourage client to join in alcoholism support groups
- Seizure precautions can minimize chances of injury
- Intravenous barbiturates may be required to control extreme agitation
- Provide a safe environment for self-abusive or suicidal clients.
- Arrange dietary consultation with input by client
- STABILIZING MEDICAL CONDITION, STABILZING BEHAVIOR. MEDICAL MANAGEMENT,