Glucose

Question 1

Give the 4 clinical indications for the use of glucose.

Answer 1

1) Glucose 5% is used to provide water intravenously in patients unable to take enough orally.
2) Glucose 10%, 20% and 50% are used to treat hypoglycaemia when this is severe or cannot be treated orally. Glucagon is an alternative.
3) Glucose 10%, 20% and 50% are used with insulin to treat Hyperkalaemia. Calcium gluconate may also be given in this setting.
4) Glucose 5% is used for reconstitution and dilution of drugs intended for administration by injection or infusion.

Question 2

1) Which type of glucose is highly irritant to veins?
2) What else might this type of glucose cause?
3) Because of this, how must this type of glucose be administered?

Answer 2

1) 50% glucose and to a lesser extent, 20% glucose.
2) Phlebitis and thrombosis.
3) Use of 50% glucose is now discouraged unless it can be given by a central line.

Question 3

1) In renal failure, when giving IV glucose what type of monitoring is essential and why?
2) What is the risk of giving significant volumes of hypotonic fluid to a patient with hyponatraemia?
3) Glucose has an antagonistic effect with what?

Answer 3

1) Close monitoring of fluid balance is essential to avoid overload.
2) It may precipitate hyponatraemic encephalopathy.
3) Insulin.

Question 4

Describe a typical prescription that would cover ‘maintenance requirements’ in an adult.

Answer 4

2L 5% glucose and 500mL 0.9% NaCl would cover typical maintenance requirements in adults for water and sodium.

Question 5

1) When treating hypoglycaemia and hyperkalaemia, what should be monitored?
2) When using glucose to provide water intravenously, what should be monitored?

Answer 5

1) Plasma glucose and serum potassium concentrations should be monitored closely.
2) Fluid balance should be monitored (measure fluid input and output and calculate the net fluid balance per 24 hour period.

Question 6

In a patient that requires a red cell transfusion and IV glucose, what must you not allow to happen and why?

What is the solution to this?

Answer 6

You should not allow them to mix as this may cause agglomeration of cells. If appropriate, administer them sequentially rather than concurrently. Alternatively, give them through different cannulas.

Question 7

Give 3 P drugs that can be used to treat hypoglycaemia.

Answer 7

1) 20% glucose
2) Oral glucose solutions
3) Glucagon (Glucogen)