NEODOSE

INDICATIONS

• Hyperkalemia in combination with insulin
• Hypoglycemia, Prophylaxis: The incidence of hypoglycemia was reduced with prophylactic dextrose buccal gel compared with placebo in babies at 1 hour of age at risk of developing neonatal hypoglycemia in a randomized, double-blind, placebo-controlled, dosefinding study (n=416); relative risk was 0.68 (95% CI, 0.47 to 0.99) for the 200 mg/kg single dose. There was no difference between any dextrose dose and placebo in the rate of intensive care admission, breast feeding rates, and supplementary dextrose. The majority of babies (73%) were born to mothers with diabetes.
• Hypoglycemia, Treatment: Administration of buccal dextrose gel (40%) improved blood glucose better than feedings alone in at-risk late preterm and term babies who became hypoglycemic within the first 48 hours of birth in a randomized, double-blind, placebocontrolled study (n=237). Treatment failure rates were 14% and 24% (relative risk, 0.57 (95% CI, 0.33 to 0.98)) for the dextrose and placebo groups, respectively. Rebound and recurrent hypoglycemia were no different between dextrose gel and placebo groups. Almost all babies were breastfed. No additional risks or benefits were identified in 184 out the 237 eligible infants evaluated at 2 years’ corrected age. There was no difference between dextrose gel and placebo in neurosensory impairment or processing difficulties. Dextrose IV is recommended for hypoglycemia in the setting of cardiopulmonary resuscitation.
• Nutritional supplement in parenteral nutrition solutions

CONTRAINDICATIONS/PRECAUTIONS

Contraindicated when intracranial or intraspinal hemorrhage is present. Concentrated dextrose solutions (ie, 25% and 50%) are hypertonic and may cause phlebitis and thrombosis at injection site. Rapid administration may cause significant hyperglycemia and possible hyperosmolar syndrome.

ADVERSE EFFECTS

Excessive glucose provided by parenteral nutrition is associated with promotion of fat deposition, liver impairment and steatosis, and impairment of protein metabolism.

ADMINISTRATION

• Intravenous: Generally, glucose concentrations greater than 15% should be administered via a central vein to minimize risk of phlebitis and thrombosis. However, in one study in term neonates (n=121), peripheral infusion of a 20% glucose solution did not cause a higher rate or severity of phlebitis compared with peripheral infusion of a 15% glucose solution. Bolus doses should be administered only by slow IV injection. Abruptly discontinuing a dextrose infusion is not recommended due the risk for rebound hypoglycemia. For Hypoglycemia, use continuous infusion of a 5% to 10% dextrose IV solution with appropriate maintenance electrolytes.
• Buccal: Buccal: Prior to application, dry the mouth with a gauze. Massage the gel into the buccal mucosa followed by breastfeeding.

MONITORING

Laboratory

• Frequent monitoring of blood glucose is recommended; reasonable goal is blood glucose between 40 and 50 mg/dL.
• Monitor sodium and potassium levels closely.
• Obtain urine glucose and electrolytes periodically during therapy.
• Monitor acid-base balance and fluid status.