This product is a compound preparation, its components are: 5% glucose and 0.9% sodium chloride.

【Properties】

This product is a colorless and clear liquid.

【Pharmacology and Toxicology】

Glucose is one of the main sources of calories in the human body. Sodium and chlorine are important electrolytes in the body, mainly in the extracellular fluid, and play a very important role in maintaining the body's normal blood and extracellular fluid volume and osmotic pressure.

【Pharmacokinetics】

After glucose enters the human body, the normal human body can utilize 6mg/kg per minute.

【Indications】

Replenish heat and body fluids. Used for insufficient food or loss of a large amount of body fluids caused by various reasons.

[Usage and dosage] The usage and dosage of glucose and sodium chloride should be considered at the same time:

1. Usage and dosage of glucose:

1. Supplementary heat. When the patient's eating is reduced or unable to eat due to some reasons, 10% to 25% glucose injection can be given intravenously and body fluids can be supplemented at the same time. The amount of glucose is calculated based on the required heat energy.

2. Total intravenous nutrition therapy Glucose is the most important energy supply substance for this therapy. In non-protein heat energy, the ratio of energy supplied by glucose to fat is 2:1. The specific dosage is determined according to the clinical calorie requirement. According to the needs of the amount of rehydration, glucose can be prepared into different concentrations of 25% to 50%. If necessary, add insulin, plus 1 unit of regular insulin for every 5-10g of glucose. Since this product is often used with hypertonic solutions, it is more irritating to the veins and requires the infusion of fat emulsions, so the deep large veins, such as the subclavian vein and internal jugular vein, are generally used.

3. For severe hypoglycemia, 20-40ml of 50% glucose injection can be given intravenously.

4. In severe cases, 5-25% glucose injection should be used for intravenous drip, 100g glucose per day can basically control the condition.

5. Water loss isotonic water loss, give 5% glucose injection intravenously.

6. Hyperkalemia The use of 10-25% injection, plus 1 unit of regular insulin infusion for every 2-4g glucose, can reduce the serum potassium concentration. However, this therapy only allows extracellular potassium ions to enter the cell, and the total potassium content in the body remains unchanged. If you do not take measures to excrete potassium, there is still the possibility of hyperkalemia again.

7. Tissue dehydration Hypertonic solution (usually 50% glucose injection) is used for rapid intravenous injection of 20-50ml. But the effect is short-lived. Clinically, attention should be paid to prevent hyperglycemia, and it is rarely used at present. When used to adjust the osmotic pressure of the peritoneal dialysate, 20ml of 50% glucose injection, that is, 10g glucose, can increase the osmotic pressure of 1L of peritoneal dialysate by 55mOsm/kgH2O. That is, for every 1% increase in the glucose concentration in the dialysate, the osmotic pressure increases by 55mOsm/kgH2O.

2. Usage and dosage of sodium chloride:

1. Hyperosmotic water loss The osmotic concentration of brain cells and cerebrospinal fluid increases in patients with hypertonic water loss. If the sodium concentration and osmotic concentration of plasma and extracellular fluid drop too quickly, brain edema may be caused. Therefore, it is generally believed that within 48 hours of the beginning of treatment, plasma sodium concentration does not drop more than 0.5 mmol/L per hour. If the patient has shock, sodium chloride injection should be given first, and the colloid should be supplemented as appropriate. After the shock is corrected, blood sodium>155mmol/L, plasma osmotic concentration>350mOsm/L, 0.6% hypotonic sodium chloride injection can be given. When the plasma osmotic concentration is less than 330mOsm/L, switch to 0.9% sodium chloride injection. The total amount of rehydration is calculated according to the following formula, as a reference: the required rehydration amount (L) = blood sodium concentration (mmol/L) × 0.6 × body weight (Kg)

Generally, half of the amount will be replenished on the first day, and the remaining amount will be replenished within 2 to 3 days, and adjusted according to the cardiopulmonary and renal function.

2. The principle of isotonic water loss is to give isotonic solutions, such as 0.9% sodium chloride injection or compound sodium chloride injection, but the chlorine concentration of the above solution is significantly higher than that of plasma, and a large amount of use alone can cause hyperchloremia, so The 0.9% sodium chloride injection and 1.25% sodium bicarbonate or 1.86% (1/6M) sodium lactate can be prepared at a ratio of 7:3 and then refilled. The latter has a chlorine concentration of 107 mmol/L and can correct metabolic acidosis. The amount of replenishment can be calculated based on body weight or hematocrit as a reference. ①Calculated by body weight: fluid replacement volume (L)=(weight loss (kg) ×142)/154; ②calculated by hematocrit: fluid fluid volume (L)=(actual hematocrit-normal hematocrit × body weight (kg) )×0.2)/ Normal hematocrit. Normal hematocrit is 48% for men and 42% for women.

3. Hypotonic water loss In severe hypotonic water loss, the solute in brain cells is reduced to maintain cell volume. If the treatment causes the plasma and extracellular fluid sodium concentration and osmotic concentration to rise rapidly, it can cause brain cell damage. It is generally believed that when the blood sodium is less than 120 mmol/L, the treatment will increase the blood sodium at a rate of 0.5 mmol/L per hour and not more than 1.5 mmol/L per hour. When blood sodium is lower than 120 mmol/L or when symptoms of the central nervous system appear, 3% to 5% sodium chloride injection can be given slowly instillation. It is generally required to increase the blood sodium concentration above 120 mmol/L within 6 hours. Sodium supplementation (mmol/L) = [142-actual blood sodium concentration (mmol/L)] × body weight (kg) × 0.2. When the blood sodium rises to above 120-125mmol/L, you can switch to an isotonic solution or add hypertonic glucose injection or 10% sodium chloride injection as appropriate.

4. Low-chlorine alkalosis: Give 0.9% sodium chloride injection or compound sodium chloride injection (ringer's solution) 500~1000ml, and decide the dosage according to the situation of alkalosis.

【Adverse reactions】

1. Too much or too fast infusion can cause water and sodium retention, causing edema, increased blood pressure, increased heart rate, chest tightness, dyspnea, and even acute left heart failure.

2. Improper administration of hypertonic sodium chloride can cause hypernatremia.

3. Too much or too fast administration of hypotonic sodium chloride can cause hemolysis and cerebral edema.

4. Phlebitis: occurs when hypertonic glucose injection is instilled. Switching to large intravenous drip, the incidence of phlebitis decreased.

5. The extravasation of high concentration solution injection can cause local swelling and pain.

6. Reactive hypoglycemia: combined with excessive use of insulin, the original tendency to hypoglycemia and the sudden stop of total intravenous nutrition therapy are likely to occur.

7. Hyperglycemia nonketotic coma: It is more common in diabetes, stress, high-dose glucocorticoids, uremic peritoneal dialysis patients given intraperitoneal hypertonic glucose solution and total intravenous nutrition therapy.

8. Electrolyte disorders: Hypokalemia, hyponatremia and hypophosphatemia are prone to occur when simply supplementing glucose for a long time.

【Taboo】

1. People with insufficiency of brain, kidney, and heart;

2. Those with low plasma protein;

3. Patients with diabetes and ketoacidosis not controlled;

4. Patients with hypertonic dehydration;

5. Hyperglycemia and non-ketosis hypertonic state.

【Precautions】

1. Use with caution in the following situations: ① Edema diseases, such as nephrotic syndrome, liver cirrhosis, ascites, congestive heart failure, acute left heart failure, cerebral edema and idiopathic edema, etc.; ② Acute renal failure, oliguria, chronic Renal failure with reduced urine output and poor response to diuretics; ③hypertension; ④hypokalemia; ⑤the amount and speed of fluid replacement in the elderly and children should be strictly controlled.

2. Follow-up examination: ①serum sodium, potassium, and chloride concentration; ②blood acid-base balance index; ③renal function; blood pressure and heart and lung function.

3. Excessive glucose injection during childbirth can stimulate fetal insulin secretion and cause hypoglycemia in the baby after delivery.

4. Use with caution in the following situations: ①Patients with periodic paralysis and hypokalemia; ②Hyperglycemia is easily induced by stress or glucocorticoids; ③Edema, severe heart and kidney insufficiency, and liver cirrhosis, ascites are likely to cause water. For retention, the amount of infusion should be controlled; especially those with cardiac insufficiency should control the drip rate.

[Medicine for pregnant and lactating women]

No special attention.

【Children's Medication】

The amount and speed of rehydration should be strictly controlled.

【Medication for elderly patients】

The amount and speed of rehydration should be strictly controlled.

【Overdose】

Can cause hypernatremia and hypokalemia, and can cause loss of bicarbonate.