Use Of Dextrose Research Articles

Intrapartum Care for People with Diabetes-Working towards Evidence-Based Management.

The consensus in the literature supports the need for careful monitoring and management of maternal blood glucose during labor to optimize neonatal outcomes. Guidelines generally recommend strict control of maternal blood glucose during labor, involving frequent checks, and the use of dextrose and insulin as needed. However, recent evidence has not consistently shown a strong association between strict control of blood glucose and a reduction in the rate of neonatal hypoglycemia. This raises questions about the extent to which intrapartum blood glucose control impacts neonatal hypoglycemia. This review aims to explore the literature on intrapartum maternal blood glucose management in individuals with pregestational or gestational diabetes, utilizing peer-reviewed journals and datasets, including PubMed, Google Scholar, and clinical guidelines. Observational studies, small sample sizes, variability in definitions of maternal hyperglycemia and neonatal hypoglycemia, and differences in measurement methods such as timing and thresholds for intervention limit the literature on this topic. Additionally, many studies may not fully account for confounding factors such as maternal body mass index, diet, and other comorbidities affecting blood glucose levels. These limitations underscore the need for a cautious interpretation of current findings and highlight the necessity for future research in this area. This review elaborates on the available data and summarizes evidence on managing labor in pregnancies complicated by diabetes. We also emphasize the need for further research to clarify the relationship between maternal blood glucose during labor and neonatal blood glucose. KEY POINTS: · The benefits of strict intrapartum blood glucose control are unclear.. · The optimal maternal blood glucose range to prevent neonatal hypoglycemia remains undefined.. · Additional research is necessary to understand the relationship between maternal and neonatal blood glucose..

Association between dextrose-containing maintenance fluids and phosphorus supplementation during total parenteral nutrition initiation in adult patients who were hospitalized: A retrospective cohort study.

Use of dextrose-containing maintenance fluids prior to parenteral nutrition (PN) initiation is speculated to reduce the risk for refeeding syndrome. We aimed to assess if the use of dextrose vs nondextrose maintenance fluids before PN initiation changes electrolyte supplementation requirements and shifts during initiation. This retrospective cohort study included patients who received nothing by mouth but received maintenance fluids ≥72 h before PN. The major end point was phosphorus supplementation over 48 h following nutrition initiation. Minor end point included other electrolyte supplementation, changes in electrolyte levels, time to discharge, and goal kilocalories per day. Fifty-three patients between August 1, 2019, and August 26, 2020, met criteria for analysis; 60% (n = 32) used a dextrose and 40% (n = 21) used a nondextrose maintenance fluid. Baseline characteristics were similar between fluid groups except for body mass index (25.1 dextrose vs 27.5 kg/m2 nondextrose), sex (43.8% female vs 52.4% male), and severe malnutrition (46.9% vs 28.6%), respectively. Phosphorus (52.5 vs 50 mmol; P = 0.33) and magnesium (24 vs 22 g; P = 0.63) supplementation 48 h following nutrition initiation were similar between groups; however, potassium supplementation was lower in the dextrose group (165.0 vs 208.7 mEq; P = 0.01). No difference was observed between groups for time to discharge following nutrition initiation or time to goal kilocalories per day. After controlling for patients who were malnourished between fluid groups using linear regression, phosphorus repletion differences remained nonsignificant. This study did not detect a difference in phosphorus supplementation between groups, even after controlling for patients who were malnourished.

Simple Sugar Solution Injection to Cure Knee Osteoarthritis (OA)

Abstract: Knee osteoarthritis (oa) is a degenerative arthritis which commonly affects knee joint , mostly bilateral1. Till date offered treatment is analgesics, physiotherapy, support in form of braces and lastly surgery. Steroid injection tried but with only short lasting effect2. We recommend use of dextrose 15% & local anaesthetic solution, each month for 3 months to stimulate regeneration and pain reliev

Perioperative Dextrose Infusion and Postoperative Nausea and Vomiting: A Meta-analysis of Randomized Trials.

Perioperative IV dextrose infusions have been investigated for their potential to reduce the risk of postoperative nausea and vomiting. In this meta-analysis, we investigated the use of an intraoperative or postoperative infusion of dextrose for the prevention of postoperative nausea and vomiting. Our group searched PubMed, Embase, Cochrane library, and Google Scholar for relevant randomized controlled trials examining the use of perioperative IV dextrose for prevention of postoperative nausea and vomiting. The primary outcome was the incidence of postoperative nausea and vomiting (both in the postanesthesia care unit and within the first 24 h of surgery). Secondary outcomes included postoperative antiemetic administration and serum glucose level. Our search yielded a total of 10 randomized controlled trials (n = 987 patients) comparing the use of a perioperative dextrose infusion (n = 465) to control (n = 522). Perioperative dextrose infusion was not associated with a significant reduction in postoperative nausea and vomiting in the postanesthesia care unit (risk ratio = 0.91, 95% CI, 0.73-1.15; P = .44) or within the first 24 h (risk ratio = 0.76, 95% CI, 0.55-1.04; P = .09) of surgery. Although the use of dextrose was associated with a significant reduction in antiemetic administration within the first 24 h (risk ratio = 0.55, 95% CI, 0.45-0.69; P < .001), it also increased postoperative plasma glucose levels compared to controls. The use of perioperative dextrose did not result in a statistically significant association with postoperative nausea and vomiting. When utilized, plasma glucose monitoring is recommended to assess for postoperative hyperglycemia. Further prospective trials are necessary to examine the potential impact of timing of administration of a dextrose infusion on incidence of postoperative nausea and vomiting and rescue antiemetic requirements.

Fixed-rate insulin for adult diabetic ketoacidosis is associated with more frequent hypoglycaemia than rate-reduction method: a retrospective cohort study.

To assess whether hypoglycaemia incidence during management of adult diabetic ketoacidosis (DKA) differed following transition from a fixed-rate insulin protocol to a protocol using an empiric insulin rate reduction after normoglycaemia. We retrospectively reviewed charts from adult patients managed with a DKA order set before and after order set revision. In cohort 1 (n=77), insulin rate was 0.1unit/kg/h with no adjustments and dextrose was infused at 12.5g/h after glucose reached 250mg/dl. In cohort 2 (n=78), insulin was reduced to 0.05unit/kg/h concurrent with dextrose initiation at 12.5g/h after glucose reached 200mg/dl. The primary outcome was hypoglycaemia (glucose<70mg/dl) within 24h of the first order for insulin. The 24-h incidence of hypoglycaemia was 19.2% in cohort 2 versus 32.5% in cohort 1; the adjusted odds ratio was 0.46 (95% confidence interval (CI) [0.21, 0.98]; P=0.047). The 24-h use of dextrose 50% in water (D50W) was also reduced in cohort 2. No differences were seen in anion gap or bicarbonate normalization, rebound hyperglycaemia or ICU length of stay. In most patients who became hypoglycaemic, the preceding glucose value was below 100mg/dl. The insulin rate-reduction protocol was associated with less hypoglycaemia and no obvious disadvantage. Robust intervention for low-normal glucose values could plausibly achieve low hypoglycaemia rates with either approach.

Altered Mental Status: Current Evidence-based Recommendations for Prehospital Care.

IntroductionIn the United States emergency medical services (EMS) protocols vary widely across jurisdictions. We sought to develop evidence-based recommendations for the prehospital evaluation and treatment of a patient with an acute change in mental status and to compare these recommendations against the current protocols used by the 33 EMS agencies in the State of California.MethodsWe performed a literature review of the current evidence in the prehospital treatment of a patient with altered mental status (AMS) and augmented this review with guidelines from various national and international societies to create our evidence-based recommendations. We then compared the AMS protocols of each of the 33 EMS agencies for consistency with these recommendations. The specific protocol components that we analyzed were patient assessment, point-of-care tests, supplemental oxygen, use of standardized scoring, evaluating for causes of AMS, blood glucose evaluation, toxicological treatment, and pediatric evaluation and management.ResultsProtocols across 33 EMS agencies in California varied widely. All protocols call for a blood glucose check, 21 (64%) suggest treating adults at <60mg/dL, and half allow for the use of dextrose 10%. All the protocols recommend naloxone for signs of opioid overdose, but only 13 (39%) give specific parameters. Half the agencies (52%) recommend considering other toxicological causes of AMS, often by using the mnemonic AEIOU TIPS. Eight (24%) recommend a 12-lead electrocardiogram; others simply suggest cardiac monitoring. Fourteen (42%) advise supplemental oxygen as needed; only seven (21%) give specific parameters. In terms of considering various etiologies of AMS, 25 (76%) give instructions to consider trauma, 20 (61%) to consider stroke, and 18 (55%) to consider seizure. Twenty-three (70%) of the agencies have separate pediatric AMS protocols; others include pediatric considerations within the adult protocol.ConclusionProtocols for patients with AMS vary widely across the State of California. The evidence-based recommendations that we present for the prehospital diagnosis and treatment of this condition may be useful for EMS medical directors tasked with creating and revising these protocols.

Hyperglycemia in critical patients: Determinants of insulin dose choice.

To identify factors that can determine the choice of intermittent subcutaneous regular insulin dose in critically ill patients with hyperglycemia. Cross-sectional study in a general adult ICU with 26 beds, data collected between September and October 2014. The variables analyzed were: sex, age, previous diagnosis of diabetes mellitus, use of corticosteroids, use of lactulose, sepsis, fasting, enteral nutrition, use of dextrose 5% in water, NPH insulin prescription and blood glucose level. Patients with one or more episodes of hyperglycemia (blood glucose greater than 180 mg/dL) were included as a convenience sample, not consecutively. Those with continuous insulin prescription were excluded from analysis. We included 64 records of hyperglycemia observed in 22 patients who had at least one episode of hyperglycemia. The median administered subcutaneous regular human insulin was 6 IU and among the factors evaluated only blood glucose levels were associated with the choice of insulin dose administered. Clinical characteristics such as diet, medications and diagnosis of diabetes mellitus are clearly ignored in the decision-making regarding insulin dose to be administered for glucose control in critically ill patients with hyperglycemia.

Dextrose as carbon source in the culture of Litopenaeus vannamei (Boone, 1931) in a zero exchange system

This work compared the use of dextrose and molasses as carbon sources for biofloc development, water quality maintenance, microorganism composition and growth performance of Litopenaeus vannamei juveniles in biofloc technology (BFT). Two treatments, dextrose and molasses, were tested with four replicates each. Carbon was added to achieve a C:N-AT (N-(NH3+NH4+)) ratio of 6:1. Physical and chemical water quality variables were monitored daily, and shrimp growth was estimated through periodic biometry. After 30 days, survival, final biomass, and feeding conversion rate (FCR) were determined. Dissolved organic carbon, chlorophyll-a, floc volume, total ammonia, nitrite, nitrate and phosphate concentrations, and microorganisms (qualified by groups), were measured every three days. Water quality variables remained within acceptable levels throughout the experimental period, except for nitrite, which reached higher levels than recommended for this species. The use of dextrose resulted in higher water transparency, which influenced the remaining centric diatoms. A superior shrimp performance was observed at this treatment, presumably because of variations on the microbial community. Therefore, it is concluded that the addition of dextrose results in a superior growth performance of L. vannamei when cultured in BFT systems.

Antioxidant and antimicrobial profile of chicken sausages prepared after fermentation of minced chicken meat with Lactobacillus plantarum and with additional dextrose and starch

Lactobacillus plantarum, one of the most resourceful probiotic bacteria which has been known for its antioxidant and antimicrobial property. The aim of this study was to assess the antioxidant and antimicrobial properties of L. plantarum with the use of dextrose and starch as a substrate in chicken sausage prepared before and after fermentation of minced chicken meat with L. plantarum. Results indicated that chicken sausages prepared after fermentation of minced chicken meat (without spices) supplemented with dextrose and starch and fermented with L. plantarum showed higher antioxidant scavenging activity against hydroxyl, superoxide anion (SASA) and DPPH free radicals activity of L. plantarum both in fermented raw minced chicken meat and cooked chicken sausage as compared to those groups without addition of sugars. The minced chicken meat supplemented with dextrose and starch subjected to fermentation with L.plantarum also showed lower lipid oxidation as well better scores for sensory as well as lower microbial counts as compared to sausages prepared from fermented minced chicken meat without addition of sugars. However, combinations of sugars exerted better antioxidant and antimicrobial effect than using singly. The results indicated usefulness of sugars in enhancing the antioxidant and antimicrobial potential of L. plantarum in minced chicken meat during fermentation.

The use of dextrose in winemaking

In this work the benefit of using dextrose instead of sucrose was investigated. Trials with stuck fermentation could show the potential of compensating glucose / fructose imbalances by adding dextrose. Trials on sparkling wine production showed that under stressful conditions the second fermentation started earlier and finished more complete, when dextrose was used instead of sucrose in the tirage liqueur. In general the sensory property of the later product was not changed when dextrose was used as alternative to sucrose. Several trials on must chaptalization showed in general no clear differences in terms of fermentation kinetics. The aroma analysis showed as well, that the fermentation aroma was not clearly different when dextrose used as sugar source.

Minerals and extremely low birth weight infants

The 80% of bone mineralisation occurs in the third trimester of pregnancy. The daily fetal requirement is 310 mg of calcium and 170 mg of phosphorus[1]. The bone mineral density (BMD) correlates positively with gestational age, weight and length[2]. At birth, extremely premature infants (ELBWI)canpresent hypocalcaemiabecause of interruption of the maternal calcium supply, high level of calcitoninand immature response to PTH. Early parenteral nutrition solutionisnecessary to maintain normal serum calcium and phosphorus levels. Indeed, the exclusive use of dextrose and calcium gluconate leads to thehypophosphatemia, deleterious to intermediary metabolism, intracellular energy transfer and bone mineral homeostasis[3]. The ELBWI are at risk of Osteopenia of prematurity, also known as neonatal metabolic bone disease (MBD). The pathophysiology includesreduction in organic protein matrix (osteopenia) and/or a reduction in mineral component (osteomalacia). MBD causes rickets, fractures and may affect growth in infancy and childhood. The structural basis of osteopenia is decreased thickness or number of trabeculae and/or decreased thickness of the bone cortex. Osteomalaciais a disorder of the physiological process of mineralisation, when the incorporation of mineral into the organic bone matrix is disturbed, whereas “rickets” describes defective mineralisation of growth plate cartilage and its morphological consequences[4]. The ethiology is multifactorial: placental dysfunction, prolonged (>4 weeks) parenteral nutrition, diureticsand steroids treatment, immobilization and inadequate nutrient intake of calcium, phosphorus, and vitamin D[5]. The main ethiology factor is deficit of mineral substrates, whereas the critical factor is lack of phosphorus[4]. It should be needed an adequate mineral supplementation with parenteral and enteral nutrition, although the difficulties to fortify appropriately the human milk. The dosage recommended of vitamin D is between, 400 IU/d (AAP) and 1000 IU/d (ESPGHAN)[6]. Moreover hypotonia and immobilization are an additional risk factors [7], daily passive exercise canimproves the bone mineral content [8]. MBD could be detected by X-Ray, dual-energy x-ray absorptiometry (DEXA) or quantitative ultrasound. The serumdiagnostic markers are alkaline phosphatases, calcium and phosphateserum levels. Preterm infants with low serum phosphate (<2 mmol/l) are at risk of MBD and levels less than 1.8 mmol/l have been strongly associated with the presence of radiographically evident rickets. Because of preterm has a much lower renal phosphate threshold and this is not bound in the plasma like calcium, the tubular reabsorption is the best guide to calculate itssupplementation[8].

The early management of pancreatitis associated with hypertriglyceridaemia.

In triglyceridaemia-associated pancreatitis, decreasing the serum triglyceride level below 5.65 mmol/l alleviates abdominal pain and is purported to improve outcome. We analysed hypertriglyceride level normalisation and outcome in a patient cohort of acute pancreatitis. Patients presenting with pancreatitis and hypertriglyceridaemia were assessed. All patients with presenting triglycerides levels >10 mmol/l were assessed for resolution to a level below 5.65 mmol/l at days 3 and 5. Patients with triglyceride levels in excess of 10 mmol/l were treated with either standard supportive therapy or an insulin dextrose infusion. In the period June 2001 to April 2008, there were 503 admissions of 439 patients with a diagnosis of acute pancreatitis; 26 (6%) had hypertriglyceridaemia >10 mmol/l at admission. Standard therapy was used in all patients; in 6 patients, it was the sole therapy. A dextrose and insulin infusion was used in 20 cases. On day 3, 7 (32%) of the measured triglyceride levels had fallen below 5.65 mmol/l and, on day 5, all but 4 (83%) were <5.65 mmol/l. Three patients died. Standard therapy was equivalent to the use of dextrose and insulin in the resolution of hypertriglyceridaemia. Our methods to reduce triglyceride levels produce morbidity and mortality rates similar to those attained when alternate lipid-lowering strategies are employed.

Dextrose 50% as a better substitute for saturated salt solution in mothball float test

We describe the use of dextrose 50% solution to differentiate naphthalene and paradichlorobenzene in the mothball float test. Its advantages over saturated salt solution are discussed.

Effects of Dextrose Plus Lactose in the Sows Diet on Subsequent Reproductive Performance and within Litter Birth Weight Variation

Effects of dextrose plus lactose in sow's feed were tested on subsequent reproductive performance and within litter birth weight variation. During the last week of gestation and lactation, sows were either fed a commercial lactation diet (Control: C), or an isocaloric diet containing 25 g/kg dextrose plus 25 g/kg lactose ( T). In the subsequent weaning-to-oestrus interval (WEI), all sows received the same amount of a commercial feed, but T sows were supplemented with 150 g dextrose plus 150 g lactose per day. Weight and backfat changes were recorded as well as litter characteristics during the treatment period and the subsequent parity. No significant effect of treatment was found on the subsequent reproductive performance, including the number of piglets born, although the number of live born piglets was 0.51 larger (p=0.31) and weight of the live born piglets was 84 g higher in the T sows (p=0.07) than in the C sows. When sows were categorized in sows with 12 or less and more than 12 total born piglets in the previous litter, treatment of sows with dextrose plus lactose resulted for the group with 12 or less piglets in a strong increase in subsequent total born piglets (13.97), whereas in the untreated sows the subsequent litter size was 11.89. In the group with more than 12 total born piglets, no effect of treatment was found (interaction between previous litter size and treatment p=0.03). The within litter variation in birth weight in the subsequent litter was numerically lower in the T sows. We concluded that the use of dextrose and lactose during lactation and WEI seems to enhance litter size in sows with low previous litter size and seems to have the potential to reduce the within litter variation in birth weight.

Perioperative fluid therapy in children: a survey of current prescribing practice

Fluid therapy in children may be associated with iatrogenic hyponatraemia. We surveyed anaesthetists' current fluid prescribing practice during the perioperative period, departmental fluid protocols and awareness of the concerns of the Royal College of Paediatrics and Child Health (RCPCH) about the use of dextrose 4%/saline 0.18% in children. Questionnaire survey of 477 consultant anaesthetists in two training areas in the UK. Responses were received from 289 anaesthetists (60.6%)--responses from the 203 consultants that anaesthetized children were analysed. A total of 67.7% did not have a local departmental policy for fluid prescription, and 58.1% were unaware of the concerns of RCPCH. A total of 60.1% of anaesthetists said that they prescribed hypotonic dextrose saline solutions in the intraoperative period and 75.2% did so in the postoperative period. Anaesthetists working in specialist paediatric hospitals were 5.1 times more likely to prescribe isotonic fluids intraoperatively than those working in district hospitals (95% CI 1.48-17.65, P=0.01), but they all prescribed hypotonic dextrose saline solutions postoperatively. The Holliday and Segar formula for maintenance fluid was quoted by 81.8% of anaesthetists; only 5.9% of anaesthetists would restrict fluids in the immediate postoperative period. Anaesthetists working in specialist paediatric hospitals were 13.2 times more likely to restrict fluids postoperatively than those working in district hospitals (95% CI 2.8-61.8, P=0.001). The prescription of hypotonic dextrose saline solutions by anaesthetists may be putting children at risk from iatrogenic hyponatraemia. Departmental protocols for perioperative fluid prescription in children are uncommon. We suggest that national guidance is required.

Use of Dextrose 5% in Water Instead of Saline to Protect Against Inadvertent Radiofrequency Injuries

Use of Dextrose 5% in Water Instead of Saline to Protect Against Inadvertent Radiofrequency Injuries

Paediatric anaesthesia: past, present and future.

Paediatric anaesthesia: past, present and future.

Bones benefit from better biochemical control in type 1 glycogen storage disease

Bones benefit from better biochemical control in type 1 glycogen storage disease

Clinical Research: Can Changes to a Total Parenteral Nutrition Order Form Improve Prescribing?

The Nutrition Quality Improvement Team identified low compliance with institutional recommendations regarding total parenteral nutrition (TPN) prescribing and monitoring. Particular problems identified included excessive use of dextrose with resultant hyperglycemia and provision of the goal caloric requirements on day 1 of TPN therapy. To improve compliance, the TPN order form was revised. To determine the impact of the revisions, orders were compared for 50 patients for whom TPN had been prescribed using the original form (1996) to 50 patients using the revised form (1998). Total calories received on day 1 were significantly reduced from 25.7 ≤ 9.7 kcal/kg per day in 1996 to 21.0 ≤ 7.0 kcal/kg per day in 1998 (p = .007). Dextrose concentrations were also significantly reduced from 5.1 ≤ 2.4 g/kg per day to 3.7 ≤ 1.3 g/kg per day, respectively (p = .004). Although prescribing of calories and dextrose was reduced, the incidence of hyperglycemia was unaffected. This suggests that additional interventions are necessary to educate prescribers regarding the importance of avoiding hyperglycemia.

Glucose dynamics during continuous hemodiafiltration and total parenteral nutrition.

To determine glucose balance during dextrose-free continuous hemodiafiltration with or without dextrose-containing ultrafiltrate replacement fluid and full nutritional support. Prospective, nonrandomized, observational study. A 24-bed multiple trauma critical care unit in a level-I trauma center. Seventeen multiple trauma patients with multiple organ dysfunction syndrome requiring hemodialysis for acute renal failure. Continuous hemodiafiltration effluent volume and glucose concentration were measured. Study days were classified according to whether dextrose was used in the ultrafiltrate replacement therapy. Use of dextrose in replacement therapy was determined clinically. Parenteral nutrition was not altered for potential glucose absorption from continuous hemodiafiltration. Ultrafiltrate replacement consisted of 5% dextrose in saline on 21 study days (D5YES) and dextrose-free solutions on 54 study days (D5NO). The D5YES group received 316 +/- 145 g glucose/day from the ultrafiltrate replacement fluid, in addition to glucose in total parenteral nutrition (total glucose intake = 942 +/- 229 g/day in D5YES, 682 +/- 154 g/day in D5NO) (p < 0.05). Glucose loss in continuous hemodiafiltration effluent was 82 +/- 61 g/day in D5YES and 57 +/- 22 g/day in D5NO (P < 0.05), for a net glucose uptake of 8.1 +/- 2.1 mg/kg per min in D5YES and 5.4 +/- 1.5 mg/kg per min in D5NO (p < 0.05). Glucose loss was predictable when dialysate and ultrafiltrate replacement fluids were dextrose-free (R2 = 0.77), but less so when dextrose was used as ultrafiltrate replacement (R2 = 0.47). Dextrose-free dialysate promotes glucose loss during continuous hemodiafiltration, but the loss is small and predictable. Use of a dextrose-containing ultrafiltrate replacement fluid results in a significant increase in glucose intake without a commensurate increase in glucose loss, and makes glucose loss in effluent less predictable.