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invert sugar

C05BB03

Forms & Strengths

Injectable solution 5% (50 mg/mL) in water
Injectable solution 10% (100 mg/mL) in water
Available in various sterile infusion bags (e.g., 500 mL, 1000 mL)

Adult Dosing

Parenteral nutrition/carbohydrate replacement: Individualized based on clinical condition, fluid balance, and metabolic needs
Max rate of infusion: Generally not to exceed 0.5 to 0.8 g/kg/hour to minimize glycosuria and osmotic diuresis
Total daily dose: Determined by caloric requirements, typically up to 2-3 g/kg/day as part of a parenteral regimen

Pediatric Dosing

Neonates and infants: Individualized strictly based on weight, fluid restriction, and glucose/fructose tolerance
Children: Titrated carefully according to daily caloric requirements and blood glucose/electrolyte monitoring
Infusion rate: Must be carefully controlled to avoid hyperglycemia, hyperosmolarity, or fluid overload

Indications

Source of water and calories in parenteral nutrition
Carbohydrate replacement in patients requiring parenteral alimentation where fructose/glucose mixture is preferred

Mechanism of Action

Equimolar mixture of D-glucose (dextrose) and D-fructose
D-glucose is directly utilized in cellular metabolism via glycolysis and tricarboxylic acid cycle, or stored as glycogen
D-fructose enters the metabolic pathway via fructokinase independently of insulin for initial phosphorylation, though subsequent steps overlap with glucose metabolism
Provides immediate caloric support (4 kcal/g) and reduces protein catabolism

Contraindications

Hereditary fructose intolerance (due to absence of fructose-1-phosphate aldolase, leading to severe hypoglycemia, hepatic and renal damage)
Clinically significant anuria or severe renal impairment
Severe hepatic dysfunction where fructose metabolism is severely compromised
Classic galactosemia (if combined with galactose-containing solutions)
Hypersensitivity to fructose or glucose solutions

Adverse Reactions

Hyperglycemia and glycosuria (with rapid infusion)
Fluid overload, pulmonary edema, and electrolyte disturbances (dilutional hyponatremia, hypokalemia, hypophosphatemia)
Osmotic diuresis and dehydration
Lactic acidosis (rare, associated with high-dose fructose infusion)
Venous thrombosis, phlebitis, or extravasation at the infusion site

Drug Interactions

Insulin and oral hypoglycemic agents: May antagonize the hyperglycemic effects of invert sugar; adjust dosing accordingly
Corticosteroids and diuretics: May increase blood glucose levels or exacerbate fluid and electrolyte imbalances
Potentially incompatible with certain medications in Y-site administration due to pH and chemical stability; check specific drug compatibility charts

Curated Content: Needs Vetting Before Put to Clinical Use