MICROSPAN TM

Indications

• Fluid and electrolyte imbalances
• Hypoglycemia
• Nutritional supplementation
• Diabetic emergencies

Dosage

Children: Refer to the BNF for Children for appropriate paediatric dosing guidelines.

Adults: The dosage varies based on the clinical condition and specific formulation used. For intravenous administration, consult product literature for precise dosing.

Mechanism of action

Glucose supplies energy to tissues by undergoing glycolysis, which begins with its phosphorylation by hexokinase to form glucose 6-phosphate. This activates glucose for breakdown, ultimately generating ATP and NADH. The aerobic metabolism of glucose can yield up to 36 ATP molecules. Glucose also serves as a precursor for other biomolecules and regulates various physiological processes including gene transcription and hormone secretion.

Pharmacodynamics

Glucose is an obligatory energy source for cellular activities and plays a significant role in metabolic signaling. It is oxidized to yield energy through glycolysis, the citric acid cycle, and oxidative phosphorylation. Glucose can be converted into fat for energy storage and is stored as glycogen in the liver and muscles. Its administration increases blood glucose levels and stimulates insulin secretion, particularly through oral routes that activate gut incretin hormones.

Pharmacokinetics

Glucose is rapidly absorbed from the gastrointestinal tract or directly into the bloodstream when administered intravenously. It is distributed widely throughout the body and metabolized primarily in tissues requiring energy. The body maintains glucose homeostasis through regulatory mechanisms involving insulin and glucagon. Excess glucose can be stored as glycogen or converted to triglycerides for long-term energy storage.

Adverse effects

• Hyperglycemia
• Increased osmolarity
• Fluid overload
• Electrolyte imbalances

Interactions

• Insulin - may require dose adjustments

Precautions

• Use with caution in patients with diabetes mellitus
• Monitor blood glucose levels in patients receiving parenteral glucose
• Adjust dosage in renal impairment

Pregnancy

Glucose is generally considered safe in pregnancy; however, monitoring is advised, especially in diabetic patients.

Breast-feeding

Glucose is considered safe during breastfeeding, as it is a natural sugar found in breast milk.

Storage

Store at room temperature, away from light. Avoid freezing.

Formulations

• Glucose 5% solution for infusion
• Glucose 10% solution for infusion
• Glucose 0.9% solution for injection
• Glucose sodium chloride combination solutions

Dosage

Children: Refer to specific drug guidelines for paediatric dosing.

Adults: Refer to specific drug guidelines for adult dosing.

Pregnancy

Consult healthcare provider before use, as safety is not established.

Breast-feeding

Consult healthcare provider before use, as safety is not established.

Storage

Store in a cool, dry place away from light.

Indications

• Hypovolemia
• Shock
• Surgery
• Burns

Dosage

Children: Refer to the specific product information or guidelines for paediatric dosage, as it may vary based on the indication and formulation used.

Adults: Refer to the specific product information or guidelines for adult dosage, as it may vary based on the indication and formulation used.

Mechanism of action

Dextran acts as an osmotic agent. When administered intravenously, it increases plasma volume by drawing water into the vascular space. This expansion of blood volume helps in maintaining blood pressure and improving perfusion to tissues.

Pharmacodynamics

The pharmacodynamics of dextran involves its ability to enhance blood flow and reduce blood viscosity. It can improve rheological properties of blood, thereby facilitating better circulation. Dextran's molecular size allows it to remain in the circulation for an extended period, contributing to its volume-expanding effects.

Pharmacokinetics

Dextran is administered intravenously and is distributed in the vascular compartment. Its elimination occurs through renal filtration, and it is eventually degraded by enzymatic action in the liver. The half-life can vary depending on the molecular weight of the dextran used, with larger molecules generally having a longer half-life.

Contra-indications

• Hypersensitivity to dextran or any component of the formulation
• Severe renal impairment
• Congestive heart failure
• Active bleeding or hemorrhagic disorders

Adverse effects

• Allergic reactions, including anaphylaxis
• Fluid overload
• Hypotension
• Headache
• Nausea and vomiting
• Fever
• Thrombocytopenia
• Acute kidney injury

Interactions

• Anticoagulants - may enhance the effects of anticoagulants leading to increased bleeding risk
• Diuretics - may increase the risk of fluid overload and electrolyte imbalances

Precautions

• Use with caution in patients with cardiovascular disease
• Monitor fluid balance closely in patients with renal impairment
• Careful administration in patients with a history of allergic reactions

Pregnancy

Safety during pregnancy has not been established. Use only if clearly needed and potential benefits justify potential risks.

Breast-feeding

Excretion in human milk is unknown. Caution is advised when administering to nursing mothers.

Storage

Store at room temperature, away from direct sunlight and moisture. Do not freeze.

Formulations

• Injectable solution for intravenous infusion
• Oral formulations (less common, specific to certain indications)

Mechanism of action

Glucose supplies most of the energy to all tissues by generating energy molecules ATP and NADH during a series of metabolism reactions called glycolysis. Glycolysis can be divided into two main phases where the preparatory phase is initiated by the phosphorylation of glucose by hexokinase to form glucose 6-phosphate. The addition of the high-energy phosphate group activates glucose for the subsequent breakdown in later steps of glycolysis and is the rate-limiting step. Products end up as substrates for following reactions, to ultimately convert C6 glucose molecule into two C3 sugar molecules. These products enter the energy-releasing phase where the total of 4ATP and 2NADH molecules are generated per one glucose molecule. The total aerobic metabolism of glucose can produce up to 36 ATP molecules. These energy-producing reactions of glucose are limited to D-glucose as L-glucose cannot be phosphorylated by hexokinase. Glucose can act as precursors to generate other biomolecules such as vitamin C. It plays a role as a signaling molecule to control glucose and energy homeostasis. Glucose can regulate gene transcription, enzyme activity, hormone secretion, and the activity of glucoregulatory neurons. The types, number, and kinetics of glucose transporters expressed depends on the tissues and fine-tunes glucose uptake, metabolism, and signal generation to preserve cellular and whole body metabolic integrity. Vascular calcification is a hallmark of type 2 diabetes. Glucose stimulates calcification in culture of vascular smooth muscle cells (VSMCs) but the underlying mechanisms remain obscure. We observed that high glucose levels stimulated mouse and human VSMC trans-differentiation into chondrocytes, with increased levels of Sox9, type II collagen, glycosaminoglycan and Runx2 expression, and increased alkaline phosphatase activity and mineralization. These effects were associated with increased expression of IL-1beta, which stimulated alkaline phosphatase and calcification, suggesting that glucose induces chondrocyte differentiation of VSMCs, possibly through IL-1beta activation.

Pharmacodynamics

Blood glucose is an obligatory energy source for humans involved in various cellular activities, and it also acts as a signaling molecule for diverse glucose-sensing molecules and proteins. Glucose undergoes oxidation into carbon dioxide, water, and yields energy molecules in the process of glycolysis and subsequent citric cycle and oxidative phosphorylation. Glucose is readily converted into fat in the body which can be used as a source of energy as required. Under a similar conversion into storage of energy, glucose is stored in the liver and muscles as glycogen. Glucose stores are mobilized in a regulated manner, depending on the tissues' metabolic demands. Oral glucose tablets or injections serve to increase the supply of glucose and oral glucose administration is more effective in stimulating insulin secretion because it stimulates the incretin hormones from the gut, which promotes insulin secretion.