NORMOSOL-R AND DEXTROSE- dextrose, unspecified form, sodium chloride, sodium acetate anhydrous, sodium gluconate, potassium chloride and magnesium chloride injection, solution
MULTIPLE ELECTROLYTES AND 5% DEXTROSE INJECTION TYPE 1, USP
For Replacing Acute Losses of Extracellular Fluid
Flexible Plastic Container
Normosol-R and 5% Dextrose Injection is a sterile, nonpyrogenic solution of balanced electrolytes (with dextrose) in water for injection. The solution is administered by intravenous infusion for parenteral replacement of acute losses of extracellular fluid (with minimal carbohydrate calories).
Each 100 mL of Normosol-R and 5% Dextrose Injection contains dextrose 5 g; sodium chloride 526 mg; sodium acetate, anhydrous 222 mg; sodium gluconate 502 mg; potassium chloride 37 mg; magnesium chloride, hexahydrate 30 mg; pH adjusted with hydrochloric acid.
See TABLE for summary of electrolyte content, caloric value and characteristics of this solution.
The solution contains no bacteriostat, antimicrobial agent or added buffer (except for pH adjustment) and is intended only for use as a single-dose injection. When smaller doses are required the unused portion should be discarded.
Normosol-R and 5% Dextrose Injection is a parenteral fluid, electrolyte and nutrient replenisher.
Dextrose, USP is chemically designated D-glucose monohydrate (C6 H12 O6 • H2 0), a hexose sugar freely soluble in water. It has the following structural formula:
Sodium Chloride, USP is chemically designated NaCl, a white crystalline powder freely soluble in water.
Potassium Chloride, USP is chemically designated KCl, a white granular powder freely soluble in water.
Magnesium Chloride, USP is chemically designated magnesium chloride hexahydrate (MgCl2 • 6H2 0) deliquescent crystals very soluble in water.
Sodium Acetate, USP, is chemically designated sodium acetate anhydrous (C2 H3 NaO2 ), a hygroscopic powder soluble in water. It has the following structural formula:
Sodium gluconate is chemically designated C6 H11 NaO7 , the normal sodium salt of gluconic acid soluble in water. It has the following structural formula:
Water for Injection, USP is chemically designated H2 0.
The flexible plastic container is fabricated from a specially formulated polyvinylchloride. Water can permeate from inside the container into the overwrap but not in amounts sufficient to affect the solution significantly. Solutions in contact with the plastic container may leach out certain chemical components from the plastic in very small amounts; however, biological testing was supportive of the safety of the plastic container materials. Exposure to temperatures above 25°C/77°F during transport and storage will lead to minor losses in moisture content. Higher temperatures lead to greater losses. It is unlikely that these minor losses will lead to clinically significant changes within the expiration period.
When administered intravenously, Normosol-R and 5% Dextrose Injection provides water and electrolytes with carbohydrate calories for replacement of acute extracellular fluid losses without disturbing normal electrolyte relationships. The electrolyte composition approaches that of the principal ions of normal plasma (extracellular fluid). The electrolyte concentration is approximately isotonic in relation to the extracellular fluid (approx. 280 mOsmol/liter) and provides a physiologic sodium to chloride ratio, normal plasma concentrations of potassium and magnesium and two bicarbonate alternates, acetate and gluconate. Dextrose provides minimal calories and renders the solution hypertonic.
Solutions containing carbohydrate in the form of dextrose restore blood glucose levels and supply calories. Carbohydrate in the form of dextrose may aid in minimizing liver glycogen depletion and exerts a protein-sparing action. Dextrose injected parenterally undergoes oxidation to carbon dioxide and water.
Sodium chloride in water dissociates to provide sodium (Na+) and chloride (Cl‾) ions. Sodium (Na+) is the principal cation of the extracellular fluid and plays a large part in the therapy of fluid and electrolyte disturbances. Chloride (Cl‾) has an integral role in buffering action when oxygen and carbon dioxide exchange occurs in the red blood cells. The distribution and excretion of sodium (Na+) and chloride (Cl‾) are largely under the control of the kidney which maintains a balance between intake and output.
Potassium chloride in water dissociates to provide potassium (K+) and chloride (Cl‾) ions. Potassium is the chief cation of body cells (160 mEq/liter of intracellular water). It is found in low concentration in plasma and extracellular fluids (3.5 to 5.0 mEq/liter in a healthy adult and child over 10 days old; 3.5 to 6.0 mEq/liter in a child less than 10 days old). Potassium plays an important role in electrolyte balance.
Normally about 80 to 90% of the potassium intake is excreted in the urine; the remainder in the stools and to a small extent, in the perspiration. The kidney does not conserve potassium well so that during fasting or in patients on a potassium-free diet, potassium loss from the body continues resulting in potassium depletion.
Magnesium chloride in water dissociates to provide magnesium (Mg++) and chloride (Cl‾) ions. Magnesium is the second most plentiful cation of the intracellular fluids. It is an important cofactor for enzymatic reactions and plays an important role in neurochemical transmission and muscular excitability. Normal plasma concentration ranges from 1.5 to 2.5 or 3.0 mEq per liter. Magnesium is excreted solely by the kidney at a rate proportional to the plasma concentration and glomerular filtration.
Sodium acetate provides sodium (Na+) and acetate (CH3 COO‾) ions, the latter anion (a source of hydrogen ion acceptors) serving as an alternate source of bicarbonate (HCO3 ‾) by metabolic conversion in the liver. This has been shown to proceed readily even in the presence of severe liver disease. Thus, acetate anion exerts a mild systemic antiacidotic action that may be advantageous during fluid and electrolyte replacement therapy.
Sodium gluconate provides sodium (Na+) and gluconate (C6 H11 07 ‾) ions. Although gluconate is a theoretical alternate metabolic source of bicarbonate (HC03 ‾) anion, a significant antiacidotic action has not been established. Thus, the gluconate anion serves primarily to complete the cation-anion balance of the solution.
Water is an essential constituent of all body tissues and accounts for approximately 70% of total body weight. Average normal adult daily requirement ranges from two to three liters (1.0 to 1.5 liters each for insensible water loss by perspiration and urine production).
Average normal pediatric daily requirements are based on the child’s weight as described in the table below:
Up to 10 kg
11 to 20 kg
1,000 mL + 50 mL/kg for each
kg above 10 kg
Above 20 kg
1,500 mL + 20 mL/kg for each
kg above 20 kg
Water balance is maintained by various regulatory mechanisms. Water distribution depends primarily on the concentration of electrolytes in the body compartments and sodium (Na+) plays a major role in maintaining physiologic equilibrium.
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