The primary source of energy during intravenous therapy is usually provided by dextrose (D-glucose). This is especially true in infants and children when higher energy requirements often necessitate glucose infusion rates of up to 15mg/kg/min or more. Not until 1945 did Zimmerman report the first attempt at infusing intravenous solutions through a catheter placed in the superior vena cava. Experiments performed by Dudrick in beagle puppies advanced the glucose infusion solutions closer to what is utilized currently with hypertonic dextrose solutions. In current practice, hypertonic solutions are infused through a catheter with its tip centrally located in the superior vena cava or inferior vena cava. It continues to be the major energy component of intravenous support.
Initial doses of glucose should be approximately 5-7 mg carbohydrate/kg/min with incremental increases by 2-5 mg/kg/min. Frequent monitoring of blood glucose and urine for glucosuria is important to assess tolerance to increasing glucose infusion rates. It is important to avoid excessive carbohydrate intake to minimize complications from potential hyperglycemia with subsequent osmotic diuresis and over the long-term hepatic stea-tosis from increased fat synthesis that can occur with overfeeding. Hyperglycemia may ensue even without excess carbohydrate infusion in certain clinical situations, such as sepsis and renal failure, and also with the use of medications such as steroids. Glucose infusion rates should be decreased if hyperglycemia ensues; however, it may still be necessary to add insulin to control blood glucose to provide adequate support.
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