Metabolic and resuscitation agents
| Drug monograph · NCLEX study reference | |
| Trade names | D50 |
|---|---|
| Therapeutic class | Emergency metabolic agents |
| Pharmacologic class | Alkalinizer, electrolyte, concentrated glucose, osmotic agents |
| Onset / peak / duration | Rapid IV. |
| Half-life / level | Variable; titrate to labs. |
| Routes | IV |
| High-alert (ISMP) | No |
| Black box warning | None |
| Antidote / reversal | Supportive care. |
| Pregnancy / lactation | Used in emergencies. |
Nursing pharmacology study reference (NCLEX-style monograph). Numeric values are standard teaching ranges for study and must be verified against current manufacturer labeling before clinical use. This is educational content, not prescribing guidance.
Metabolic and resuscitation agents (brand name D50) — Emergency metabolic agents; Alkalinizer, electrolyte, concentrated glucose, osmotic agents.
Identification
- Therapeutic class: Emergency metabolic agents.
- Pharmacologic class: Alkalinizer, electrolyte, concentrated glucose, osmotic agents.
Pharmacology
- Mechanism of action: Sodium bicarbonate corrects severe acidosis and is used in certain overdoses; calcium stabilizes the cardiac membrane in hyperkalemia and treats hypocalcemia and toxicities; dextrose 50% reverses hypoglycemia; mannitol and hypertonic saline reduce cerebral edema.
- Onset / peak / duration: Rapid IV.
- Half-life / therapeutic level: Variable; titrate to labs.
Clinical use
- Indications: Severe metabolic acidosis and tricyclic or aspirin overdose (bicarbonate), hyperkalemia and hypocalcemia and calcium channel or beta blocker or magnesium toxicity (calcium), severe hypoglycemia (dextrose 50%), increased intracranial pressure (mannitol, hypertonic saline).
- Usual dose, route, frequency: IV per protocol; calcium gluconate is less irritating than calcium chloride peripherally.
- Maximum dose / adjustments: Titrate to labs; flush lines between bicarbonate and calcium (they precipitate).
Safety
- Contraindications: Calcium with digoxin toxicity caution; mannitol in anuria or severe dehydration.
- Black box warning: None.
- Interactions: Bicarbonate and calcium precipitate together; bicarbonate alters elimination of some drugs.
- Pregnancy / lactation: Used in emergencies.
- High-alert: No.
Adverse effects
- Common side effects: Vein irritation, fluid and electrolyte shifts.
- Serious effects to report: Calcium extravasation and necrosis, metabolic alkalosis, fluid overload, dextrose extravasation.
- Antidote / reversal: Supportive care.
Nursing process
- Assessment before administration: Relevant labs (pH, potassium, calcium, glucose), IV access, neuro status (ICP agents).
- Interventions during therapy: Flush between bicarbonate and calcium; give calcium slowly with cardiac monitoring; use a filter and monitor for mannitol crystals.
- Monitor: Arterial blood gases, electrolytes, glucose, neuro status, ECG.
- Evaluation / expected outcome: Corrected metabolic derangement or reduced intracranial pressure.
Patient teaching
- Patient teaching: Critical care setting; team manages.
- Notify provider if: Not applicable (monitored setting).
- Administration tips: Flush lines between incompatible drugs; calcium slow IV with monitoring.