Hartsol Plus

Approved Indications:

• Fluid and electrolyte replenishment: To treat or prevent dehydration and electrolyte imbalances in patients with fluid loss due to surgery, trauma, burns, or illness.
• Parenteral nutrition: Provides carbohydrates (from dextrose) and balanced electrolytes (from Hartmann’s solution) to patients unable to take oral nutrition.
• Metabolic acidosis: Used to correct mild to moderate metabolic acidosis by supplying bicarbonate precursors (lactate) via Hartmann’s solution.
• Hypoglycemia: Provides glucose for patients with low blood sugar levels.
• Maintenance fluid therapy: Used for ongoing hydration and electrolyte balance during perioperative or critical care.
• Burn therapy and trauma resuscitation: Supports volume expansion with balanced electrolytes and energy substrate.
• Surgical procedures: To maintain fluid and electrolyte homeostasis during and after surgery.

Off-label/Clinically Accepted Uses:

• Correction of mild acid-base imbalances.
• Adjunct in diabetic ketoacidosis management (with insulin).
• Supportive therapy in sepsis and shock (when balanced crystalloid solutions are preferred over normal saline).

Route: Intravenous infusion (IV).

Adult Dosage:

• Dosage depends on fluid and electrolyte requirements, clinical condition, and response.
• Typical maintenance infusion rates: 1–2 mL/kg/hour or adjusted to achieve fluid balance.
• For hypoglycemia, dextrose concentration and infusion rate are tailored based on blood glucose levels.
• Infusion rates should be adjusted carefully in fluid-overloaded or cardiac patients.

Pediatric Dosage:

• Calculated based on body weight and fluid requirements.
• Typical maintenance fluid volume: 100–150 mL/kg/day with electrolyte content adjusted accordingly.
• Dextrose concentration and infusion rate are modified for neonates and infants to prevent hypoglycemia or hyperglycemia.

Elderly:

• May require slower infusion rates due to decreased cardiac and renal function.
• Careful monitoring of fluid status and electrolytes is recommended.

Special Populations:

• Renal impairment: Reduced dose or slower infusion rates to prevent fluid overload and electrolyte accumulation.
• Hepatic impairment: Use cautiously as lactate metabolism may be impaired.
• Cardiac disease: Monitor for signs of fluid overload; adjust fluid volume accordingly.

Administration Notes:

• Administer via sterile IV infusion set.
• Use large veins or central lines for hypertonic or large-volume infusions.
• Monitor vital signs, blood glucose, electrolytes, and acid-base status regularly.
• Adjust infusion rates according to clinical response.

Dextrose & Hartmann’s Solution combines glucose (dextrose) with a balanced electrolyte solution (Hartmann’s solution) to provide both an immediate energy substrate and fluid-electrolyte replenishment. Dextrose supplies glucose for cellular metabolism, rapidly increasing blood sugar to meet energy demands. Hartmann’s solution contains sodium, potassium, calcium, chloride, and lactate ions; the lactate acts as a bicarbonate precursor, helping to buffer acid-base imbalances and restore physiological pH. Together, this combination replenishes extracellular fluid volume, restores electrolyte balance, and provides energy, thereby improving cellular function and supporting metabolic homeostasis in patients with dehydration, hypoglycemia, or acid-base disturbances.

• Absorption: Immediate bioavailability with intravenous administration.
• Distribution:
• Dextrose distributes rapidly into total body water and is taken up by cells via glucose transporters.
• Electrolytes distribute primarily in extracellular fluid compartments.
• Metabolism:
• Dextrose is metabolized intracellularly by glycolysis and oxidative phosphorylation to produce ATP.
• Lactate from Hartmann’s solution is metabolized by the liver into bicarbonate, aiding acid-base correction.
• Elimination:
• Metabolic byproducts of glucose are exhaled as CO₂ and eliminated via kidneys.
• Electrolytes are regulated and excreted primarily by renal mechanisms.
• Onset: Immediate with IV administration.
• Half-life: Not applicable in the classical sense; glucose is rapidly metabolized, and electrolytes are regulated dynamically.

• Pregnancy:
• Considered safe as a fluid and electrolyte replacement and energy source during pregnancy.
• No known teratogenic effects; used when clinically indicated.
• Lactation:
• Components are naturally present in maternal circulation and breast milk.
• Use is not expected to pose risk to breastfeeding infants.
• Note: Monitor maternal glucose levels to prevent hyperglycemia, which can affect fetal development.

• Intravenous fluid therapy
• Electrolyte replacement solution
• Carbohydrate supplement

• Known hypersensitivity to any component of dextrose or Hartmann’s solution.
• Hyperglycemia or uncontrolled diabetes without adequate insulin therapy.
• Severe renal impairment with fluid overload risk.
• Conditions where sodium or potassium administration is contraindicated (e.g., hyperkalemia).
• Severe hepatic impairment (due to impaired lactate metabolism).
• Metabolic alkalosis or respiratory alkalosis.

• Use caution in patients with diabetes; monitor blood glucose closely.
• Monitor electrolytes frequently to avoid imbalances (especially potassium and calcium).
• Avoid fluid overload in patients with cardiac or renal dysfunction.
• Monitor acid-base balance to prevent worsening of metabolic disturbances.
• Risk of local vein irritation or phlebitis, especially with hypertonic dextrose concentrations.
• Avoid extravasation; may cause tissue damage.
• Lactate metabolism may be impaired in liver disease, leading to accumulation and lactic acidosis.

Common:

• Hyperglycemia
• Electrolyte imbalances (hypokalemia or hyperkalemia)
• Local irritation or phlebitis at infusion site
• Fluid overload symptoms (edema, hypertension)

Serious/Rare:

• Extravasation injury with tissue necrosis
• Hyperosmolar hyperglycemic state
• Lactic acidosis in patients with hepatic impairment
• Electrolyte disturbances leading to cardiac arrhythmias

• Insulin and oral hypoglycemics: May require dose adjustments due to glucose administration.
• Potassium-sparing diuretics or potassium supplements: Risk of hyperkalemia when combined with potassium in Hartmann’s solution.
• Calcium-containing drugs: Caution when used concurrently due to calcium content.
• Drugs affecting renal function: May alter electrolyte balance.
• Corticosteroids and sympathomimetics: Can increase blood glucose levels, increasing hyperglycemia risk.
• Alcohol: Chronic use can impair glucose metabolism and increase complications.

• Current clinical guidelines prefer balanced crystalloid solutions like Hartmann’s over normal saline in many clinical situations to reduce risks of hyperchloremic metabolic acidosis.
• Emphasis on glucose monitoring during dextrose-containing fluid administration, especially in diabetic and critically ill patients.
• Updated protocols recommend careful electrolyte and acid-base monitoring during combined dextrose and balanced electrolyte therapy.
• Recommendations highlight individualized fluid therapy guided by patient condition, electrolyte status, and metabolic needs.

• Store at controlled room temperature: 20°C to 25°C (68°F to 77°F).
• Protect from freezing; do not use if solution is frozen or contains precipitate.
• Keep container tightly closed until use.
• Protect from light if packaging specifies.
• Use immediately after opening or as per manufacturer’s instructions.
• Do not mix with incompatible drugs or solutions unless compatibility is confirmed.
• For premixed bags, observe expiration dates and storage guidelines strictly.