DEXTROSE 50%

Class

Carbohydrate

Pharmacology and Actions

1. Glucose is the body's basic fuel and is required for cellular metabolism. A sudden drop in blood sugar levels will result in disturbances of normal metabolism, manifested clinically as a decrease in mental status, sweating, and tachycardia. Further decreases in blood sugar may result in coma, seizures, and cardiac arrhythmias. Serum glucose is regulated by insulin, which stimulates storage of excess glucose form the blood stream, and glucagon, which mobilizes stored glucose into the bloodstream.

Indications

1. Hypoglycemic states (i.e., insulin shock in the diabetic).
2. The unconscious patient with an unknown history. Any patient with focal or partial neurologic deficit or altered state of consciousness, which may be due to hypoglycemia.
3. Blood glucose test < 60 mg/dL if clinically indicated.
4. In children with alcohol exposure, suspected sepsis, hypoperfusion or altered mental status.

Precautions

1. In patients with clinical findings suggestive of a CVA, caution should be used when considering dextrose unless the patient has a measurable hypoglycemia.
2. Draw appropriate blood tubes for blood sugar determination prior to administering dextrose.
3. Extravasation of glucose can cause tissue necrosis. Ensure IV patency before and during dextrose infusion.

Administration

1. Adult dose: 250mL of D₁₀, IV/IO into a secure vein (D₁₀ is 25 grams of dextrose per 250 mL).
2. In pediatric patients: Administer 5mL/kg of D₁₀ up to 125mL
   1. This dose is for all ages (newborn – adult size.)
   2. If blood glucose remains <60, a repeat dose may be administered.
3. May give oral glucose preparations if the patient is awake and able to swallow effectively.

Side Effects and Special Notes

1. One bolus should raise the blood sugar 50-100 mg/dL and, therefore, will be adequate for most patients.
2. Effect may be delayed in elderly patients with poor circulation.
3. Do not withhold dextrose in a patient suspected of being hypoglycemic.