Dextrose (50%, 10%)

Question 1

Generic Name:

Answer 1

Dextrose 50%, 10%

Question 2

Class:

Answer 2

Carbohydrate, hyperglycemic, nutrient

Question 3

Supplied:

Answer 3

• 25g/50mL pre-filled 50%

- 25g/250mL bag 10%

Question 4

Mechanism of Action: Pharmacological:

Answer 4

Aerobic metabolic substrate (ATP production)

Question 5

Mechanism of Action: Clinical:

Answer 5

• Reverses CNS effects of hypoglycemia by rapidly increasing serum glucose levels.
• Provides short-term osmotic diuresis

Question 6

Indications and Field Use:

Answer 6

• Known hypoglycemia
• ALOC of unknown etiology
• Seizures of unknown etiology
• Hyperkalemia

Question 7

Contraindications:

Answer 7

• Known thiamine deficiency (relative, if suspected give thiamine close to same time).
  - Delirium tremens; use with caution in patients with acute alcoholism. Administer in conjunction with thiamine
  - Head injury (unless documented hypoglycemia).
  - Intra cranial hemorrhage (relative).
  - Severe pain (paradoxical excitement may occur).

Question 8

Adverse Reactions:

Answer 8

- Cerebral edema in children when given IV undiluted.
- Worsening elevated ICP or cerebral edema from trauma or cerebral vascular accident.
- Extravasation leads to severe tissue necrosis.
- Sclerosing effect on peripheral veins.

Question 9

Incompatibilities/Drug Interactions:

Answer 9

• Sodium bicarbonate

- Diazepam will precipitate if given concurrently without flushing

Question 10

Adult Dosage: Hypoglycemia, ALOC or seizures of unknown etiology:

Answer 10

25-100mL of D50% (12.5-50g, 1/2 to 2 amps) IV

Question 11

Adult Dosage: Hyperkalemia:

Answer 11

50g of Dextrose IV administered in conjunction with calcium chloride and sodium bicarbonate. Insulin may be given upon arrival to ED.

Question 12

Pediatric Dosage: (14 yrs and below includes infant)

Answer 12

- Administer 0.5 - 1 Gm/kg of a dextrose 10% solution; recommended to give slowly over a 20 minute period.
- Dilute D50 (dextrose 50% containing 25 Gm of dextrose) to a 1:4 solution. To prepare, obtain a 250 ml container of normal saline for IV use; waste 50 ml and add 50 ml of dextrose 50%. The resulting solution is dextrose 10% in normal saline or 10 grams/100ml.

Question 13

Routes of Administration:

Answer 13

IV bolus (rapid)

Question 14

Onset of Action:

Answer 14

Seconds

Question 15

Peak Effects:

Answer 15

Variable

Question 16

Duration of Action:

Answer 16

Variable

Question 17

Arizona Drug Box Minimum Supply:

Answer 17

50g

Question 18

Special Notes:

Answer 18

• Determine a blood glucose level before initiating administration of dextrose. Inducing an unnecessary hyperosmolar state during certain illness/injury states (i.e. head injuries, cerebral edema, Intra cranial bleeds, etc.) may worsen neurological outcome. Additionally dextrose is very necrosing to the vascular system, will cause necrosis if infiltrated and should not be administered through small veins (all drugs may do harm, so does D50).
•  Emergency treatment of hyperkalemia (clinical presentation, PMH and ECG changes) includes CaCl (or gluconate), sodium bicarbonate, and insulin and dextrose. Insulin may be given upon arrival to ED.