Dextrose 50%

Question 1

class

Answer 1

carbohydrate, hyperglycemic

Question 2

mechanism of action

Answer 2

Pharmacological: Aerobic metabolic substrate (ATP production).
Clinical effects: Reverses CNS effects of hypoglycemia by rapidly increasing serum
glucose levels.
Provides short-term osmotic diuresis.

Question 3

indications for field use

Answer 3

 Known hypoglycemia
 Altered level of consciousness of unknown etiology
 Seizures of unknown etiology
 Hyperkalemia

Question 4

contraindications

Answer 4

 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 5

adverse reactions

Answer 5

 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 6

incompatibilities/drug reactions

Answer 6

Sodium bicarbonate

Diazepam will precipitate if given concurrently without flushing

Question 7

adult dose

Answer 7

Hypoglycemia, altered level of consciousness or seizures of unknown etiology: 25-
100 ml of D50 (12.5-50 Gm, 1/2 to 2 amps) IV.
Hyperkalemia: 50 Gm of Dextrose IV administered in conjunction with calcium chloride and sodium bicarbonate. Insulin may be given upon arrival to ED.

Question 8

peds dose

Answer 8

 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 9

routes of admin

Answer 9

IV bolus (rapid)

Question 10

onset of action

Answer 10

seconds

Question 11

peak effects

Answer 11

variable

Question 12

duration of action

Answer 12

variable

Question 13

AZ drug box minimum

Answer 13

50 g

Question 14

special notes

Answer 14

 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.