Should I administer D50 (Dextrose 50%) for hypoglycemia in an unconscious patient?

From the Guidelines

No, you should not administer D50 for a blood sugar of 65 in an unconscious patient without considering glucagon as the first-line treatment. According to the most recent guidelines, glucagon is indicated for the treatment of hypoglycemia in people unable or unwilling to consume carbohydrates by mouth 1. The use of glucagon is preferred due to its ease of administration, resulting in more rapid correction of hypoglycemia, especially with the availability of intranasal and ready-to-inject preparations 1. Some key points to consider when treating hypoglycemia in unconscious patients include:

• The importance of having glucagon readily available, especially for individuals at high risk of hypoglycemia 1
• Ensuring that those in close contact with the patient are educated on the use of glucagon and when to administer it 1
• Never administering insulin to individuals experiencing hypoglycemia 1 Given the patient's unconscious state and the blood sugar level of 65, glucagon administration is the recommended initial treatment, considering its ease of use and rapid effect in correcting hypoglycemia 1.

From the FDA Drug Label

In insulin-induced hypoglycemia, intravenous injection of 10 to 25 grams of dextrose (20 to 50 mL of 50% dextrose) is usually adequate. A specimen for blood glucose determination should be taken before injecting the dextrose In such emergencies, dextrose should be administered promptly without awaiting pretreatment test results

For an unconscious patient with a blood sugar of 65, D50 (Dextrose 50%) administration is indicated to treat hypoglycemia and restore blood glucose levels 2.

• The recommended dose is 10 to 25 grams of dextrose (20 to 50 mL of 50% dextrose), which can be administered intravenously.
• Prompt administration is necessary in emergency situations, even without waiting for pretreatment test results.
• It is essential to monitor the patient's condition and adjust the treatment as needed.

From the Research

Administration of D50 for Hypoglycemia in Unconscious Patients

• The decision to administer D50 (Dextrose 50%) for hypoglycemia in an unconscious patient should be based on the patient's blood glucose level and clinical presentation 3.
• A study comparing D10 (Dextrose 10%) to D50 found that both treatments had nearly complete resolution of hypoglycemia, but D10 may be as effective as D50 at resolving symptoms and correcting hypoglycemia with fewer adverse events 3.
• However, the mean time to resolution was approximately four minutes longer in the D10 group, and there was a greater need for subsequent doses with the use of D10 3.

Considerations for D50 Administration

• The American College of Endocrinology and the American Association of Clinical Endocrinologists suggest that octreotide may be an effective treatment for patients with refractory hypoglycemia attributable to sulfonylureas 4, 5.
• A study on the blood glucose response to rescue dextrose in hypoglycemic, critically ill patients receiving an insulin infusion found that the overall median blood glucose response was 4.0 mg/dL per gram of D50W administered 6.
• The response to D50W increased with increasing insulin infusion rate, and burn patients experienced a significantly larger blood glucose response compared with other patient groups 6.

Alternative Treatments

• Octreotide has been shown to reverse hyperinsulinemia and prevent hypoglycemia induced by sulfonylurea overdoses, and may be a logical therapeutic alternative for this metabolic emergency 5.
• A case report described a patient with prolonged and recurrent hypoglycemia unresponsive to large intravenous doses of glucose, who was treated successfully with intravenously administered octreotide 4.