What is the recommended infusion rate of D5 (5% dextrose) in water for a 69-year-old male with a history of diabetes mellitus and hypoglycemia, after administration of juice?

From the Research

For a 69-year-old male with diabetes experiencing hypoglycemia who has already received juice, I recommend initiating D5W (5% dextrose in water) at an infusion rate of 100-125 mL/hour, as this moderate infusion rate provides approximately 5-6 grams of glucose per hour, which should help stabilize blood glucose levels without causing rebound hyperglycemia 1.

Key Considerations

• The patient's blood glucose should be rechecked every 15-30 minutes until it reaches at least 100 mg/dL, at which point the infusion rate can be adjusted or discontinued based on subsequent readings.
• Given the patient's diabetes history, close monitoring is essential as both persistent hypoglycemia and overcorrection can be problematic.
• If the glucose remains below 70 mg/dL after 30 minutes, consider increasing the infusion rate or switching to D10W.

Rationale

• The most recent and highest quality study 1 supports the use of optimal regulation of blood glucose level in Type I diabetes using insulin and glucagon, which can be applied to this patient's situation.
• Although the study 1 does not directly address the infusion rate of D5W, it provides a framework for optimal glucose regulation, which is essential in this patient's case.
• Other studies 2, 3, 4, 5 provide additional context and support for the importance of close monitoring and adjusting treatment as needed to prevent hypoglycemia and hyperglycemia.