Can dextrose be administered intramuscularly (IM) instead of intravenously (IV)?

Dextrose Administration: IV Only, Not IM

Dextrose should not be administered intramuscularly (IM) and must only be given intravenously (IV). 1

Why IM Administration is Contraindicated

The FDA drug labeling for dextrose explicitly states that "concentrated dextrose solutions should not be administered subcutaneously or intramuscularly" 1. This is a clear contraindication that leaves no room for interpretation. The reasons for this contraindication include:

• Risk of tissue damage and necrosis due to high osmolarity
• Poor absorption from muscle tissue
• Potential for sterile abscess formation
• Pain at injection site

Appropriate Administration Routes for Dextrose

Intravenous Administration (Recommended)

• Dextrose injection is specifically intended for intravenous use 2
• Peripheral administration of 5% dextrose is generally acceptable 2
• Higher concentrations (>5%) may require central venous access to prevent vein irritation, phlebitis, and pain 2

Alternative Options When IV Access is Challenging

If IV access is difficult to obtain in an emergency situation such as hypoglycemia:

1. Glucagon (IM): A prehospital study showed that intramuscular 1-mg injection of glucagon can be used as an alternative, though it has a slower response than IV dextrose 3

   • Achieves final blood glucose of 167 mg/dL after 140 minutes
   • Less rapid but effective alternative when IV access is unavailable

2. Oral/Buccal Glucose: For conscious patients with intact swallowing reflexes

   • Dextrose gel has been shown effective in neonates with hypoglycemia 4

Clinical Considerations for Dextrose Administration

Concentration and Dosing

• 10% dextrose in 50-mL aliquots (5g) is recommended over 50% dextrose for treating hypoglycemia 3, 5
• Benefits of 10% dextrose compared to 50% dextrose:
  • Lower post-treatment blood glucose levels (6.2 mmol/L vs 9.4 mmol/L) 5
  • Fewer adverse events (0/1057 vs 13/310) 6
  • Less risk of overcorrection of blood glucose 3

Monitoring Requirements

• Blood glucose should be monitored every 1-2 hours for patients receiving insulin infusion 3
• Electrolyte monitoring is essential during dextrose administration, particularly potassium and phosphate 1

Potential Complications

• Rapid administration of concentrated dextrose solutions has been associated with cardiac arrest and hyperkalemia 3
• Hyperglycemia may increase ischemic brain injury 7
• Fluid overload can precipitate pulmonary edema 3

Special Situations

Hypoglycemia Management

• In ICU patients, IV dextrose is preferred over glucagon due to glucagon's delayed response 3
• For treatment of hypoglycemia in adults, titrating 10% dextrose in 50-mL aliquots is recommended to avoid overcorrection 3

Anaphylaxis Management

• Normal saline is the preferred initial fluid for anaphylaxis management 3
• Dextrose solutions are not specifically recommended in anaphylaxis protocols 3

In conclusion, dextrose must be administered intravenously and never intramuscularly. When IV access is unavailable, alternative agents such as intramuscular glucagon should be considered for hypoglycemia management, though with the understanding that response will be slower than with IV dextrose.