IV 20% Glucose Administration for Hypoglycemia
For hypoglycemia treatment, IV 20% glucose should be administered at a dose of 75 mL infused over 15 minutes, which effectively raises blood glucose while causing fewer side effects than 50% glucose solutions. 1
Classification of Hypoglycemia and Treatment Approach
Hypoglycemia is classified into three levels, each requiring specific management:
| Level | Blood Glucose | Description | Treatment |
|---|---|---|---|
| 1 | <70 mg/dL and ≥54 mg/dL | Mild hypoglycemia | 15-20g oral glucose |
| 2 | <54 mg/dL | Moderate hypoglycemia | 15-20g oral glucose |
| 3 | Any level | Severe event with altered mental status requiring assistance | IV glucose or glucagon |
IV Glucose Administration Protocol
For Conscious Patients with IV Access
- First-line treatment: 75 mL of 20% glucose solution infused over 15 minutes 1
- Check blood glucose 15 minutes after starting infusion
- If blood glucose remains ≤3.9 mmol/L (70 mg/dL), repeat administration
For Unconscious or Severely Hypoglycemic Patients
- First-line treatment: 75 mL of 20% glucose solution infused over 15 minutes 1
- For children: 2-5 mL/kg of D10W (10% glucose solution) 2, 3
- Monitor vital signs, neurologic status, and blood glucose hourly 3
Evidence Supporting 20% Glucose Use
Recent research demonstrates that 20% glucose solution is as effective as 50% glucose solution for treating hypoglycemia, with several advantages:
- Equivalent efficacy in raising blood glucose at 15 minutes post-administration 1
- More stable blood glucose levels at 60 minutes post-treatment (6.37±1.04 vs. 7.20±1.36 mmol/L) 1
- Lower incidence of local vascular pain (0% vs. 9.4%) 1
- No reported cases of phlebitis or extravasation 1
Monitoring After Administration
- Check blood glucose 15 minutes after starting infusion
- Monitor for resolution of autonomic and neuroglycopenic symptoms
- Continue monitoring blood glucose every hour until stable 3
- Provide a meal or snack with both fast-acting and long-acting carbohydrates once blood glucose normalizes 3
Alternative Options When IV Access is Unavailable
When IV access is unavailable:
- Administer glucagon: 1 mg for adults and children >44 lbs (20 kg), or 0.5 mg for children <44 lbs (20 kg) 3
- For severe hypoglycemia in children, glucagon dose of 30 mcg/kg subcutaneously (maximum 1 mg) will increase blood glucose within 5-15 minutes 2
Special Considerations
- For moderate hypoglycemia in conscious patients who can swallow, oral administration of 15-20g glucose is preferred 2, 3
- In pediatric patients, hypoglycemia treatment should be age-appropriate, with lower doses for younger children 2
- Be aware that repeated episodes of hypoglycemia may result in hypoglycemia unawareness, requiring more vigilant monitoring 2
The use of 20% glucose solution represents an optimal balance between efficacy and safety for treating hypoglycemia, with research showing it to be equally effective as 50% solutions while causing fewer adverse effects.