D10 Infusion Rate for Treating Hypoglycemia
For treating hypoglycemia, D10 (Dextrose 10%) should be administered at a rate of 100 mL/kg per 24 hours (equivalent to 7 mg/kg per minute), with the rate titrated to achieve normoglycemia. 1
Initial Management of Hypoglycemia
Immediate Treatment
- For blood glucose <70 mg/dL (<100 mg/dL in neurologic injury patients):
Follow-up Monitoring
- Repeat blood glucose measurement in 15 minutes after dextrose administration
- Administer additional dextrose as needed to achieve BG >70 mg/dL
- Monitor closely to avoid iatrogenic hyperglycemia 1
D10 vs. Higher Concentration Dextrose Solutions
D10 offers several advantages over higher concentration solutions like D50:
- Similar efficacy with fewer side effects: Recent research shows D10 is as effective as D50 at resolving hypoglycemia symptoms, with fewer adverse events 3, 4
- More physiologic glucose correction: D10 results in lower post-treatment blood glucose levels (6.2 mmol/L vs. 8.5 mmol/L with D50) 3
- Lower risk of complications: No adverse events were observed with D10 in a systematic review of 1,057 patients, compared to 13 adverse events in 310 patients receiving D50 3
Dosing Considerations
Pediatric Patients
- For pediatric hypoglycemia: D10W at 200 mg/kg (2 mL/kg) 1
- Constant infusion of D10W-containing IV fluids with appropriate maintenance electrolytes at 100 mL/kg per 24h (7 mg/kg per min) 1
- Older children may require substantially lower doses 1
Adult Patients
- Initial bolus: 5g (50mL of D10) aliquots administered over 1 minute 4, 5
- Median effective dose: 10g of D10 (compared to 25g of D50) 5
- Time to clinical improvement (GCS 15): Approximately 6-8 minutes 4, 5
Special Considerations
High-Risk Populations
- Patients with low initial blood glucose are at higher risk for developing recurrent hypoglycemia 6
- Patients without diabetes or with baseline blood glucose <110 mg/dL may benefit from higher initial dextrose doses 7
- Neurologic injury patients should maintain higher glucose targets (>100 mg/dL) 1
Monitoring Requirements
- Monitor blood glucose levels every 1-2 hours initially 2
- Continue to monitor glucose, sodium, and potassium levels carefully
- Be aware that hypoglycemia may recur depending on etiology 1
Cautions
- Avoid rapid administration of concentrated dextrose solutions due to risk of cardiac complications 2
- D50W is irritating to veins; dilution to D10 or D25 is preferable 1
- Titrate the rate to achieve normoglycemia, as hyperglycemia has adverse central nervous system effects 1
The evidence strongly supports using D10 infusions at a rate of 100 mL/kg per 24 hours (7 mg/kg per minute) for treating hypoglycemia, with titration based on blood glucose response and patient-specific factors.