What is the recommended dose of dextrose (D-glucose) gel in mg/kg for treating hypoglycemia?

Dextrose Gel Dosing for Hypoglycemia Treatment

The recommended dose of dextrose gel for treating hypoglycemia is 200 mg/kg (0.5 ml/kg of 40% dextrose gel). 1, 2, 3

Dosing Guidelines by Age Group

Neonates and Infants

• Dose: 200 mg/kg (0.5 ml/kg of 40% dextrose gel) 3
• Administration: Apply to buccal mucosa and massage gently
• Timing: Can be used as treatment for hypoglycemia or prophylactically in at-risk newborns 3, 4

Children

• Dose: 200 mg/kg of dextrose gel 2
• Alternative formulations:
  • D10W: 2 mL/kg (200 mg/kg) 1
  • D25W: 0.5-1.0 g/kg (2-4 mL/kg) 1
  • D50W: 0.5-1.0 g/kg (1-2 mL/kg) 1

Administration Technique

1. Calculate dose based on weight (200 mg/kg)
2. Apply gel to buccal mucosa (inside of cheek)
3. Gently massage the area to enhance absorption
4. Follow with feeding when possible (does not impair subsequent feeding) 5

Clinical Considerations

Efficacy

• Single dose of 200 mg/kg is more effective than higher doses (400 mg/kg) with fewer side effects 3, 6
• Reduces risk of hypoglycemia by approximately 12% compared to placebo (RR 0.88; 95% CI 0.80,0.98) 4
• Number needed to treat to prevent one case of hypoglycemia: 10 6

Route of Administration

• Buccal/oral administration is preferred for conscious patients who can swallow 1, 2
• Sublingual administration may be considered for uncooperative children 2
• IV dextrose should be used for unconscious patients or when oral route is not feasible 2

Monitoring After Administration

• Recheck blood glucose 15-20 minutes after administration
• If hypoglycemia persists after 10 minutes, consider:
  • Repeating the dose
  • Activating emergency medical services
  • Transitioning to IV dextrose 2

Special Considerations

• D50W is irritating to veins; dilution to D25W is preferable for IV administration 1
• Monitor glucose, sodium, and potassium levels carefully after treatment 1
• Hypoglycemia may recur depending on etiology; continued monitoring is essential 1
• For neonates, dextrose gel treatment does not impair subsequent feeding and may actually improve breastfeeding quality 5

Cautions

• Higher doses (400 mg/kg) have been associated with feeding difficulties and are not recommended 5, 3
• Avoid using dextrose gel in unconscious patients due to aspiration risk
• Ensure proper technique when administering to prevent aspiration

The 200 mg/kg dose of dextrose gel represents the optimal balance between efficacy and safety, with evidence showing it effectively treats hypoglycemia while minimizing potential adverse effects.