Should I give D10 (dextrose 10%) to this baby?

D10 Administration for Neonatal Hypoglycemia

D10 (dextrose 10%) should be administered to babies with hypoglycemia when oral feeding and dextrose gel have failed to maintain normal blood glucose levels. 1

Indications for D10 Administration in Neonates

• D10 is indicated for treatment of hypoglycemia in neonates, particularly when other interventions have failed 1
• D10 is the preferred concentration for IV dextrose administration in neonates rather than more concentrated solutions like D25W or D50W which can be irritating to veins 1
• D10 can be administered as a bolus at 2 mL/kg (200 mg/kg) for acute hypoglycemia management 1

Administration Guidelines

• For hypoglycemia treatment, D10W can be given at 200 mg/kg (2 mL/kg) as an IV bolus 1
• For maintenance therapy, D10W-containing IV fluids with appropriate electrolytes can be administered at a rate of 100 mL/kg per 24 hours (approximately 7 mg/kg per minute) 1
• The infusion rate should be titrated to achieve normoglycemia, as hyperglycemia can have adverse central nervous system effects 1

Special Considerations

• D10 is preferred over D50W in neonates as higher concentrations are irritating to veins; D50W should be diluted to D25W or D10W for neonatal use 1
• When administering D10, careful monitoring of glucose, sodium, and potassium levels is essential 1, 2
• Electrolyte deficits, particularly in serum potassium and phosphate, may occur during prolonged use of concentrated dextrose solutions 2
• D10NS (D10 with normal saline) is recommended during the first hour of treatment for adrenal insufficiency 1

Clinical Decision Algorithm

1. First-line treatment: For asymptomatic hypoglycemia in neonates, consider oral dextrose gel (40%) followed by breastfeeding before resorting to IV dextrose 3, 4

   • Oral dextrose gel reduces mother-infant separation and increases likelihood of exclusive breastfeeding 4
   • Multiple doses (up to three) of dextrose gel may be effective before moving to IV therapy 5

2. When to use IV D10:

   • If blood glucose remains low after oral feeding and dextrose gel administration 6
   • For symptomatic hypoglycemia requiring rapid correction 1
   • When oral feeding is contraindicated or not possible 1

3. Monitoring during D10 administration:

   • Monitor blood glucose levels frequently until stable 1
   • Watch for signs of hyperglycemia and adjust infusion rate accordingly 1
   • Monitor electrolytes, particularly potassium and phosphate 2

Potential Complications and Precautions

• Hyperglycemia can occur with excessive dextrose administration; titrate to maintain normoglycemia 1
• Extravasation of dextrose solutions can cause tissue damage; ensure proper IV placement 2
• Rebound hypoglycemia can occur when concentrated dextrose infusion is abruptly withdrawn; consider tapering or following with 5% or 10% dextrose 2
• Electrolyte imbalances may occur with prolonged dextrose administration; monitor electrolytes regularly 2

Evidence Summary

Recent evidence suggests that oral dextrose gel should be considered as first-line treatment for neonatal hypoglycemia before moving to IV dextrose administration 4. A 2022 Cochrane review found that oral dextrose gel probably increases correction of hypoglycemic events and reduces mother-infant separation 4. However, when oral therapy fails or is not appropriate, IV D10 remains the standard of care for neonatal hypoglycemia 1, 6.