Treatment of Severe Hypoglycemia with 25% Dextrose
For severe hypoglycemia, administer 10-20g of 25% dextrose intravenously, titrated based on the initial blood glucose level to avoid overcorrection. 1
Dosing and Administration
- For adults with severe hypoglycemia (blood glucose <60 mg/dL), administer 25% dextrose in 5g (20mL) aliquots repeated as needed until symptoms resolve 1
- A formula to calculate patient-specific dosing can be used: 50% dextrose dose in grams = [100 − BG] × 0.2g, which typically results in 10-20g of IV dextrose 1
- Monitor blood glucose 15 minutes after administration and give additional doses if needed to achieve blood glucose >70 mg/dL 1
- For patients with neurologic injury, target a higher blood glucose level (>100 mg/dL) 1
Efficacy Considerations
- 25% dextrose provides a middle ground between 10% and 50% concentrations, balancing rapid correction with avoidance of excessive hyperglycemia 1, 2
- Intravenous dextrose is significantly more effective than oral carbohydrates for treating severe hypoglycemia, with 88.3% of patients achieving euglycemia with IV dextrose versus only 22.5% with oral treatment 3
- IV dextrose produces a more rapid response compared to glucagon (4 minutes vs 140 minutes to achieve normal mental status) 1, 4
Safety Considerations
- Avoid rapid and repeated administration of concentrated dextrose solutions, as this has been associated with cardiac arrest and hyperkalemia 1
- 25% dextrose may cause less hyperglycemic rebound than 50% dextrose while still providing effective treatment 2, 5
- Post-treatment blood glucose levels are typically lower with more dilute dextrose solutions (10% dextrose results in BG of approximately 6.2 mmol/L vs 8.5 mmol/L with 50% dextrose) 5, 6
- Extravasation of concentrated dextrose solutions can cause tissue damage; proper IV placement should be confirmed before administration 5
Special Populations
- For pediatric patients, more dilute solutions (10-25%) are preferred over 50% dextrose to reduce the risk of complications 1
- In patients with stroke, hypoglycemia should be corrected urgently with 25 mL of 50% dextrose administered as a slow intravenous push (equivalent to 12.5g of dextrose) 1
- For critically ill patients with insulin infusions, IV dextrose is preferred over glucagon due to the delay in glucagon response 1
Monitoring
- After treatment, monitor blood glucose every 1-2 hours in patients receiving insulin infusions to detect recurrent hypoglycemia 1
- Continue monitoring for at least 24 hours in patients with sulfonylurea-induced hypoglycemia due to risk of recurrence 6
- For patients with altered mental status, restoration of normal consciousness typically occurs within 6-8 minutes after dextrose administration 2, 6