What is the recommended dosing for diazoxide (intravenous) in treating acute hypoglycemia?

Diazoxide Dosing for Acute Hypoglycemia

For intravenous diazoxide in treating acute hypoglycemia, the recommended dosage is 3-5 mg/kg administered as an infusion at a rate of 15 mg/minute (maximum total dose of 5 mg/kg body weight). 1, 2

Dosing Protocol

• Initial dose: 3 mg/kg IV infused at a rate of 15 mg/minute 1, 2
• Maximum dose: 5 mg/kg total body weight 1, 2
• Administration method: Slow infusion preferred over bolus injection to achieve more gradual blood pressure reduction and minimize adverse effects 2
• Duration: Continue until blood glucose stabilizes or until maximum dose is reached 1

Clinical Considerations

Patient Monitoring

• Monitor blood glucose levels every 15-30 minutes during infusion 1
• Monitor blood pressure continuously during administration due to potential hypotensive effects 2
• Assess for fluid retention and pulmonary complications, particularly in patients with cardiac conditions 3, 4

Efficacy Assessment

• Therapeutic response should be evident within 25 minutes with infusion method 2
• If no response is observed after reaching maximum dose, alternative treatments should be considered 1

Specific Populations

• Pediatric patients: Start at lower end of dosing range (3 mg/kg) 1, 5
• Patients with cardiac conditions: Use with extreme caution due to increased risk of pulmonary hypertension 3
• Pregnant patients with hypertension: Infusion method (15 mg/minute) is preferred over bolus administration 2

Precautions and Contraindications

• Fluid restriction: Total fluid volume should not exceed 130 mL/kg/day prior to and during diazoxide treatment to reduce risk of pulmonary hypertension 3
• Cardiac screening: Consider echocardiography before initiating treatment in high-risk patients 3
• Concomitant medications: Use caution when administering with other antihypertensive medications due to additive effects 2

Adverse Effects to Monitor

• Fluid retention and edema (most common) 3, 4
• Hypotension (may be severe with rapid administration) 2
• Pulmonary hypertension (occurs in approximately 7% of patients) 3
• Congestive heart failure (particularly with higher doses or prolonged use) 4

Alternative Treatments

If diazoxide is ineffective or contraindicated, consider:

• Glucose administration (D10W: 200 mg/kg or 2 mL/kg) 1
• Glucagon: 0.03 mg/kg up to maximum of 1 mg; may repeat every 15 minutes up to 3 doses if needed 1