What is the recommended rate for administering D10W (10% dextrose solution) for persistent hypoglycemia?

D10W Administration Rate for Persistent Hypoglycemia

For persistent hypoglycemia, D10W should be administered as a constant infusion 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

• For initial treatment of hypoglycemia, administer D10W at a dose of 0.5-1.0 g/kg (5-10 mL/kg) 1
• For adults with persistent hypoglycemia, D10W is preferred over D50W due to:
  • Lower risk of rebound hyperglycemia 2, 3
  • Fewer adverse events compared to D50W (0/1057 vs 13/310) 2
  • More physiologic correction of blood glucose levels 3, 4

Continuous Infusion Protocol

When hypoglycemia persists despite initial bolus treatment:

• Start D10W infusion at 100 mL/kg/24 hours (7 mg/kg/min) 1
• Titrate the rate to achieve target glucose levels of 140-180 mg/dL for most patients 1
• For non-critically ill patients, a target range of 100-180 mg/dL may be appropriate 1
• Monitor blood glucose frequently (every 30 min to 2 hours) during IV dextrose administration 1

Important Considerations

• The maximum rate at which dextrose can be infused without producing glycosuria is 0.5 g/kg/hour 5
• Approximately 95% of dextrose is retained when infused at 0.8 g/kg/hour 5
• Older children and adults may require substantially lower doses than the standard pediatric rate 1
• Hyperglycemia should be avoided as it has adverse central nervous system effects 1

Monitoring and Adjustments

• Monitor glucose, sodium, and potassium levels carefully during treatment 1
• Be aware that hypoglycemia may recur depending on the underlying etiology 1
• For diabetic patients, consider the need for additional doses or continued infusion if oral intake is not possible 4
• Non-diabetic patients typically maintain normal glucose levels for up to 60 minutes after a single dose of dextrose 4

Cautions

• D50W is irritating to veins; dilution to D10W or D25W is preferable 1
• Rebound hyperglycemia occurs more frequently in non-diabetic patients (73.3%) compared to diabetic patients (56.3%) when using D50W 4
• Studies show D10W is as effective as D50W at resolving symptoms with fewer adverse events, though it may take slightly longer to achieve the desired effect 2, 3