What is the expected increase in blood glucose level after administering 25ml of D50 (50% dextrose)?

From the Guidelines

Administering 25ml of D50 (50% dextrose solution) is expected to increase blood glucose by approximately 50-75 mg/dL in an average adult. This concentrated glucose solution contains 0.5g of dextrose per milliliter, meaning 25ml delivers 12.5 grams of glucose directly into the bloodstream 1. The blood glucose elevation is rapid but temporary, typically occurring within minutes of administration and lasting about 30-60 minutes. This intervention is commonly used in emergency situations to treat severe hypoglycemia (blood glucose <50 mg/dL), particularly in unconscious or severely symptomatic patients. The rapid increase occurs because D50 provides immediately available glucose without requiring digestion or metabolism. However, the actual increase in blood glucose can vary based on the patient's weight, current metabolic state, insulin levels, and underlying conditions.

Some key points to consider when administering D50 include:

• The dose of 25-g IV dextrose administered to nondiabetic volunteers produced significant but variable BG increases of 162 ± 31 mg/dL and 63.5 ± 38.8 mg/dL when measured 5 and 15 mins post-injection, respectively 1.
• The effects of D50 are short-lived and hypoglycemia may recur without additional treatment, making it essential to monitor blood glucose levels and provide longer-acting carbohydrates once the patient is alert enough to eat.
• It's crucial to be aware of the potential for hypoglycemia unawareness, particularly in patients with diabetes, and to investigate and review the treatment plan as needed 1.
• The classification of hypoglycemia is outlined in Table 6.4, with level 1 hypoglycemia defined as a measurable glucose concentration <70 mg/dL (3.9 mmol/L) but ≥54 mg/dL (3.0 mmol/L), and level 2 hypoglycemia defined as a blood glucose concentration <54 mg/dL (3.0 mmol/L) 1.

In terms of morbidity, mortality, and quality of life, it's essential to prioritize the prompt treatment of hypoglycemia to prevent long-term cognitive impairment, seizures, loss of consciousness, permanent brain damage, depression, and death 1. The administration of D50 is a critical intervention in emergency situations, and its effects should be closely monitored to ensure the patient's safety and well-being.

From the FDA Drug Label

For peripheral vein administration: ... In insulin-induced hypoglycemia, intravenous injection of 10 to 25 grams of dextrose (20 to 50 mL of 50% dextrose) is usually adequate. The maximum rate at which dextrose can be infused without producing glycosuria is 0.5 g/kg of body weight/hour.

The expected increase in blood glucose level after administering 25ml of D50 (50% dextrose) cannot be directly determined from the provided information, as the label does not specify the exact increase in blood glucose levels.

• The label provides the maximum rate of dextrose administration without resulting in glycosuria, but does not provide a direct correlation to blood glucose level increase.
• It does mention that 10 to 25 grams of dextrose (20 to 50 mL of 50% dextrose) is usually adequate for treating insulin-induced hypoglycemia, but this does not provide a specific expected increase in blood glucose level 2.

From the Research

Expected Increase in Blood Glucose Level

• The expected increase in blood glucose level after administering 25ml of D50 (50% dextrose) can be estimated based on the study by 3, which found that the overall median blood glucose response was 4.0 mg/dL per gram of D50W administered.
• Since 25ml of 50% dextrose contains 12.5g of dextrose, the expected increase in blood glucose level would be approximately 50mg/dL (12.5g x 4.0 mg/dL per gram).
• Another study by 4 found that the post-treatment glycemic profile was increased by 3.2mmol/L in the D50 group, which is equivalent to approximately 57.6mg/dL.
• However, it's worth noting that the actual increase in blood glucose level may vary depending on individual factors, such as the patient's initial blood glucose level, insulin sensitivity, and other underlying medical conditions.

Factors Affecting Blood Glucose Response

• The study by 3 also found that the blood glucose response to D50W was affected by various factors, including the presence of diabetes, recurrent hypoglycemia, and the insulin infusion rate.
• Patients with diabetes had a significantly higher blood glucose response to D50W, while those with recurrent hypoglycemia had a lower response.
• The study by 4 also found that the post-treatment glycemic profile was lower in the D10 group compared to the D50 group, suggesting that the use of D10 may result in fewer untoward hyperglycemic episodes.

Clinical Implications

• The findings of these studies have important implications for the management of hypoglycemia in clinical practice.
• The use of D50 or D10 should be tailored to the individual patient's needs, taking into account their initial blood glucose level, medical history, and other underlying conditions.
• Further studies are needed to determine the optimal dose and concentration of dextrose for the treatment of hypoglycemia in different patient populations, as noted by 5 and 6.