What dose of D10 (10% dextrose) intravenous (IV) solution should be administered to a patient with hypoglycemia on the ward?

From the Guidelines

For a hypoglycemic patient on the ward, administer 5g of dextrose as D10W (10% dextrose in water) by giving 50ml IV, and repeat as necessary to avoid overcorrection of blood glucose levels. This approach is supported by a study that recommends titrating 10% dextrose in 50-mL IV (5-g) aliquots to treat the symptoms of hypoglycemia and to avoid overcorrection of blood glucose 1. After administration, recheck the blood glucose level in 15-30 minutes to ensure it has normalized. If the patient remains hypoglycemic, repeat the dose. For patients with severe hypoglycemia (glucose <50 mg/dL or 2.8 mmol/L) who are unconscious or unable to take oral glucose, this IV dextrose is the preferred treatment. Once the patient is stabilized, identify and address the underlying cause of hypoglycemia, which may include adjusting diabetes medications, addressing missed meals, or evaluating for other medical conditions. Ensure the patient receives appropriate follow-up nutrition and consider initiating a maintenance IV with dextrose if the patient cannot eat. D10W is preferred over D50W because it causes less vein irritation and tissue damage if extravasation occurs, while still effectively raising blood glucose levels. Additionally, a study suggests that the rate of administration of concentrated dextrose solutions may be important, as rapid and repeated administration of 50% dextrose has been associated with cardiac arrest and hyperkalemia 1.

Some key points to consider when treating hypoglycemia include:

• Monitoring blood glucose levels every 1-2 hours for most patients receiving an insulin infusion 1
• Being aware of the potential limitations in accuracy of glucose meters for patients with concurrent anemia, hypoxia, and interfering drugs 1
• Using arterial or venous whole blood sampling instead of finger-stick capillary blood glucose testing for patients in shock, on vasopressor therapy, or with severe peripheral edema 1
• Avoiding finger-stick testing in patients who are on vasopressors or exhibit hypoperfusion, as it may provide significantly different results compared with arterial or venous specimens 1

It's also important to note that the use of glucose meters has become common in hospitals, but they may lack accuracy when used in critically ill patients, and clinicians must be aware of the limitations with the specific device used 1.

In terms of the dose of D10W, a study suggests that 0.5-1.0 g/kg of dextrose can be administered IV, which is equivalent to 5-10 mL/kg of D10W 1. However, the recommended dose of 5g of dextrose as D10W (10% dextrose in water) by giving 50ml IV is a more practical and effective approach for treating hypoglycemia in adult patients.

From the FDA Drug Label

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

The dose of D10 (10% dextrose) IV solution is not directly stated in the label for the treatment of hypoglycemia. The label provides information on the dose of 50% dextrose for hypoglycemia, which is 10 to 25 grams. To administer D10 (10% dextrose), the dose would need to be adjusted to provide an equivalent amount of dextrose.

• For 10 grams of dextrose, the volume of D10 (10% dextrose) would be 100 mL.
• For 25 grams of dextrose, the volume of D10 (10% dextrose) would be 250 mL. The administration rate should not exceed 0.5 g/kg of body weight/hour to avoid glycosuria 2.

From the Research

Dose of D10 for Hypoglycemia

• The ideal dose of D10 (10% dextrose) intravenous (IV) solution for a patient with hypoglycemia is not explicitly stated in the provided studies, but several studies suggest that 100mL of D10 can be effective in treating hypoglycemia 3.
• A study comparing D10 to D50 found that D10 may be as effective as D50 at resolving symptoms and correcting hypoglycemia, although the desired effect can take several minutes longer 4.
• Another study found that 5g aliquots of intravenous 10% dextrose were effective in treating hypoglycemic patients, with no difference in median time to achieve a Glasgow Coma Scale (GCS) of 15 compared to 25% or 50% dextrose 5.

Administration and Efficacy

• The administration of 100mL of D10 has been shown to be feasible, safe, and effective in treating hypoglycemia, with a median initial field blood glucose of 37mg/dL increasing to a median of 91mg/dL after treatment 3.
• A study found that 23.0% of patients required an additional dose of IV D10 solution due to persistent or recurrent hypoglycemia, and 0.8% required a third dose 3.
• The use of D10 may result in fewer adverse events compared to D50, with no reported deaths or other adverse events related to D10 administration for hypoglycemia 3.

Comparison to D50

• A study comparing D10 to D50 found that D10 may be as effective as D50 at resolving symptoms and correcting hypoglycemia, although the desired effect can take several minutes longer 4.
• Another study found that the use of D10 instead of D50 did not reduce hypoglycemia incidence in the overall patient population, but may be beneficial in select patient populations, such as patients without type 2 diabetes or patients with a baseline blood glucose <110 mg/dl 6.