What is the recommended infusion rate for D25 (Dextrose 25%) with hourly Random Blood Sugar (RBS) monitoring?

D25 Infusion Rate with Hourly Blood Glucose Monitoring

For D25W (Dextrose 25%) administration, give 0.5–1.0 g/kg as a bolus (equivalent to 2–4 mL/kg of D25W), followed by continuous infusion at a maximum rate of 0.5 g/kg/hour (approximately 2 mL/kg/hour of D25W) with hourly blood glucose monitoring. 1, 2

Bolus Dosing for Acute Hypoglycemia

• Administer 0.5–1.0 g/kg of dextrose as an initial bolus, which translates to 2–4 mL/kg of D25W 1
• For acute hypoglycemia treatment, the FDA-approved dosing is 10–25 grams of dextrose (20–50 mL of 50% dextrose), but D25W is preferred over D50W as D50W is irritating to veins and dilution to 25% dextrose is desirable 1, 2
• Titrated replacement is superior to traditional fixed dosing: administer dextrose in smaller aliquots to avoid overcorrection and subsequent hyperglycemia 1

Continuous Infusion Rate

• Maximum infusion rate: 0.5 g/kg/hour of dextrose (equivalent to approximately 2 mL/kg/hour of D25W) 2
• The FDA states that the maximum rate at which dextrose can be infused without producing glycosuria is 0.5 g/kg of body weight/hour, with about 95% retention when infused at 0.8 g/kg/hour 2
• For pediatric patients requiring constant infusion, D10W-containing IV fluids at a rate of 100 mL/kg per 24 hours (7 mg/kg per minute) is recommended, with the rate titrated to achieve normoglycemia 1

Blood Glucose Monitoring Protocol

• Monitor blood glucose hourly during D25 infusion 1
• Blood glucose should be maintained at 180–200 mg/dL during dextrose infusion 1
• Very frequent serum glucose monitoring (up to every 15 minutes) may be needed during the initial phase when using high-dose dextrose with insulin 1
• For patients receiving insulin infusions, blood glucose checks every 1–2 hours are suggested, as protocols using every 4-hour checks have hypoglycemia rates above 10% 1

Critical Safety Considerations

Avoiding Overcorrection

• Traditional D50W dosing causes excessive hyperglycemia: 72% of patients receiving 500 mL of 5% dextrose in saline had plasma glucose exceeding 10 mmol/L (180 mg/dL) 3
• The median blood glucose response to D50W is approximately 4 mg/dL per gram of dextrose administered in critically ill patients 4
• Titrated dextrose administration (5-g aliquots) prevents overcorrection and achieves symptom resolution with lower final blood glucose levels compared to bolus dosing 1

Preventing Rebound Hypoglycemia

• At the end of cyclic dextrose infusion, reduce the infusion rate to half over the last 30 minutes to avoid rebound hypoglycemia 1
• If tube feeding or dextrose infusion is interrupted, start intravenous 10% dextrose infusion at 50 mL/hour 1

Monitoring Requirements

• Glucose, sodium, and potassium levels should be monitored carefully during dextrose administration 1
• Depending on etiology, hypoglycemia may recur and require repeated doses 1

Special Clinical Scenarios

Hyperkalemia Treatment

• When using dextrose with insulin for hyperkalemia, 50 g of dextrose (200 mL of D25W) may reduce hypoglycemia risk compared to 25 g, particularly in patients without diabetes or with baseline blood glucose <110 mg/dL 5
• The ratio is 1 unit of insulin for every 4 g of glucose (0.1 unit/kg with 400 mg/kg glucose) 1

Pediatric Considerations

• For pediatric hypoglycemia: D10W at 200 mg/kg (2 mL/kg); D25W at 0.5–1.0 g/kg (2–4 mL/kg); D50W at 0.5–1.0 g/kg (1–2 mL/kg) 1
• Older children may require substantially lower doses than the standard weight-based calculations 1

Central vs. Peripheral Administration

• For central venous administration, 50% dextrose can be used after admixture with amino acid solutions or dilution with sterile water 2
• For peripheral vein administration, injection should be made slowly at the rates specified above 2