Can we give D5 (5% dextrose solution) or D25 (25% dextrose solution) for a blood glucose level of 49, indicating severe hypoglycemia?

Treatment of Blood Glucose 49 mg/dL: D5 vs D25

For a blood glucose of 49 mg/dL, you should NOT use D5 (5% dextrose) as it is hypotonic and inappropriate for acute hypoglycemia treatment; instead, use concentrated dextrose solutions (D10, D25, or D50) with D10 given in 5-10 gram aliquots being the preferred approach to minimize overcorrection while achieving rapid symptom resolution. 1, 2

Why D5 is Contraindicated

• D5 is a hypotonic solution that distributes into intracellular spaces after glucose metabolism and is specifically contraindicated for hypoglycemia treatment 3
• D5 provides insufficient glucose concentration to rapidly correct severe hypoglycemia (blood glucose <60 mg/dL) 3
• Hypotonic solutions like D5 can exacerbate cerebral edema if the patient has any concurrent neurological condition 3

Recommended Treatment Approach

First-Line: Titrated Lower Concentration Dextrose (Preferred)

• Administer D10 in 5-10 gram aliquots (50-100 mL) repeated every 1-2 minutes until symptoms resolve 1, 2
• This approach achieves symptom resolution with post-treatment glucose levels of 112 mg/dL versus 169 mg/dL with traditional D50 boluses 1
• Median total dose required is typically 10 grams with D10 versus 25 grams with D50 2
• Recheck blood glucose in 15 minutes and repeat treatment if still <70 mg/dL 4

Alternative: D25 or D50 in Smaller Doses

• If D10 is unavailable, use 10-15 grams of D50 (20-30 mL of a 50% solution) or equivalent D25 volume rather than the full 25-gram ampule 1
• The American Heart Association/American Stroke Association recommends 25 mL of 50% dextrose (12.5 grams) as a slow IV push for blood glucose <60 mg/dL 3
• Recent evidence shows 5-gram aliquots of any concentration (D10, D25, or D50) achieve similar time to GCS 15 (approximately 6 minutes) 5

Critical Safety Considerations

• Stop any insulin infusion immediately when treating hypoglycemia <70 mg/dL 3
• Traditional 25-gram D50 boluses cause overcorrection and have been associated with cardiac arrest and hyperkalemia 1
• Avoid iatrogenic hyperglycemia as post-treatment glucose >200 mg/dL worsens outcomes in critically ill patients 3
• No adverse events were observed with D10 (0/1057 patients) compared to 13/310 adverse events with D50 6

Clinical Context for Blood Glucose 49 mg/dL

• At 49 mg/dL, the patient is below the threshold where brain dysfunction typically begins (47 mg/dL in healthy individuals) 3
• This level requires urgent correction to prevent permanent brain damage, seizures, or death 3
• If the patient is conscious and able to swallow, 15-20 grams of oral glucose tablets are preferred over IV dextrose 3, 4
• If unconscious or unable to swallow, IV dextrose is mandatory—oral glucose is contraindicated 3, 4

Monitoring After Treatment

• Recheck blood glucose at 15-minute intervals until consistently ≥70 mg/dL 4
• Time to symptom resolution averages 4 minutes with D50 versus 8 minutes with D10, but D10 requires fewer subsequent doses (19.5% vs 8.1%) 6
• Both D10 and D50 achieve nearly complete resolution of hypoglycemia (99.2% vs 98.7%) 6