D50 Dosing for Hypoglycemia
For severe hypoglycemia requiring intravenous treatment, administer 10-25 grams of dextrose 50% (20-50 mL of D50), with the FDA-approved standard dose being 10-25 grams, though titrated dosing with smaller 5-10 gram aliquots is superior to avoid overcorrection. 1
Initial Treatment Approach
Standard Bolus Dosing
- The FDA-approved dose for insulin-induced hypoglycemia is 10-25 grams of dextrose (20-50 mL of 50% dextrose) administered intravenously. 1
- Most EMS protocols in the United States specify 25 grams of glucose as the initial dose for adults (73-78% of protocols). 2
- Repeated doses and supportive treatment may be required in severe cases. 1
Titrated Dosing (Preferred Method)
- Administer 5-10 gram aliquots of dextrose every 1-2 minutes until symptoms resolve, rather than giving a single large 25-gram bolus. 3
- This titrated approach corrects blood glucose into the target range in 98% of patients within 30 minutes while avoiding overcorrection. 4
- A patient-specific formula can be used: (100 − current blood glucose) × 0.2 grams = dose of 50% dextrose needed. 4
Alternative Concentrations
D10 as an Alternative
- Dextrose 10% given in 5-gram (50 mL) aliquots achieves the same time to recovery as D50 (median 8 minutes) but requires lower total doses (median 10g vs 25g) and results in lower post-treatment glucose levels (6.2 mmol/L vs 9.4 mmol/L). 5
- D10 has fewer adverse events (0/1057 patients) compared to D50 (13/310 patients), though it requires more frequent repeat dosing (19.5% vs 8.1%). 6
- Recent studies show D10 and D25 are equally effective as D50 in achieving baseline mental status, with lower total doses required. 7
Critical Monitoring and Follow-Up
Immediate Monitoring
- Check blood glucose before administering dextrose when possible, though treatment should not be delayed in emergencies. 1
- Recheck blood glucose 15 minutes after treatment, as additional doses may be needed. 4
- Blood glucose should be evaluated again at 60 minutes, as the effect may be only temporary. 4
Ongoing Management
- Monitor blood glucose every 1-2 hours during any subsequent insulin infusion therapy. 4
- Watch for rebound hypoglycemia, especially in patients with long-acting insulin or sulfonylurea overdose. 3
Special Considerations
Avoiding Overcorrection
- Rapid administration of 25 grams of D50 can cause excessive blood glucose elevation (162 ± 31 mg/dL at 5 minutes) and has been associated with cardiac arrest and hyperkalemia when given rapidly and repeatedly. 4
- Target post-treatment glucose of 100-180 mg/dL rather than aggressive normalization. 3
- The rate of dextrose administration should not exceed 0.5 g/kg/hour to avoid glycosuria. 1
When Oral Treatment is Insufficient
- Intravenous dextrose is 97.2% more effective than oral carbohydrates for severe hypoglycemia (blood glucose <50 mg/dL), with 88% of IV-treated patients achieving euglycemia after one treatment versus only 23% with oral treatment. 8
- For patients unable to take oral glucose due to altered consciousness, IV dextrose is preferred over glucagon due to faster response time. 4
Pediatric Dosing
- Children require 15-20 grams of glucose for moderate hypoglycemia (versus 10 grams for younger children with mild hypoglycemia). 4
- Most protocols specify 0.5 g/kg for pediatric patients, with diluted concentrations (D25 or D10) preferred over D50. 2
Common Pitfalls
- Avoid administering the full 25-gram dose reflexively—titrate based on initial glucose level and patient response. 4, 3
- Do not delay treatment waiting for laboratory confirmation in symptomatic patients with suspected hypoglycemia. 1
- Remember that glucose levels ≥60-80 mg/dL may still require treatment decisions even if not meeting strict hypoglycemia definitions. 4