Is 100ml per hour of dextrose acceptable?
The acceptability of 100ml/hour dextrose infusion depends entirely on the concentration and clinical indication—this rate is appropriate for maintenance therapy in specific contexts (e.g., 5% dextrose during DKA treatment or preventing hypoglycemia when nutrition is interrupted), but requires careful consideration of the patient's clinical status, dextrose concentration, and risk of fluid overload.
Critical Context-Dependent Factors
Dextrose Concentration Matters
- For 5% dextrose (D5): 100ml/hour delivers 5 grams of dextrose per hour, which is within safe parameters for maintenance therapy 1
- For 10% dextrose (D10): 100ml/hour delivers 10 grams per hour, which may be excessive for routine maintenance 1
- For 50% dextrose (D50): 100ml/hour would be dangerously concentrated and inappropriate for peripheral administration 2
Maximum Safe Infusion Rates
- The FDA states that the maximum rate at which dextrose can be infused without producing glycosuria is 0.5 g/kg/hour, with approximately 95% retention when infused at 0.8 g/kg/hour 2
- For a 70kg patient, this translates to a maximum of 35 grams/hour before glycosuria occurs, or 56 grams/hour with some urinary loss 2
- 100ml/hour of 5% dextrose (5g/hour) is well below these thresholds for most adults 2
Clinical Scenarios Where 100ml/hour May Be Appropriate
During Diabetic Ketoacidosis (DKA) Treatment
- When serum glucose reaches 250 mg/dL during DKA treatment, the American Diabetes Association recommends changing fluid to 5% dextrose with 0.45-0.75% NaCl while continuing insulin therapy 1
- This rate prevents hypoglycemia while allowing continued insulin administration to resolve ketoacidosis 1
When Enteral Nutrition Is Interrupted
- The American Diabetes Association recommends immediately starting 10% dextrose infusion if enteral nutrition is interrupted in diabetic patients receiving insulin coverage, particularly critical for type 1 diabetics who require continuous basal insulin 1
- 100ml/hour of 10% dextrose (10g/hour) provides adequate glucose to prevent hypoglycemia in this setting 1
During Severe Malaria Treatment
- Guidelines recommend 10 mL/kg of 5% dextrose infused over 3 hours between quinine doses, which for a 70kg patient would be approximately 233ml/hour during the infusion period 3
- However, caution is required as fluid overload can precipitate pulmonary edema or ARDS and worsen cerebral edema 3
Critical Safety Considerations
Fluid Overload Risk
- Care in fluid administration is essential, as fluid overload can precipitate pulmonary edema, ARDS, or worsen cerebral edema 3
- The rate must be adjusted based on the patient's volume status, cardiac function, and risk factors for fluid overload 3
Monitoring Requirements
- Blood glucose should be monitored every 1-2 hours during dextrose infusion with insulin therapy 1
- Additional monitoring at 15 and 60 minutes post-administration is needed when treating hypoglycemia 1
Route of Administration
- For peripheral vein administration, the American Heart Association recommends injecting dextrose slowly through a small-bore needle into a large vein to minimize venous irritation and thrombosis risk 1
- Concentrated dextrose solutions (>10%) requiring sustained infusion need central venous access 1, 2
Common Pitfalls to Avoid
Overcorrection of Hypoglycemia
- Traditional 25-gram D50 boluses frequently cause overcorrection with post-treatment glucose levels of 169 mg/dL versus 112 mg/dL with titrated D10 4
- Rapid or repeated D50 boluses have been associated with cardiac arrest and hyperkalemia 1, 4
Inappropriate Concentration Selection
- Using 50% dextrose at 100ml/hour peripherally would deliver 50 grams/hour and cause severe venous irritation 2
- Always verify the concentration before setting the infusion rate 2