Can 25% Dextrose Be Used in Children?
Yes, 25% dextrose can be safely used in children to treat hypoglycemia, with a recommended dose of 0.5-1.0 g/kg (equivalent to 2-4 mL/kg of D25W) administered slowly intravenously. 1
Dosing and Administration
The standard treatment dose for proven hypoglycemia in children is 0.5 g/kg of glucose, which can be given as either 10% or 25% dextrose solution administered slowly. 1
Specific Concentration Guidelines:
- For D25W: 0.5-1.0 g/kg = 2-4 mL/kg 1
- For D10W: 0.5-1.0 g/kg = 5-10 mL/kg (200 mg/kg = 2 mL/kg) 1
- For D50W: 0.5-1.0 g/kg = 1-2 mL/kg (but requires dilution - see below) 1
Important Safety Considerations
Vein Irritation and Dilution
D50W is irritating to veins, and dilution to 25% dextrose is desirable. 1 This makes 25% dextrose an optimal concentration that balances efficacy with safety, avoiding the vein irritation associated with higher concentrations while providing adequate glucose delivery.
Administration Speed
Administer slowly to avoid complications. 1 Rapid administration can cause rebound hypoglycemia or other metabolic disturbances.
Monitoring Requirements
Glucose, sodium, and potassium levels should be monitored carefully, as hypoglycemia may recur depending on the etiology. 1
Maintenance Therapy After Bolus
After initial correction with 25% dextrose bolus:
- Constant infusion of D10W-containing IV fluids with appropriate maintenance electrolytes at a rate of 100 mL/kg per 24 hours (7 mg/kg per minute) is recommended. 1
- For infants at risk of hypoglycemia, glucose intake of 4-6 mg/kg/min is advised (6-8 mg/kg/min in newborns), typically provided as D10% normal saline solution. 1
- The rate should be titrated to achieve normoglycemia, because hyperglycemia has its own adverse central nervous system effects. 1
Critical Warnings About Hyperglycemia
Indiscriminate or excessive treatment with glucose should be avoided because animal evidence suggests that hyperglycemia increases ischemic brain injury. 1 An infusion of 5% dextrose at 15 mL/kg/h given before and after an arrest was associated with significantly worse neurological outcome in experimental kittens. 1
When to Treat
Sick children and especially infants may be hypoglycemic - look for evidence during resuscitation and treat accordingly. 1 Treatment should only be given for proven hypoglycemia, not empirically. 1
Alternative Routes for Conscious Children
For children who are awake and able to swallow:
- Oral glucose (15-20 grams) is the first-line treatment. 1, 2
- For children who are awake but unwilling or unable to swallow glucose, it may be reasonable to apply a slurry of granulated sugar and water under the tongue. 1, 2
- Research supports that sublingual sugar administration can be effective in moderately hypoglycemic children, with bioavailability of 77-99%. 3
When NOT to Use Oral/Enteral Routes
Oral glucose should not be administered to people who are not awake or not able to swallow. 1, 2 In these cases, intravenous dextrose (including 25% concentration) is the appropriate route.
Common Pitfalls to Avoid
- Do not underdose: Use the full recommended 0.5-1.0 g/kg dose 1
- Do not use D50W undiluted in children: The high osmolarity causes vein irritation and sclerosis 1
- Do not give excessive glucose: This can cause hyperglycemia-related brain injury 1
- Do not forget to monitor for recurrence: Hypoglycemia often recurs depending on the underlying cause 1
- Do not use hypotonic solutions like D5W alone in acute neurologic emergencies: These can exacerbate cerebral edema 4