What is the proper administration and dosage of a D10 (10% dextrose solution) infusion for treating hypoglycemia?

D10 Infusion for Hypoglycemia

For treating hypoglycemia with D10 (10% dextrose), administer 5-10 gram aliquots (50-100 mL) intravenously every 1-2 minutes until symptoms resolve, rather than giving a single large bolus, with a target post-treatment glucose of 100-180 mg/dL. 1

Initial Treatment Protocol

Titrated dosing is superior to bolus administration:

• Give 5-10 grams of dextrose as D10 (50-100 mL) every 1-2 minutes until the patient becomes alert and symptomatic hypoglycemia resolves 1
• This approach corrects blood glucose into the target range in 98% of patients within 30 minutes while avoiding dangerous overcorrection 1
• A patient-specific formula can guide dosing: (100 − current blood glucose in mg/dL) × 0.2 grams = total dose of dextrose needed 1

For continuous infusion in insulin overdose or prolonged hypoglycemia:

• Start D10 at 100 mL/kg per 24 hours (approximately 4.2 mL/kg/hour or 7 mg/kg/minute) 2
• Titrate the infusion rate to maintain blood glucose between 100-180 mg/dL 2

Critical Monitoring Requirements

Immediate monitoring:

• Recheck blood glucose 15 minutes after initial treatment, as additional doses are frequently needed 1
• Repeat glucose measurement at 60 minutes, as the effect may be temporary 1

During continuous infusion:

• Monitor blood glucose every 1-2 hours during any ongoing dextrose infusion 1, 2
• Check serum potassium and sodium levels carefully, as dextrose administration can cause electrolyte shifts 2
• Monitor every 30-60 minutes initially when starting continuous infusion 2

Advantages of D10 Over D50

D10 demonstrates superior safety profile:

• No extravasation injuries reported with D10 (0/1057 patients) compared to 13/310 adverse events with D50 3
• Lower post-treatment glucose levels: 6.2 mmol/L with D10 versus 8.5-9.4 mmol/L with D50 4, 3
• Median total dose administered is significantly lower with D10 (10 grams) compared to D50 (25 grams) 4, 5

Efficacy is equivalent or superior:

• Symptom resolution rates: 95.9% with D10 versus 88.8% with D50 3
• Complete resolution of hypoglycemia: 99.2% with D10 versus 98.7% with D50 3
• Time to achieve Glasgow Coma Scale of 15 is similar (6-8 minutes) across concentrations 4, 5

Important Caveats and Pitfalls

Avoid reflexive full-dose administration:

• Do not automatically give 25 grams of dextrose—this causes excessive blood glucose elevation and has been associated with cardiac arrest and hyperkalemia when given rapidly and repeatedly 1
• Titrate based on initial glucose level and patient response rather than administering fixed large doses 1

Prevent rebound hypoglycemia:

• Never abruptly discontinue dextrose infusion in insulin overdose patients 2
• Reduce infusion rate by 50% over the final 30 minutes before discontinuing to prevent rebound 2

Additional dose requirements:

• Approximately 20-23% of patients require a second dose of D10 3, 6
• This is higher than D50 (8.1%), but the trade-off is improved safety and lower post-treatment hyperglycemia 3

Maximum Infusion Rates

Per FDA labeling:

• The maximum rate at which dextrose can be infused without producing glycosuria is 0.5 g/kg/hour 7
• About 95% of dextrose is retained when infused at 0.8 g/kg/hour 7

Special Populations

Pediatric dosing:

• Children require 15-20 grams of glucose for moderate hypoglycemia 1
• For pediatric patients, D5W should be administered as a constant infusion at 100 mL/kg per 24 hours (approximately 7 mg/kg/min) with appropriate maintenance electrolytes 8

Patients unable to swallow:

• IV dextrose is preferred over glucagon due to faster response time 1
• For conscious patients able to swallow, oral glucose is first-line treatment 9