Intravenous Dextrose for Hypoglycemia
For hypoglycemic patients unable to take oral glucose, administer intravenous dextrose in 5-10 gram aliquots (50 mL of 10% dextrose or 10-20 mL of 50% dextrose), repeating every minute until symptoms resolve or blood glucose exceeds 70 mg/dL, with a maximum total dose of 25 grams. 1
Immediate Management Algorithm
For Conscious Patients Who Can Swallow
- Administer 15-20 grams of oral glucose (preferably glucose tablets) as first-line treatment 2
- Recheck blood glucose every 15 minutes and repeat treatment if glucose remains <70 mg/dL 3, 2
- Oral glucose should never be given to patients who are unconscious or unable to protect their airway 1
For Unconscious or Unable-to-Swallow Patients
IV Dextrose Administration:
- Give 5-10 gram aliquots of IV dextrose over 1 minute, repeating every minute until recovery 1
- 10% dextrose is preferred over 50% dextrose due to lower overcorrection rates and fewer adverse events, though it may take 4 minutes longer to achieve symptom resolution 4, 5
- The FDA-approved dose for insulin-induced hypoglycemia is 10-25 grams (20-50 mL of 50% dextrose), though this frequently causes overcorrection 6
- Maximum total dose should not exceed 25 grams to avoid hyperglycemic overcorrection 1
Alternative When IV Access Unavailable:
- Administer 1 mg glucagon intramuscularly or intranasally 1, 7
- Glucagon takes 5-15 minutes to work (slower than IV dextrose which works in 4-6 minutes) and may cause nausea 1, 8
Critical Monitoring Requirements
- Check blood glucose before initial dextrose administration 6
- Recheck at 15 minutes post-treatment 1
- Continue monitoring every 1-2 hours if patient is on insulin infusion 1
- Stop any insulin infusion immediately when treating hypoglycemia to prevent recurrence 1
Concentration-Specific Considerations
10% Dextrose (Preferred):
- Results in fewer adverse events (0% vs 4.2% with 50% dextrose) 4
- Lower post-treatment glucose (6.2 mmol/L vs 8.5 mmol/L with 50% dextrose) 4
- Requires repeat dosing more frequently (19.5% vs 8.1% with 50% dextrose) 4
- Symptom resolution rate of 95.9% 4
50% Dextrose:
- Faster symptom resolution (4 minutes vs 8 minutes with 10% dextrose) 4
- Higher risk of overcorrection to hyperglycemia (6.8% rate when following standard protocols) 9
- Each gram produces approximately 4 mg/dL increase in blood glucose 9
- More vascular complications and extravasation risk 8
Special Population Adjustments
Neurologic Injury Patients:
- Treat blood glucose <100 mg/dL (rather than standard <70 mg/dL threshold) 1
Patients with Diabetes:
- Higher blood glucose response to dextrose compared to non-diabetics 9
- May require insulin supplementation after treatment to prevent rebound hyperglycemia 1
Patients with Baseline Glucose <110 mg/dL:
- Use 50 grams of dextrose instead of 25 grams to reduce hypoglycemia recurrence 10
Common Pitfalls to Avoid
- Do not use 5% dextrose solutions in acute stroke patients as they can worsen cerebral edema; use isotonic solutions instead 1
- Avoid sliding-scale insulin alone in hospitalized patients—this is strongly discouraged 3
- Do not give the full 25 gram bolus upfront—titrate in 5-10 gram aliquots to prevent overcorrection 1, 5
- Never administer oral glucose to unconscious patients—use IV dextrose or IM glucagon instead 1
Post-Treatment Protocol
- Once symptoms resolve and glucose normalizes, provide starchy or protein-rich foods if more than 1 hour until next meal 3
- Any severe hypoglycemic episode requiring external assistance mandates reevaluation of the diabetes management plan 2
- Investigate underlying causes including medication timing, reduced oral intake, or interruption of nutrition 3