What type of dextrose (intravenous glucose solution) should be administered for hypoglycemia (low blood sugar)?

Intravenous Dextrose for Hypoglycemia

For hypoglycemic patients requiring intravenous treatment, administer 10% dextrose in 5-gram aliquots (50 mL) over 1 minute, repeating every minute until symptoms resolve or blood glucose exceeds 70 mg/dL, with a maximum total dose of 25 grams. 1, 2

Why 10% Dextrose Over 50% Dextrose

The traditional approach of using 50% dextrose (D50) has been replaced by 10% dextrose (D10) in modern practice for several compelling reasons:

• D10 achieves equivalent symptom resolution with the same median time to recovery (approximately 6-8 minutes to reach GCS 15) as D50 3, 4
• Lower total doses are required with D10 (median 10g) compared to D50 (median 25g), resulting in more physiologic post-treatment glucose levels (6.2 mmol/L vs 9.4 mmol/L) 3
• Fewer adverse events occur with D10 (0/1057 patients) compared to D50 (13/310 patients), including no extravasation injuries 5
• Lower risk of rebound hyperglycemia and subsequent glycemic instability, which is particularly important in diabetic patients 5, 3

Administration Protocol

Initial Treatment

• Give 5 grams of dextrose (50 mL of 10% dextrose) intravenously over 1 minute 1, 2
• Check blood glucose before administration and document the initial value 6, 1
• Repeat 5-gram aliquots every minute until the patient's symptoms resolve or blood glucose exceeds 70 mg/dL 1, 2
• Maximum total dose is 25 grams to avoid overcorrection 1, 2

Monitoring

• Recheck blood glucose 15 minutes after treatment and retreat if glucose remains below 70 mg/dL 1, 2
• Continue monitoring every 1-2 hours if the patient is on insulin infusion 1, 2
• Stop any insulin infusion immediately when treating hypoglycemia to prevent recurrence 1, 2

Alternative: 50% Dextrose (When 10% Unavailable)

If 10% dextrose is not available, the FDA-approved regimen for 50% dextrose is:

• Administer 10-25 grams (20-50 mL of 50% dextrose) as a slow intravenous push 7
• Use 25 grams for severe hypoglycemia (insulin shock), though this frequently causes overcorrection with glucose increases of 162 ± 31 mg/dL at 5 minutes 1
• Repeated doses may be required in severe cases 7

Special Population Considerations

Neurologic Injury Patients

• Treat blood glucose below 100 mg/dL rather than the standard 70 mg/dL threshold in patients with neurologic injury 1, 2

Acute Ischemic Stroke Patients

• Avoid 5% dextrose solutions as they are hypotonic and can exacerbate cerebral edema after glucose metabolism 6, 2
• Use isotonic solutions (0.9% saline) for maintenance fluids in stroke patients 6
• Correct hypoglycemia urgently with 25 mL of 50% dextrose if blood glucose is below 60 mg/dL 6

Diabetic Patients

• Exercise caution as these patients may require insulin supplementation after treatment to prevent rebound hyperglycemia 1, 2

Critical Pitfalls to Avoid

Overcorrection

• A 25-gram bolus of dextrose causes excessive glucose elevation (162 ± 31 mg/dL increase at 5 minutes), which is why titrated 5-gram aliquots are preferred 1
• Severe hypoglycemia is associated with 3-fold increased mortality risk (OR 3.233), making both under-treatment and over-treatment dangerous 1

Unconscious Patients

• Never administer oral glucose to patients who are unconscious or unable to protect their airway 6, 2
• Use intravenous dextrose or intramuscular glucagon (1 mg) for unconscious patients 6, 2
• Glucagon takes longer to work (5-15 minutes) and may cause nausea, but is safer when IV access is unavailable 1

Route Selection

• Oral glucose (15-20 grams) is first-line for conscious patients who can swallow 2
• Intravenous dextrose is reserved for patients unable to swallow, having seizures, or not improving within 10 minutes of oral glucose 6

Post-Treatment Management

• Provide starchy or protein-rich foods once symptoms resolve if more than 1 hour until the next meal 2
• 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 2