D10 Rate for Newborns
For newborns requiring continuous dextrose infusion, start D10W at 100 mL/kg per 24 hours (equivalent to 7 mg/kg per minute), with appropriate maintenance electrolytes. 1
Standard Infusion Rate
The recommended starting rate for D10W continuous infusion in newborns is 100 mL/kg per 24 hours, which delivers approximately 7 mg/kg per minute of glucose. 1
This rate should be titrated to achieve normoglycemia, as both hypoglycemia and hyperglycemia have adverse central nervous system effects. 1
Critical Dosing Considerations
Bolus Dosing for Acute Hypoglycemia
For acute hypoglycemia treatment, administer 200 mg/kg as D10W only (equivalent to 2 mL/kg of D10W). 1
For more severe hypoglycemia requiring larger glucose loads, give 0.5-1.0 g/kg, which equals 5-10 mL/kg of D10W. 1
Infusion Rate Adjustments
Older children may require substantially lower infusion rates than the standard 7 mg/kg per minute. 1
Neonates requiring dextrose infusion rates above 12 mg/kg per minute should be investigated for underlying causes of hypoglycemia, such as hyperinsulinism or metabolic disorders. 2
Important Safety Considerations
Monitoring Requirements
Glucose, sodium, and potassium levels should be monitored carefully during continuous D10W infusion. 1
Depending on the etiology, hypoglycemia may recur despite adequate initial treatment. 1
Risk of Hyperglycemia
**Very low birthweight infants (<1,000 g) have an 18-times greater risk of hyperglycemia** compared to infants >2,000 g when receiving D10W infusion. 3
The risk of hyperglycemia increases with both decreasing body weight and increasing dextrose dose, with these effects being independent. 3
Hyperglycemia may affect renal function or potentially lead to intraventricular hemorrhage in neonates. 3
Clinical Pitfalls to Avoid
Do not use D50W in newborns as it is irritating to veins; dilution to 25% dextrose is desirable if higher concentrations are needed. 1
Avoid starting at rates higher than 7 mg/kg per minute without clear indication, as this increases hyperglycemia risk, particularly in extremely low birthweight infants. 3
Do not neglect to add appropriate maintenance electrolytes to continuous D10W infusions. 1