What is the administration protocol for 10% dextrose (D10) solution in managing severe hypoglycemia?

D10 Formulation for Severe Hypoglycemia

For severe hypoglycemia, administer 10% dextrose (D10) as 5-gram aliquots (50 mL) repeated every 1-2 minutes until blood glucose exceeds 70 mg/dL, which provides equivalent efficacy to D50 with significantly lower post-treatment glucose levels and fewer adverse events. 1, 2

Composition and Dosing

• D10 contains 0.1 grams of dextrose per mL (10 grams per 100 mL), meaning each 50 mL aliquot delivers 5 grams of glucose 3
• Initial dose: 50-100 mL (5-10 grams) administered intravenously over 1-2 minutes 1, 4
• Maximum total dose: 25 grams (250 mL) if needed, though most patients require only 10 grams 4, 2

Administration Protocol

Initial Treatment

• Stop any insulin infusion immediately before administering dextrose 1
• Administer 50 mL (5 grams) of D10 intravenously over 1-2 minutes 1, 2
• Give through a small-bore needle into a large peripheral vein to minimize thrombosis risk 3, 1

Mandatory 15-Minute Recheck

• Recheck blood glucose at exactly 15 minutes post-administration—this timing is critical as dextrose effects begin waning by 30 minutes 1
• If glucose remains <70 mg/dL (or <100 mg/dL in neurologic injury patients), repeat with another 50 mL aliquot 1
• Continue repeating 5-gram doses every 1-2 minutes until target achieved 1, 5

Ongoing Monitoring

• Monitor blood glucose every 1-2 hours for patients on insulin infusions 1
• Additional checks at 15 minutes and 60 minutes after hypoglycemia treatment 1

Clinical Advantages Over D50

Efficacy

• Equivalent symptom resolution rates: D10 achieves 95.9% resolution versus 88.8% with D50 6
• Median time to Glasgow Coma Scale of 15: 6-8 minutes for both concentrations 4, 2
• Nearly complete hypoglycemia correction: 99.2% with D10 versus 98.7% with D50 6

Safety Profile

• Zero adverse events reported with D10 (0/1057 patients) versus 13/310 with D50 6
• Lower post-treatment glucose: 6.2 mmol/L (112 mg/dL) with D10 versus 9.4 mmol/L (169 mg/dL) with D50 6, 2
• Reduced total dose required: median 10 grams with D10 versus 25 grams with D50 4, 2
• No cardiac arrest or hyperkalemia risk associated with titrated D10 approach, unlike rapid D50 boluses 1, 5

Critical Safety Considerations

Avoid Overcorrection

• Traditional 25-gram D50 boluses frequently cause hyperglycemia averaging 169 mg/dL, which is associated with worse outcomes 1, 5
• Titrated 5-gram aliquots prevent overshoot while achieving symptom resolution 1, 5

Common Pitfalls to Avoid

• Never delay the 15-minute recheck—hypoglycemia can recur as dextrose effects wane, especially with ongoing insulin action 1
• Do not use D5 (5% dextrose) for acute hypoglycemia—it provides only 0.05 grams/mL and is insufficient for rapid correction 3
• Administer slowly through large veins—rapid infusion through small peripheral veins increases thrombosis risk 3, 1
• Do not use hypotonic maintenance fluids (D5 with 0.45% NaCl) for acute treatment—these are for prevention only 3

Alternative Formulations Context

When D10 is Unavailable

• D50 can be diluted: Mix 50 mL of D50 with 200 mL sterile water to create 250 mL of D10 3
• If using D50 directly: Give 10 mL (5 grams) aliquots rather than full 50 mL ampules 5, 7

Pediatric Considerations

• Dose: 0.5 g/kg as 10% or 25% solution administered slowly 8
• Avoid indiscriminate glucose administration—hyperglycemia worsens ischemic brain injury in children 8

Mortality Context

Severe hypoglycemia carries significant mortality risk (OR 3.233,95% CI 2.251-4.644), making prompt and appropriate treatment essential while avoiding the complications of overcorrection 1