Is it safe to dilute 50% glucose (GW) with 5% glucose (GW) for a patient?

Diluting 50% Glucose with 5% Glucose: Safety and Practice

Direct Answer

Do not dilute 50% glucose with 5% glucose for patient administration. Instead, use pre-manufactured 10% dextrose solutions or follow established protocols for safe glucose concentration delivery 1, 2.

Why This Matters

Concentration-Specific Safety Concerns

50% dextrose (D50) should never be used in newborns and requires careful handling in all patients due to vein irritation and extravasation risk 2, 3:

• The American Academy of Pediatrics explicitly advises against using D50W in newborns as it is irritating to veins; dilution to 25% dextrose is desirable if higher concentrations are needed 2
• Significant extravasation of D50W can lead to skin and soft tissue injury, loss of limb, or death 3
• No adverse events were observed with D10 (0/1057 patients) compared to 13/310 adverse events in the D50 group 4

Clinical Efficacy Considerations

D10 is as effective as D50 for treating hypoglycemia while producing more physiologic glucose levels 4, 5:

• D10 achieves 95.9% symptom resolution versus 88.8% with D50 4
• Post-treatment glucose levels are significantly lower and more appropriate with D10 (6.2 mmol/L) versus D50 (9.4 mmol/L), reducing rebound hyperglycemia 5
• Both achieve nearly complete resolution of hypoglycemia: 98.7% (D50) and 99.2% (D10) 4

Recommended Approach Instead

For Acute Hypoglycemia Treatment

Use commercially prepared D10 in 5g (50 mL) aliquots 5:

• Administer 5g doses titrated to effect rather than fixed 25g boluses 5
• Median effective dose is 10g with D10 versus 25g with D50 5
• Time to recovery is comparable (8 minutes median for both) 5

For Newborns Specifically

Start D10W at 100 mL/kg per 24 hours (approximately 7 mg/kg per minute) 2:

• For acute hypoglycemia: administer 200 mg/kg as D10W, equivalent to 2 mL/kg 2
• For severe hypoglycemia: give 0.5-1.0 g/kg, which equals 5-10 mL/kg of D10W 2
• Target blood glucose above 45 mg/dL while avoiding hyperglycemia above 145 mg/dL 2

For Hospitalized Patients Requiring Continuous Infusion

Use 5% dextrose solutions for maintenance, not for acute hypoglycemia correction 1:

• 5% dextrose in water at usual maintenance rates is appropriate for patients who need to fast (>4 hours) 1
• Monitor blood glucose regularly as glucose infusion can lead to hyperglycemia with subsequent osmotic diuresis 1
• Target glucose range of 140-180 mg/dL (7.8-10.0 mmol/L) for most hospitalized patients 1

Critical Safety Pitfalls

Arterial Line Contamination Risk

Never use glucose-containing solutions as arterial line flush 1:

• Sodium chloride 0.9%, with or without heparin, should be the only solution used for arterial line infusion and flushing 1
• Blood sampling from a cannula lumen that carries glucose solutions causes dangerous sampling errors and false hypoglycemia readings 1
• Fatal neuroglycopenic brain injury can occur within two hours if true hypoglycemia is missed due to contaminated samples 1

Electrolyte Monitoring

Add appropriate maintenance electrolytes to continuous glucose infusions 2:

• Glucose, sodium, and potassium levels should be monitored carefully during continuous infusions 2
• Intravenous infusion of 5% glucose mixed with sodium is a main contributor to acquired hyponatremia in hospitalized adults 6

Hyperglycemia Prevention

Avoid excessive glucose administration that leads to rebound hyperglycemia 1:

• Maximum glucose oxidation rate is 4-7 mg/kg/min; infusion should not exceed 5 mg/kg/min 1
• Persistent hyperglycemia ≥180 mg/dL requires insulin therapy 1
• Tight glycemic control (4.5-6.1 mmol/L) increases mortality and severe hypoglycemia risk compared to moderate targets 1

Bottom Line

Use commercially prepared D10 solutions rather than attempting to dilute D50 with D5. This approach provides safer, more controlled glucose delivery with fewer adverse events and more physiologic post-treatment glucose levels 4, 5.