Can D50 (50% dextrose) be administered intramuscularly (IM)?

From the Guidelines

No, D50 (50% dextrose solution) should not be given intramuscularly (IM). D50 must only be administered intravenously (IV) because it is a hypertonic solution that would cause significant tissue damage, pain, and potential necrosis if injected into muscle tissue. The high osmolarity of D50 draws fluid from surrounding tissues, causing cellular destruction and inflammation.

Key Points to Consider

• The administration of D50 via IM can lead to unpredictable absorption and variable effects on glucose, increasing the risk of frequent and unexplained hypoglycemia, as noted in studies such as 1.
• Exogenous-delivered insulin, and by extension other substances like D50, should be injected into subcutaneous tissue, not intramuscularly, to avoid complications, as recommended in 1.
• For emergency treatment of hypoglycemia when IV access is unavailable, alternative options include oral glucose for conscious patients, glucagon 1 mg administered IM or subcutaneously, or D10W (10% dextrose) which may be given intraosseously in critical situations, as discussed in 1 and 1.
• The concentrated nature of D50 makes it inappropriate for any route other than slow IV administration through a secure, patent IV line, preferably in a large vein to minimize vein irritation and potential extravasation injuries.

Clinical Implications

• Clinicians should prioritize IV administration for D50 to ensure safe and effective treatment of hypoglycemia.
• In situations where IV access is not available, clinicians should consider alternative routes and substances, such as glucagon or D10W, based on patient needs and clinical guidelines.
• Patient education on proper injection techniques and the importance of subcutaneous administration for certain medications can help prevent complications and improve outcomes, as emphasized in 1 and 1.

From the FDA Drug Label

Concentrated dextrose solutions should not be administered subcutaneously or intramuscularly. The FDA drug label states that concentrated dextrose solutions, such as D50, should not be given intramuscularly (IM).

• The label explicitly warns against IM administration of concentrated dextrose solutions, including D50 2. Therefore, D50 should not be administered IM.

From the Research

Administration of D50

• D50 is typically administered intravenously (IV) to severely hypoglycemic patients, with a standard dose of 25g ampule of 50% dextrose 3.
• There is no mention of D50 being administered intramuscularly (IM) in the provided studies.
• However, one study mentions the administration of glucagon intramuscularly as an alternative treatment for hypoglycemia 4.

Risks and Complications of D50 Administration

• D50 administration can cause phlebitis and local skin necrosis as complications 4.
• Extravasation of D50 can lead to compartment syndrome, as reported in a case study 4.
• The use of D50 may also lead to difficulties in regulating blood glucose levels post-treatment and cause harm 3.

Alternative Treatments for Hypoglycemia

• A lower concentration of dextrose, such as 10% dextrose (D10), may be a safer alternative to D50, with fewer adverse events and a lower post-treatment glycemic profile 3.
• Glucagon is also used as a treatment for severe hypoglycemia, and its current and potential formulations are reviewed in one of the studies 5.