What is the appropriate dose of continuous Dextrose (D-glucose) 10% infusion for a patient?

Continuous Dextrose 10% Dosing

For diabetic patients requiring continuous dextrose 10% infusion when enteral nutrition is interrupted, start at 50 mL/hour (5 grams/hour) to prevent hypoglycemia while maintaining basal insulin coverage. 1

Clinical Context and Indication

The primary indication for continuous D10 infusion is prevention of hypoglycemia in diabetic patients receiving insulin coverage when tube feeding or enteral nutrition is interrupted—this is particularly critical for type 1 diabetics who require continuous basal insulin even without nutritional intake. 1, 2

Standard Dosing Protocol

Initial Rate

• Start D10 at 50 mL/hour when tube feeding is interrupted in patients receiving insulin 1
• This delivers 5 grams of dextrose per hour, which aligns with physiologic glucose utilization rates 3

Maximum Safe Infusion Rate

• The FDA-approved maximum rate for dextrose infusion without producing glycosuria is 0.5 g/kg/hour 3
• Approximately 95% of dextrose is retained when infused at 0.8 g/kg/hour 3
• For a 70 kg patient, this translates to a maximum of 35 grams/hour (350 mL/hour of D10) before glycosuria occurs 3

Administration Route Considerations

Peripheral Venous Access

• D10 can be safely administered through peripheral veins when given slowly through a small-bore needle into a large vein to minimize venous irritation and thrombosis risk 2
• Concentrations >10% dextrose require central venous access for sustained infusion 2

Central Venous Access

• For total parenteral nutrition or prolonged high-concentration dextrose therapy, central line placement with tip in the superior vena cava is preferred 3

Monitoring Requirements

Blood Glucose Monitoring

• Check blood glucose every 1-2 hours during continuous D10 infusion 2
• More frequent monitoring (every 15 minutes initially) may be needed during titration phases 2
• For patients receiving insulin infusions concurrently, maintain hourly glucose checks for at least 4-6 hours 4

Target Glucose Range

• Maintain blood glucose >70 mg/dL to prevent hypoglycemia 5
• For neurologic injury patients (stroke, traumatic brain injury), use higher threshold of 100 mg/dL 5
• Avoid overcorrection leading to hyperglycemia, which worsens outcomes 5

Special Clinical Scenarios

Hyperkalemia Treatment with Insulin

• When administering insulin for hyperkalemia, give 250 mL of D10 over 2 hours in addition to initial D50 bolus if pre-insulin glucose is ≤250 mg/dL 6
• This approach reduces hypoglycemia rates from 20% to 6% in patients with impaired renal function (CrCl <30 mL/min) 6
• The prolonged D10 infusion addresses the fact that insulin's duration of action (4-6 hours) exceeds that of a single dextrose bolus 4

DKA/HHS Management

• When serum glucose reaches 250 mg/dL during DKA treatment, change fluids to 5% dextrose with 0.45-0.75% NaCl while continuing insulin therapy 2
• For HHS, add dextrose when blood glucose falls to 300 mg/dL 2

Critical Safety Considerations

Hypoglycemia Prevention

• Low initial blood glucose is the strongest predictor of developing hypoglycemia during dextrose/insulin therapy 7
• Patients with abnormal renal function, female gender, lower body weight, and no diabetes history are at higher risk 4
• Severe hypoglycemia carries significant mortality risk (OR 3.233,95% CI 2.251-4.644) 2

Avoiding Overcorrection

• Rapid or repeated concentrated dextrose boluses have been associated with cardiac arrest and hyperkalemia 2, 5
• Traditional 25-gram D50 boluses frequently cause overcorrection with post-treatment glucose averaging 169 mg/dL versus 112 mg/dL with titrated approaches 2

Common Pitfalls to Avoid

• Do not use D5 (5% dextrose) alone for acute hypoglycemia treatment—this concentration is insufficient for rapid correction 5
• Do not delay glucose rechecks beyond 15 minutes after treating hypoglycemia—the dextrose effect wanes and hypoglycemia can recur, especially with exogenous insulin 5
• Do not stop basal insulin in type 1 diabetics even when nutrition is interrupted—this is why continuous D10 is essential 1
• Do not administer D10 too rapidly through small peripheral veins—give slowly to minimize venous irritation 2

Dose Adjustment Algorithm

1. Start at 50 mL/hour for standard prevention 1
2. Check glucose every 1-2 hours initially 2
3. If glucose <70 mg/dL: Give 10-20 grams D50 bolus, then increase D10 rate by 25 mL/hour 5
4. If glucose >250 mg/dL: Decrease D10 rate by 25 mL/hour or temporarily hold 2
5. Recheck in 15 minutes after any intervention for hypoglycemia 5