Ideal Administration Rate for D10W
For continuous infusion in hypoglycemia or insulin overdose, administer D10W at 100 mL/kg per 24 hours (approximately 4.2 mL/kg/hour or 7 mg/kg/minute), titrating to maintain blood glucose between 100-180 mg/dL. 1, 2
Initial Bolus Treatment
- Administer 5-10 gram aliquots (50-100 mL) of D10W intravenously every 1-2 minutes until symptoms resolve, targeting a post-treatment glucose of 100-180 mg/dL 1
- Use a patient-specific formula to guide dosing: (100 − current blood glucose in mg/dL) × 0.2 grams = total dose of dextrose needed 1
- For acute hypoglycemia, 0.5-1.0 g/kg of dextrose as D10W requires 5-10 mL/kg 3
- Titrated dosing corrects blood glucose into the target range in 98% of patients within 30 minutes while avoiding dangerous overcorrection 1
Continuous Infusion Protocol
- Start D10W at 100 mL/kg per 24 hours with appropriate maintenance electrolytes 3, 1, 2
- This translates to approximately 7 mg/kg/minute of dextrose 3, 2
- Older children and adults may require substantially lower doses than the pediatric standard 3
- The maximum dextrose infusion rate should not exceed 5-7 mg/kg/minute to avoid hyperglycemia 3
- The FDA label states that the maximum rate at which dextrose can be infused without producing glycosuria is 0.5 g/kg/hour, with about 95% retention when infused at 0.8 g/kg/hour 4
Critical Monitoring Requirements
- Recheck blood glucose 15 minutes after initial treatment, as additional doses are frequently needed 1
- Monitor blood glucose every 30-60 minutes initially when starting continuous infusion 1, 2
- Continue monitoring every 1-2 hours during ongoing dextrose infusion 1, 2
- Check serum potassium and sodium levels carefully, as dextrose administration causes electrolyte shifts 3, 1, 2
- Blood glucose should be maintained at 100-180 mg/dL, as both hypoglycemia and hyperglycemia have adverse central nervous system effects 3, 2
Discontinuation Protocol
- Never abruptly discontinue dextrose infusion in insulin overdose patients 1, 2
- Reduce infusion rate by 50% over the final 30 minutes before discontinuing to prevent rebound hypoglycemia 1, 2
Important Caveats
- Avoid reflexive full-dose administration, as rapid and repeated large doses can cause excessive blood glucose elevation and have been associated with cardiac arrest and hyperkalemia 1
- Titrate based on initial glucose level and patient response rather than administering fixed large doses 1
- For peripheral vein administration, injection should be made slowly 4
- D50W is irritating to veins; dilution to D10W or D25W is desirable 3