What is the recommended rate of d10w (10% dextrose solution) administration for a 91.3 kg woman?

D10W Administration Rate for a 91.3 kg Woman

For a 91.3 kg woman requiring continuous D10W infusion, administer at 100 mL/kg per 24 hours (approximately 9,130 mL or 9.1 liters per day), which translates to roughly 380 mL/hour or 6.3 mL/minute. 1

Clinical Context and Calculation

The standard dosing for continuous D10W infusion is weight-based:

• Standard rate: 100 mL/kg per 24 hours 1
• For 91.3 kg patient: 91.3 kg × 100 mL/kg/24h = 9,130 mL per 24 hours
• Hourly rate: 9,130 mL ÷ 24 hours = 380 mL/hour
• This delivers approximately 7 mg/kg/minute of dextrose 1

Important Considerations for Adult Patients

Older children and adults typically require substantially lower doses than the pediatric standard of 100 mL/kg/24h. 1 For a 91.3 kg adult woman, this pediatric-derived rate may result in excessive fluid administration and hyperglycemia.

Adjusted Adult Dosing Approach

For adult patients, a more conservative starting rate is recommended:

• Start with 75-100 mL/hour of D10W (approximately 1-1.3 mL/kg/hour for this patient)
• Titrate to maintain blood glucose between 100-180 mg/dL 1
• Maximum infusion rate should not exceed 5-7 mg/kg/minute to avoid hyperglycemia 1

Monitoring Requirements

Blood glucose monitoring is critical during D10W infusion:

• Recheck blood glucose 15 minutes after initial treatment 1
• Monitor every 30-60 minutes initially when starting continuous infusion 1
• Continue monitoring every 1-2 hours during ongoing dextrose infusion 1
• Check serum potassium and sodium levels carefully, as dextrose administration causes electrolyte shifts 1

Discontinuation Protocol

Never abruptly discontinue dextrose infusion, particularly in insulin overdose patients:

• Reduce infusion rate by 50% over the final 30 minutes before discontinuing to prevent rebound hypoglycemia 1
• Continue glucose monitoring for several hours after discontinuation 1

Common Pitfalls to Avoid

Avoid reflexive full-dose administration without considering the clinical context. 1 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 The 100 mL/kg/24h rate is derived from pediatric guidelines and may be excessive for adult patients, particularly those over 70-80 kg.

Specific Clinical Scenarios

For Hypoglycemia Treatment

If treating acute hypoglycemia rather than providing maintenance infusion:

• Administer 5-10 gram aliquots of D10W intravenously every 1-2 minutes until symptoms resolve 1
• For acute hypoglycemia, 0.5-1.0 g/kg of dextrose as D10W requires 5-10 mL/kg 1
• For this 91.3 kg patient: 45-91 grams total (450-910 mL of D10W) 1

For Enteral Nutrition Interruption

If enteral nutrition is interrupted in a diabetic patient on insulin:

• A 10% dextrose infusion must be started immediately to prevent hypoglycemia 2
• Use the continuous infusion rates described above 2