What is the maximum recommended infusion rate for intravenous dextrose (IVD) D10 in a 70 kg adult patient with acute hepatitis or liver dysfunction experiencing symptomatic hypoglycemia?

Maximum Infusion Rate for D10 in Symptomatic Hypoglycemia

For acute symptomatic hypoglycemia treatment, administer D10 as 5-10 gram aliquots (50-100 mL) intravenously every 1-2 minutes until symptoms resolve, rather than as a continuous high-rate infusion. 1

Initial Treatment Protocol

• Administer titrated boluses of 5-10 grams of D10 (50-100 mL) every 1-2 minutes until the patient's symptoms resolve and blood glucose reaches 100-180 mg/dL 1
• This titrated approach corrects blood glucose into the target range in 98% of patients within 30 minutes while avoiding dangerous overcorrection 1
• Use a patient-specific formula to guide total dosing: (100 − current blood glucose in mg/dL) × 0.2 grams = total dose of dextrose needed 1
• Recheck blood glucose at 15 minutes after initial treatment, as additional doses are frequently needed 1
• Repeat glucose measurement at 60 minutes, as the effect may be temporary 1

Maximum Continuous Infusion Rate (When Indicated)

If continuous infusion is required for prolonged hypoglycemia or insulin overdose, start D10 at 100 mL/kg per 24 hours (approximately 4.2 mL/kg/hour or 7 mg/kg/minute). 1

For a 70 kg adult patient, this translates to:

• Maximum rate: ~290 mL/hour of D10 (providing approximately 29 grams/hour or 0.48 grams/kg/hour) 1
• This aligns with the FDA-approved maximum dextrose infusion rate of 0.5 g/kg/hour without producing glycosuria 2
• The maximum oxidation rate of glucose in stressed patients is 4-7 mg/kg/min (or 400-700 g/day for a 70 kg patient), so infusion should not exceed 5 mg/kg/min to decrease risk of metabolic alterations 3

Critical Monitoring Requirements

• Monitor blood glucose every 1-2 hours during any ongoing dextrose infusion 3, 1
• Check every 30-60 minutes initially when starting continuous infusion 1
• Monitor serum potassium and sodium levels carefully, as dextrose administration can cause electrolyte shifts 1
• Titrate the infusion rate to maintain blood glucose between 100-180 mg/dL 1

Important Safety Considerations for Liver Dysfunction

• In patients with hepatic failure or acute hepatitis, reduced hepatic gluconeogenesis increases the risk of severe hypoglycemia 3
• These patients may require more prolonged dextrose infusion but are also at higher risk for complications from excessive glucose administration 3
• The same maximum infusion rate applies (0.5 g/kg/hour or 7 mg/kg/min), but more frequent monitoring is essential given the unpredictable glucose metabolism in liver dysfunction 2, 3
• Duration of dextrose infusion is positively correlated with abnormal liver function test values, so use the minimum effective rate 4

Critical Pitfalls to Avoid

• Avoid reflexive full-dose administration of concentrated dextrose, as rapid or repeated boluses have been associated with cardiac arrest and hyperkalemia 3, 1
• Never abruptly discontinue dextrose infusion in insulin overdose patients; reduce infusion rate by 50% over the final 30 minutes before discontinuing to prevent rebound hypoglycemia 1
• Do not exceed 0.5 g/kg/hour (approximately 7 mg/kg/min) for sustained infusions, as about 95% of dextrose is retained when infused at 0.8 g/kg/hr, but higher rates risk glycosuria and metabolic complications 2
• Titrate based on initial glucose level and patient response rather than administering fixed large doses 1

Comparison to D50 Administration

• The FDA recommends 10-25 grams of D50 (20-50 mL of 50% dextrose) for insulin-induced hypoglycemia 2
• However, D10 may be safer with fewer adverse events (0/1057 patients) compared to D50 (13/310 patients with adverse events) 5
• D10 achieves 95.9% symptom resolution versus 88.8% with D50, though resolution takes approximately 4 minutes longer with D10 5
• Post-treatment glycemic profile is lower and more controlled with D10 (6.2 mmol/L) versus D50 (8.5 mmol/L) 5