Can glucose be administered through intraosseous (IO) access in a critically ill patient?

Can Glucose Be Administered Through Intraosseous Access?

Yes, glucose can be safely and effectively administered through intraosseous (IO) access in critically ill patients, with pharmacokinetics and clinical effects equivalent to intravenous administration.

Evidence Supporting IO Glucose Administration

The intraosseous route has been validated for glucose administration through direct comparative studies:

• Hypertonic glucose administered via IO produces equivalent serum glucose responses compared to IV administration in animal models, with both routes demonstrating effective glucose delivery and absorption 1
• 50% dextrose in water (250 mg/kg) administered IO shows comparable pharmacokinetics to central and peripheral IV routes, with equivalent peak drug levels and equal or longer durations of action 2
• IO access allows successful infusion of all standard resuscitation medications and fluids, including glucose solutions, with modern devices achieving 96% success rates 3

Clinical Context for IO Glucose Use

IO access serves as the primary alternative when IV access is unobtainable in critical situations:

• IO is indicated primarily in cardiac arrest (75.7% of cases), multi-trauma, seizures, and respiratory failure where rapid vascular access is essential 3
• Pediatric patients represent nearly one-third of IO placements, with the technique being particularly valuable in young children where IV access is challenging 3, 4
• Time to IO placement averages 60 seconds with experience, making it faster than repeated IV attempts in difficult access situations 2

Practical Considerations for IO Glucose Administration

When using IO for glucose delivery, consider these technical points:

• The tibial insertion site is preferred (29 of 32 attempts), with femoral sites as alternatives 4
• Modern powered devices (EZ-IO) achieve significantly higher first-attempt success rates (96%) compared to manual techniques (50-55%) 3
• Large volume boluses of crystalloid, colloid, and blood products can be successfully infused through IO, indicating adequate flow rates for glucose solutions 4

Glucose Management in Critically Ill Patients with IO Access

Once IO access is established for glucose administration, follow standard critical care glucose targets:

• Maintain serum glucose between 140-180 mg/dL in critically ill patients, avoiding tight control (80-110 mg/dL) due to hypoglycemia risk 5
• Monitor glucose closely when vasopressors are used, as norepinephrine increases glucose production and reduces insulin release, requiring higher insulin doses 6
• In septic shock patients requiring IO access, initiate IV glucose and advance enteral feeds as tolerated rather than complete fasting, per Surviving Sepsis Campaign guidelines 7

Safety Profile and Complications

IO glucose administration has an established safety record:

• No cases of osteomyelitis or serious complications were documented in a 7-year HEMS review of 78 IO insertions 3
• Insertion-related failures occur in 19.2% of attempts, with extravasation (3.8%) and technical problems (5.1%) being most common 3
• IO is intended for short-term use during initial resuscitation, not prolonged therapy 4

Common Pitfalls to Avoid

• Do not delay IO placement with repeated failed IV attempts in critically ill patients requiring immediate glucose administration for hypoglycemia or resuscitation 2, 4
• Ensure adequate training with powered IO devices rather than manual techniques, as success rates differ dramatically (96% vs 50-55%) 3
• Do not assume IO specimens are equivalent to venous blood for all laboratory analyses without institutional validation, though IO access itself is reliable for medication/fluid delivery 8
• Avoid aggressive glucose targets below 180 mg/dL in critically ill patients receiving IO resuscitation, as this increases hypoglycemia risk without mortality benefit 5, 6