Dextrose 10% (D10W): Clinical Indications and Dosing
Primary Recommendation for Symptomatic Hypoglycemia in Adults
For adults with symptomatic hypoglycemia who cannot take oral glucose, administer D10W in 5-10 gram aliquots (50-100 mL) intravenously every 1-2 minutes until symptoms resolve, targeting a post-treatment glucose of 100-180 mg/dL. 1
Advantages of D10W Over D50W
D10W administered in titrated 5g aliquots achieves symptom resolution in 95.9% of patients with significantly lower post-treatment glucose levels (6.2 mmol/L vs 8.5-9.4 mmol/L) and fewer adverse events compared to D50W. 2, 3
The median total dose required with D10W is significantly lower (10g vs 25g), reducing the risk of rebound hyperglycemia while maintaining equivalent efficacy. 2, 4
Time to achieve Glasgow Coma Scale of 15 is comparable between D10W and D50W (approximately 6-8 minutes), though D10W may take 3-4 minutes longer in some cases. 2, 3, 4
Patient-Specific Dosing Formula
Use the calculation: (100 − current blood glucose in mg/dL) × 0.2 grams = total dose of dextrose needed to guide initial dosing and avoid overcorrection. 1
This titrated approach corrects blood glucose into target range in 98% of patients within 30 minutes while minimizing dangerous overcorrection. 1
Continuous D10W Infusion Protocols
For Insulin Overdose or Prolonged Hypoglycemia in Adults
Start D10W at 100 mL/kg per 24 hours (approximately 4.2 mL/kg/hour or 7 mg/kg/minute) and titrate to maintain blood glucose between 100-180 mg/dL. 1
For diabetic patients receiving insulin when enteral nutrition is interrupted, immediately start D10W infusion at 50 mL/hour (5 grams/hour) to prevent hypoglycemia, particularly critical for type 1 diabetics who require continuous basal insulin. 5
Tapering Protocol
Never abruptly discontinue dextrose infusion in insulin overdose patients. 1
Reduce infusion rate by 50% over the final 30 minutes before discontinuing to prevent rebound hypoglycemia. 1
Pediatric Dosing Regimens
Initial Bolus Treatment
Administer 0.5-1.0 g/kg of glucose as D10W (5-10 mL/kg) slowly for proven hypoglycemia in children. 6
The standard dose of 0.5 g/kg can be given as either 10% or 25% dextrose solution, but D10W requires larger volumes (5-10 mL/kg vs 2-4 mL/kg for D25W). 6
Never use undiluted D50W in children due to high osmolarity causing vein irritation and sclerosis. 6
Maintenance Infusion for Pediatric Patients
After initial bolus, start continuous D10W infusion with appropriate maintenance electrolytes at 100 mL/kg per 24 hours (7 mg/kg/minute). 6
For infants at risk of hypoglycemia, provide glucose intake of 4-6 mg/kg/min (6-8 mg/kg/min in newborns), typically as D10% normal saline solution. 6
For conscious children able to swallow, oral glucose (15-20 grams) remains first-line treatment. 6
Critical Monitoring Requirements
Immediate Post-Treatment Monitoring
Recheck blood glucose 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
Monitor blood glucose every 1-2 hours during any ongoing dextrose infusion. 1, 5
Electrolyte Monitoring
Check serum potassium and sodium levels carefully, as dextrose administration can cause electrolyte shifts. 1
Monitor every 30-60 minutes initially when starting continuous infusion. 1
Critical Safety Considerations and Pitfalls
Avoid Overcorrection
Avoid reflexive full-dose administration of concentrated dextrose, as rapid and repeated boluses have been associated with cardiac arrest and hyperkalemia. 1, 5
Titrate based on initial glucose level and patient response rather than administering fixed large doses. 1
Low initial blood glucose is a predictor for developing hypoglycemia after treatment, requiring closer monitoring. 7
Hyperglycemia Risks
Rebound hyperglycemia occurs predominantly within 5 minutes of D50W administration, with mean glucose levels reaching 12.2 mmol/L and maximum readings of 22.6 mmol/L. 8
Non-diabetic patients experience rebound hyperglycemia more frequently (73.3%) compared to diabetic patients (56.3%). 8
In pediatric patients, indiscriminate or excessive glucose treatment should be avoided because hyperglycemia increases ischemic brain injury. 6
Administration Technique
For peripheral vein administration, give dextrose slowly through a small-bore needle into a large vein to minimize venous irritation and thrombosis risk. 5
Concentrated dextrose solutions (>10%) requiring sustained infusion need central venous access. 5
Special Clinical Scenarios
Diabetic Ketoacidosis (DKA) and Hyperosmolar Hyperglycemic State (HHS)
When serum glucose reaches 250 mg/dL during DKA treatment, change fluid to 5% dextrose with 0.45-0.75% NaCl to prevent hypoglycemia while continuing insulin therapy. 5
For HHS, add dextrose when blood glucose falls to 300 mg/dL. 5