Intravenous Glucose Dose for Pediatric Hypoglycemia
For pediatric patients with hypoglycemia, administer 0.5 g/kg of glucose as a 10% or 25% dextrose solution intravenously, which translates to 5 mL/kg of D10W or 2 mL/kg of D25W. 1
Initial Bolus Dosing
- The standard dose is 0.5 g/kg of glucose given as D10W (5 mL/kg) or D25W (2 mL/kg) administered slowly via IV push 1
- For neonates specifically, the American Academy of Pediatrics recommends D10W at 2 mL/kg (200 mg/kg) as an immediate bolus for symptomatic hypoglycemia or blood glucose <40 mg/dL 2
- Never use D50W in neonates or young children as it is highly irritating to veins and should be diluted to D10W or D25W before administration 2
Critical Administration Guidelines
- Administer the glucose bolus slowly to avoid rapid osmolality changes and minimize the risk of rebound hypoglycemia 1
- Verify adequate urine output (≥0.5 mL/kg/hour) before initiating treatment to confirm renal function 2
- Avoid indiscriminate or excessive glucose administration as animal evidence suggests hyperglycemia increases ischemic brain injury 1
Post-Bolus Management
- Follow the initial bolus with continuous glucose infusion to prevent recurrent hypoglycemia 2
- For term newborns (≥37 weeks), start continuous infusion at 2.5-5 mg/kg/min on Day 1, targeting 5-10 mg/kg/min on Day 2 onwards 2
- For preterm newborns (<37 weeks), start at 4-8 mg/kg/min on Day 1, targeting 8-10 mg/kg/min on Day 2 onwards 2
Monitoring Requirements
- Check blood glucose every 30 minutes to 2 hours during IV dextrose administration using blood gas analyzers for most accurate results 2
- Handheld glucose meters have significant limitations in neonates due to high hemoglobin and bilirubin levels 2
- Monitor sodium and potassium levels carefully during treatment as electrolyte shifts can occur 2
Critical Pitfalls to Avoid
- Never administer concentrated dextrose (D50W) to neonates or young children due to risk of venous thrombosis and tissue necrosis if extravasation occurs 2
- Avoid hyperglycemia >145 mg/dL (8 mmol/L) as it is associated with increased morbidity and mortality in pediatric ICU patients 2
- Do not attempt oral feeding in lethargic infants with poor tone due to aspiration risk and inability to rapidly correct hypoglycemia 2
- Repetitive or prolonged hypoglycemia ≤45 mg/dL (2.5 mmol/L) must be avoided as it causes neurological injury 2
Special Clinical Scenarios
- In diabetic ketoacidosis, add 20-40 mEq/L potassium (2/3 KCl and 1/3 KPO4) to IV fluids once K+ falls below 5.5 mEq/L with adequate urine output 2
- For children with chronic lung disease on chronic diuretic therapy, adequate KCl supplementation prevents hypokalemia and metabolic alkalosis that can exacerbate CO2 retention 3
- Newborns <28 days with acute illness should temporarily receive Day 1 glucose infusion rates (lower rates), guided by blood glucose monitoring 2
Alternative Formulations
- Research comparing D10W versus D50W in adults found that D10W delivered in 5 g (50 mL) aliquots results in lower post-treatment blood glucose levels and is administered in smaller total doses than D50W 4
- D10W infusions appear at least as effective as D50W bolus in preventing rebound hypoglycemia while avoiding the risks of hypertonic dextrose solutions 5