From the Guidelines
For hypoglycemia, D10 should be administered at a rate of 100 mL/kg per 24 hours, which translates to approximately 4.17 mL/kg per hour, as this rate is recommended to achieve normoglycemia while minimizing the risk of hyperglycemia and its adverse effects 1. The dose of D10 can be calculated based on the patient's weight, with 200 mg/kg being a commonly recommended dose, which is equivalent to 2 mL/kg of D10W 1.
- Key considerations for D10 administration include:
- Monitoring glucose, sodium, and potassium levels carefully to avoid hyperglycemia and electrolyte imbalances
- Titrating the infusion rate to achieve normoglycemia, as hyperglycemia can have adverse central nervous system effects
- Using D10W, as D50W can be irritating to veins and may require dilution to 25% dextrose
- Being aware that hypoglycemia may recur, depending on the underlying etiology, and being prepared to adjust treatment accordingly 1. The goal of treatment is to restore normoglycemia while minimizing the risk of complications, and the recommended rate of D10 administration is based on the need to provide a controlled and sustained release of glucose to the patient 1.
From the FDA Drug Label
For peripheral vein administration: Injection of the solution should be made slowly. The maximum rate at which dextrose can be infused without producing glycosuria is 0.5 g/kg of body weight/hour. In insulin-induced hypoglycemia, intravenous injection of 10 to 25 grams of dextrose (20 to 50 mL of 50% dextrose) is usually adequate.
The recommended rate of administration for d10 (dextrose) in hypoglycemia is not explicitly stated in terms of rate, but the maximum rate at which dextrose can be infused without producing glycosuria is 0.5 g/kg of body weight/hour. For treatment of hypoglycemia, 10 to 25 grams of dextrose can be administered, but the exact rate is not specified. 2
From the Research
D10 Administration Rate for Hypoglycemia
- The ideal rate for D10 administration in hypoglycemia treatment is not explicitly stated in the provided studies 3, 4, 5, 6, 7.
- However, a study comparing D10 and D50 for out-of-hospital hypoglycemia treatment found that D10 may be as effective as D50 in resolving symptoms and correcting hypoglycemia, although the desired effect can take several minutes longer 4.
- The same study reported that the post-D10-treatment blood glucose level (BGL) may result in fewer untoward hyperglycemic episodes, with a lower incidence of adverse events compared to D50 4.
- Another study suggested that intravenous dextrose (25g) can restore normal conscious level faster than intramuscular glucagon (1mg), with an average duration of hypoglycemic coma of 120 minutes 3.
- A study from 1987 compared intravenous glucagon and dextrose in the treatment of severe hypoglycemia, finding that both were effective, but recovery of normal consciousness was slower with glucagon (6.5 vs 4.0 minutes) 5.
- A 2004 study proposed a strategy for preventing hypoglycemia in hospitalized patients, including measures such as revising physician orders for antihyperglycemic therapy and establishing a ward-based protocol for responding to triggering events 6.
- A 1997 study compared intramuscular glucagon with intravenous glucose in prehospital hypoglycemia management, finding that intravenous glucose was the treatment of choice, but glucagon should also be available for intramuscular use when intravenous access is not possible 7.