Intravenous Dextrose

Aka: Intravenous Dextrose, Parenteral Glucose, Dextrose Rule of 50, Dextrose 12.5%, D12.5W, Dextrose 25%, D25W, Dextrose 50%, D50W, 5% Dextrose in Water, Dextrose in Water, D5W, Normal Saline with 5% Dextrose, D5NS

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II. Indications

  1. Hypoglycemia by rapid bedside Glucometer
  2. Child who fails to respond to Resuscitation
  3. Sulfonylurea Overdose

III. Physiology

  1. Ill children deplete glycogen stores rapidly
  2. Hypoglycemia depresses neonatal myocardial function
  3. Effects of Glucose on brain
    1. Ischemic Neonatal brain
      1. May benefit from Glucose
    2. Mature Child brain
      1. Poor neurologic outcome with Glucose

IV. Preparations: Hypoglycemia

  1. See dosing by the rule of 50 below
  2. Dextrose 12.5% (D12.5W): 1:3 dilution of D50W in water
    1. Newborn: 0.5-1.0 g/kg (4-8 ml/kg) D12.5W IV or IO
  3. Dextrose 25% (D25W): 1:1 dilution of D50W in water
    1. Children: 0.5-1.0 g/kg (2-4 ml/kg) D25W IV or IO
    2. Do not use in newborns!
  4. Dextrose 50% (D50W)
    1. Use exclusively in adults at 1 ml/kg

V. Preparations: Maintenance Fluids

  1. 5% Dextrose in Water (D5W)
    1. Osmolality: 278 mOsm/L
    2. Dextrose (Glucose): 50 g/L (170 kcal/L)
    3. Contains no Sodium or chloride
    4. Indications
      1. Primarily used to deliver intravenous medications in small volume fluid infusions (<100 ml)
      2. Replaced by Enteral Nutrition (and TPN) for Nutritional Support
        1. D5W supplies 170 kcal/L (50 g/L Dextrose) or roughly 510/kcal/day at 125 cc/h
        2. D5W infusion does prevent starvation induced endogenous Protein loss
        3. Risk of Hyperglycemia (esp. in critically ill patients)
      3. Ineffective at extracellular volume expansion
        1. Most of the fluid given accumulates in cells, and only one third remains extracellular
        2. D5W promotes lactate production (esp. in the hypoperfusion of critically ill patients)
  2. Normal Saline with 5% Dextrose (D5NS)
    1. Osmolality: 560 mOsm/L (308 NaCl mOsm/L + 278 D5W mOsm/L)
    2. Dextrose (Glucose): 50 g/L (170 kcal/L)
    3. With osmolality twice that of serum, intracellular volume depletion occurs
    4. Same risk as with Normal Saline for increased Intravenous Fluid Acidity

VI. Dosing: Rule of 50

  1. Background
    1. %Dextrose x ml/kg = 50
      1. Where %Dextrose is either 5, 10, or 25 (D5, D10, D25)
      2. Where ml/kg is the required volume of the given dextrose concentration
    2. Examples
      1. D5 x 10 ml/kg = 50 (or 5 x 10 = 50)
        1. Give 10 ml/kg of D5 (e.g. 50 ml of D5 for a 5 kg child)
      2. D10 x 5 ml/kg = 50 (or 10 x 5 = 50)
        1. Give 5 ml/kg of D10 (e.g. 25 ml of D10 for a 5 kg child)
      3. D25 x 2 ml/kg = 50 (or 25 x 2 = 50)
        1. Give 2 ml/kg of D25 (e.g. 10 ml of D25 for a 5 kg child)
        2. However, do not use D25 for newborns (use D10 or D12.5)
  2. Divide 50 by the type of dextrose solution to arrive at rate in ml/kg
    1. Adult (D50): 50/50 = 1 ml/kg
    2. Child (D25): 50/25 = 2 ml/kg
    3. Infant (D10): 50/10 = 5 ml/kg
  3. Dosing
    1. Adult: D50 at 1 ml/kg
    2. Child: D25 at 2 ml/kg
    3. Infant: D10 at 5 ml/kg

VII. Precautions

  1. Peripheral vein sclerosis
    1. Occurs with concentrated Dextrose (D25)
  2. Poor outcomes related to repeated Glucose bolus in:
    1. Severe Head Injury (poor neurologic outcome)
    2. Submersion
    3. Hypovolemic Shock

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