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**II. Indications**

- Hypoglycemia by rapid bedside Glucometer
- Child who fails to respond to Resuscitation
- Sulfonylurea Overdose

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**III. Physiology**

- Ill children deplete glycogen stores rapidly
- Hypoglycemia depresses neonatal myocardial function
- Effects of Glucose on brain

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**IV. Preparations: Hypoglycemia**

- See dosing by the rule of 50 below
- Dextrose 12.5% (D12.5W): 1:3 dilution of D50W in water
- Newborn: 0.5-1.0 g/kg (4-8 ml/kg) D12.5W IV or IO

- Dextrose 25% (D25W): 1:1 dilution of D50W in water
- Children: 0.5-1.0 g/kg (2-4 ml/kg) D25W IV or IO
- Do not use in newborns!

- Dextrose 50% (D50W)
- Use exclusively in adults at 1 ml/kg

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**V. Preparations: Maintenance Fluids**

- 5% Dextrose in Water (D5W)
- Osmolality: 278 mOsm/L
- Dextrose (Glucose): 50 g/L (170 kcal/L)
- Contains no Sodium or chloride
- Indications
- Primarily used to deliver intravenous medications in small volume fluid infusions (<100 ml)
- Replaced by Enteral Nutrition (and TPN) for Nutritional Support
- D5W supplies 170 kcal/L (50 g/L Dextrose) or roughly 510/kcal/day at 125 cc/h
- D5W infusion does prevent starvation induced endogenous Protein loss
- Risk of Hyperglycemia (esp. in critically ill patients)

- Ineffective at extracellular volume expansion
- Most of the fluid given accumulates in cells, and only one third remains extracellular
- D5W promotes lactate production (esp. in the hypoperfusion of critically ill patients)

- Normal Saline with 5% Dextrose (D5NS)
- Osmolality: 560 mOsm/L (308 NaCl mOsm/L + 278 D5W mOsm/L)
- Dextrose (Glucose): 50 g/L (170 kcal/L)
- With osmolality twice that of serum, intracellular volume depletion occurs
- Same risk as with Normal Saline for increased Intravenous Fluid Acidity

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**VI. Dosing: Rule of 50**

- Background
- %Dextrose x ml/kg = 50
- Where %Dextrose is either 5, 10, or 25 (D5, D10, D25)
- Where ml/kg is the required volume of the given dextrose concentration

- Examples
- D5 x 10 ml/kg = 50 (or 5 x 10 = 50)
- Give 10 ml/kg of D5 (e.g. 50 ml of D5 for a 5 kg child)

- D10 x 5 ml/kg = 50 (or 10 x 5 = 50)
- Give 5 ml/kg of D10 (e.g. 25 ml of D10 for a 5 kg child)

- D25 x 2 ml/kg = 50 (or 25 x 2 = 50)
- Give 2 ml/kg of D25 (e.g. 10 ml of D25 for a 5 kg child)
- However, do not use D25 for newborns (use D10 or D12.5)

- D5 x 10 ml/kg = 50 (or 5 x 10 = 50)

- %Dextrose x ml/kg = 50
- Divide 50 by the type of dextrose solution to arrive at rate in ml/kg
- Adult (D50): 50/50 = 1 ml/kg
- Child (D25): 50/25 = 2 ml/kg
- Infant (D10): 50/10 = 5 ml/kg

- Dosing
- Adult: D50 at 1 ml/kg
- Child: D25 at 2 ml/kg
- Infant: D10 at 5 ml/kg

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**VII. Precautions**

- Peripheral vein sclerosis
- Occurs with concentrated Dextrose (D25)

- Poor outcomes related to repeated Glucose bolus in:
- Severe Head Injury (poor neurologic outcome)
- Submersion
- Hypovolemic Shock