Intravenous Dextrose

Aka: Intravenous Dextrose, Parenteral Glucose, Dextrose Rule of 50

1. Indications
   1. Hypoglycemia by rapid bedside Glucometer
   2. Child who fails to respond to Resuscitation
   3. Sulfonylurea Overdose
2. 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
3. Dosing
   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% (D50)
      1. Use exclusively in adults at 1 ml/kg
4. 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
5. 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