Pharm
Intravenous Dextrose
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Intravenous Dextrose
, Parenteral Glucose, Dextrose Rule of 50
Indications
Hypoglycemia
by rapid bedside
Glucometer
Child who fails to respond to
Resuscitation
Sulfonylurea Overdose
Physiology
Ill children deplete glycogen stores rapidly
Hypoglycemia
depresses neonatal myocardial function
Effects of
Glucose
on brain
Ischemic Neonatal brain
May benefit from
Glucose
Mature Child brain
Poor neurologic outcome with
Glucose
Dosing
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% (D50)
Use exclusively in adults at 1 ml/kg
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)
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
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
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