Page 112 - 2026 SMOG

DEXTROSE 50% (GLUTOSE I B-D GLUCOSE)
Class/Mechanism of Action
• Antidote, Hypoglycemia
Basic source of calories (fuel) for the body and brain, regulated by insulin. Rapidly increases blood
glucose, decreases protein and nitrogen loss, prevents ketosis, and promotes glycogen deposition in the
liver. When used in the treatment of hyperkalemia (combined with insulin), it stimulates the transient
uptake of potassium by cells, lowering serum potassium.
˚ Onset of action—Treatment of hypoglycemia Oral dose: 10min; Treatment of Hyperkalemia IV: 30min
Indications
• Labeled Indications
Treatment of hypoglycemia. Doses may be repeated in severe cases
• ˚ Off-Label Indications
Treatment of hyperkalemia. Must be used in combination with Insulin
˚ Calcium channel blocker or beta-blocker overdose/toxicity (adjunctive agent)
˚ ˚ Hypernatremia
Contraindications
• Known hyperglycemia; otherwise none in the pre-hospital setting
Adverse Reactions/Precautions
• Most adverse effects are associated with excessive doses or infusion rates
• If evidence of malnutrition or alcohol abuse, thiamine should be given first
• Tissue necrosis if extravasation occurs; immediately D/C and change IV site
• Hyperglycemia
• Hypokalemia
• Hyponatremia
• Pregnancy: Adverse outcomes not expected.
• Lactation: Use with caution; consider benefit to mother versus exposure to infant
Dose/Administration
PEDIATRIC
ADULT
(Always reference Broselow Tape)
Hypoglycemia Hypoglycemia
• PO • IV
15–20g as a single dose; may repeat in Newborns: 5–10mL/kg D10 (max dose:
˚ 15min prn ˚ 25g/dose)
• IV Infants and Children: 2–4mL/kg D25
10–25g (40–100mL of 25% solution or ˚ (max dose: 25g/dose)
˚ 20–50mL of 50% solution) ˚ Adolescents: Refer to adult dosing
For patients with traumatic brain injury, give Note:
˚ 25g (50mL) if blood glucose <100mg/dL D25=25mL NS+25mL D50 (12.5g in 50mL
Hyperkalemia, Severe/Emergent solution)
• IV D10=100mL NS+25mL D50 (12.5g in 125mL
25–50g over 5min, administered with separate solution) or 40mL NS+10mL D50 (5g in 50mL
˚ administration of IV insulin solution)
Note: The Society of Critical Care Medicine PO: Smaller doses (5–10g) could be considered for
recommends: Treat blood glucose <70mg/dL patients on automated insulin delivery to help avoid
(<100mg/dL in patients with neurologic injury) rebound hyperglycemia
immediately by stopping insulin therapy (if
receiving) and administering 10–20g (20–40mL
of 50% solution) IV; repeat blood glucose
measurement in 15min with repeat dextrose prn;
avoid overcorrection
104 • MEDICATIONS