DESCRIPTION

Dextrose is D-glucose, a six-carbon sugar used to supplement or restore blood glucose levels.

FORMS AND USES

• Dextrose is available as 5%, 10%, 20%, 25%, or 50% (D5, D10, D20, D25, D50).
• It is used to treat hypoglycemia or presumed hypoglycemia, or hyperkalemia resulting in ECG abnormalities.

MECHANISM OF ACTION

• Glucose provides a substrate for oxidative metabolism and adenosine triphosphate production.
• Metabolism of glucose causes potassium to enter cells and thereby decreases serum potassium concentration.
• Thiamine is a required cofactor in glucose utilization.

Section Outline:

• DESCRIPTION
• FORMS AND USES
• MECHANISM OF ACTION

• Symptoms of hypoglycemia or glucose level less than 60 mg/dl
  • The most commonly encountered cause of hypoglycemia is insulin reaction from exogenous insulin.
  • Other toxic causes of hypoglycemia include ingestion of sulfonylurea oral hypoglycemic agents, salicylate, alcohol, or agents that cause fulminant hepatic failure.
  • Diabetic patients who are chronically hyperglycemic may develop hypoglycemic symptoms at "normal" glucose levels.
• Altered mental status of unknown cause
• Hyperkalemia with ECG abnormality (in conjunction with insulin)

CONTRAINDICATIONS

• Some data indicate that hyperglycemia worsens the outcome in stroke patients.
• It is reasonable to withhold dextrose in patients with a history and examination consistent with stroke if a glucose level can be btained within 5 minutes.
• Known preexisting hyperglycemia.

ADVERSE EFFECTS

• Dextrose 10%, 20%, or 50% may cause burning and thrombophlebitis at the infusion site.
• Hypokalemia may develop after dextrose administration in patients with preexisting low or low-normal serum potassium levels.
• Prolonged infusion without close monitoring may result in hyperglycemia.
• Dextrose solutions may cause volume overload in patients with congestive heart failure.
• Poorly monitored infusion can cause hyperosmolar coma in diabetic patients.

Section Outline:

• CONTRAINDICATIONS
• ADVERSE EFFECTS

• Symptoms of hypoglycemia or glucose level less than 60 mg/dl
  • Dose for adults and adolescents
    • Bolus. Initial treatment is 50 cc of 50% dextrose solution (25 g) as an intravenous bolus. Profoundly hypoglycemic patients may require multiple doses. Patients with mild hypoglycemia may be treated with oral administration.
    • Continuous infusion. Patients with recurrent hypoglycemia should be treated with a 10% dextrose infusion. Adult dose is 250 cc/h and titrated to maintain blood glucose above 100 mg/dl. Occasionally patients may require continuous infusion of 20% dextrose. This requires central venous access and should be started at 100 cc/h and titrated to maintain blood glucose above 100 mg/dl.
  • The dose for neonates is 2 to 4 cc/kg of 10% dextrose by intravenous bolus).
  • The initial pediatric dose is 2 to 4 cc/kg of 25% dextrose by intravenous bolus.
  • The infusion should not be discontinued abruptly; hypoglycemia may result. The infusion should be tapered over several hours with hourly glucose determinations.
  • The glucose level should initially be monitored hourly in all patients.
• Altered mental status of unknown cause
  • The adult and adolescent dose is 50 cc of 50% dextrose solution (25 g), administered as an intravenous bolus for symptomatic hypoglycemia.
  • The dose for neonates is 2 to 4 cc/kg of 10% dextrose.
  • The pediatric dose is 2 to 4 cc/kg of 25% dextrose.
  • If repeated doses are needed, it is preferable to administer them using a large-bore intravenous line or central line.
  • Glucose levels should be checked hourly.
  • If no response is achieved, the diagnosis should be reconsidered; for example, evaluation of altered mental status or coma.
• Hyperkalemia with ECG changes
  • The adult and adolescent dose is 50 cc of 50% dextrose (25 g) and 10 units of regular insulin administered intravenously as adjunct therapy for hyperkalemia.
  • Concurrent therapy with bicarbonate and calcium also should be given.
  • The pediatric dose is 0.5 to 1.0 g/kg (5-10 cc/kg) intravenously followed by 1 unit of insulin intravenously.

• Supplemental glucose should not be administered prophylactically to patients with oral hypoglycemic overdose before hypoglycemia develops.
  • This practice may delay the onset of hypoglycemia and obscure the diagnosis.
  • Instead, the glucose level should be monitored hourly and dextrose administered if the glucose level drops below 60 mg/dl or the patient develops symptoms of hypoglycemia.
• Severe hypoglycemia (less than 20 mg/dl) may require more than one dose for initial response.
• Hypoglycemia may recur after bolus administration.
• Continuous dextrose infusion can rapidly cause hyperglycemia if not closely monitored.
• Neonates and infants have very limited glycogen stores, and hypoglycemia recurs readily.
• Geriatric patients have limited glycogen stores and exaggerated responses to medications, resulting in hypoglycemia.

Poisoning by hormones and synthetic steroids: insulins and antidiabetic agents.

See Also: SECTION IV, Insulin, Metformin and Biguanide Hypoglycemic Agents, and Oral Hypoglycemic Agents chapters.

RECOMMENDED READING

POISINDEX Editorial Staff. Sulfonylurea and related drugs. In: Rumack BH, Sayre NK, Gelman CR, eds. POISINDEX System. Englewood, CO: MICROMEDEX, Inc. (Edition expires November 30, 1997).

Author: Kennon Heard

Reviewer: Katherine M. Hurlbut