Dextrose 10% in the Treatment of Out-of-Hospital Hypoglycemia

Kiefer, Matthew V.; Hern, H. Gene; Alter, Harrison J.; Barger, Joseph

doi:10.1017/s1049023x14000284

Cited by 16 publications

(13 citation statements)

References 14 publications

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“…Many studies have demonstrated the feasibility, safety, and efficacy of using D10 instead of D50, with no increased time to resolution of symptoms and no significant differences in on-scene times. 70 , 71 In comparing glucagon intramuscular (IM) to dextrose intravenous (IV), median time to full orientation for glucagon was 10–30 minutes, compared with 1–10 minutes for dextrose. 72 , 73 …”

Section: Methodsmentioning

confidence: 99%

Altered Mental Status: Current Evidence-based Recommendations for Prehospital Care

Sanello¹,

Gausche‐Hill²,

Mulkerin³

et al. 2018

WestJEM

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IntroductionIn the United States emergency medical services (EMS) protocols vary widely across jurisdictions. We sought to develop evidence-based recommendations for the prehospital evaluation and treatment of a patient with an acute change in mental status and to compare these recommendations against the current protocols used by the 33 EMS agencies in the State of California.MethodsWe performed a literature review of the current evidence in the prehospital treatment of a patient with altered mental status (AMS) and augmented this review with guidelines from various national and international societies to create our evidence-based recommendations. We then compared the AMS protocols of each of the 33 EMS agencies for consistency with these recommendations. The specific protocol components that we analyzed were patient assessment, point-of-care tests, supplemental oxygen, use of standardized scoring, evaluating for causes of AMS, blood glucose evaluation, toxicological treatment, and pediatric evaluation and management.ResultsProtocols across 33 EMS agencies in California varied widely. All protocols call for a blood glucose check, 21 (64%) suggest treating adults at <60mg/dL, and half allow for the use of dextrose 10%. All the protocols recommend naloxone for signs of opioid overdose, but only 13 (39%) give specific parameters. Half the agencies (52%) recommend considering other toxicological causes of AMS, often by using the mnemonic AEIOU TIPS. Eight (24%) recommend a 12-lead electrocardiogram; others simply suggest cardiac monitoring. Fourteen (42%) advise supplemental oxygen as needed; only seven (21%) give specific parameters. In terms of considering various etiologies of AMS, 25 (76%) give instructions to consider trauma, 20 (61%) to consider stroke, and 18 (55%) to consider seizure. Twenty-three (70%) of the agencies have separate pediatric AMS protocols; others include pediatric considerations within the adult protocol.ConclusionProtocols for patients with AMS vary widely across the State of California. The evidence-based recommendations that we present for the prehospital diagnosis and treatment of this condition may be useful for EMS medical directors tasked with creating and revising these protocols.

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Section: Methodsmentioning

confidence: 99%

Altered Mental Status: Current Evidence-based Recommendations for Prehospital Care

Sanello¹,

Gausche‐Hill²,

Mulkerin³

et al. 2018

WestJEM

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“…No difference in time to restoration of consciousness was found between the treatment groups (median: 8 min), but total dextrose administered and post‐treatment glucose level were greater in the 50% dextrose‐treated cohort, leading authors to recommend the 10% preparation. An observational study evaluated the efficacy of 10% dextrose in the prehospital environment and showed that the administration of 10 g of 10% dextrose was effective in restoring euglycaemia in the majority (78%) of participants, with a further 17.7% responding after a second dose (20 g total). No timing intervals were imposed or examined in that study, however, and no other studies comparing treatment dosage or repeat treatment intervals of i.v.…”

Section: Resultsmentioning

confidence: 99%

“…Effective dosages of i.v. dextrose range from 10 to 25 g and, while both 50% and 10% concentrations restore consciousness, the 10% preparation has been advocated because of lower post‐treatment glycaemia and less total glucose administration . Although i.m.…”

Section: Discussionmentioning

confidence: 99%

Emergency treatment of hypoglycaemia: a guideline and evidence review

2017

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“…This case emphasizes the importance of early detection and treatment when suspecting extravasation of D50 in order to prevent the development of serious complications like compartment syndrome. 10% dextrose (D10) is now emerging as a safer (given the lower concentration) and equally effective alternative to D50 administration and could become the standard of care for hypoglycemia management [3].…”

Section: Discussionmentioning

confidence: 99%

All Sugars are Not Sweet

Shah¹,

Garg²,

Rothman³

2021

Journal of Scientific Innovation in Medicine

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Background: Extravasation is defined as the leakage of drugs from the vessel to the surrounding area with the potential to cause tissue necrosis. Such drugs (known as vesicants) that can extravasate include vasopressors, alkylating chemotherapeutic agents, hyperosmolar or hypo-osmolar agents, and certain antibiotics (vancomycin) [1]. Dextrose, at concentrations of 10% or greater, is also considered to be a vesicant, with rates of extravasation from 50% dextrose (D50) injections varying between 10-30% [2]. Case Report: A cachectic 48-year-old female with a past medical history of HIV, former IV drug use, and alcohol use, presented with lethargy. Upon initial assessment, she had track marks on her arms and was only responsive to sternal rub, with her exam otherwise unremarkable. She briefly improved with intravenous naloxone but ultimately required intensive care unit admission following intubation for airway protection. The toxicology screen was positive for methadone, opioids, and alcohol. Initial labs revealed ALT of 118 units per liter, AST of 94 units per liter, hemoglobin of 9.5 grams per deciliter, and albumin of 2.3 grams per deciliter. She was started on thiamine, multivitamin, and folate supplementation, and despite starting tube feeds, glucose measurements were consistently low (with the lowest reading of 35 milligrams per deciliter). She received 2 ampules of 50 milliliters (25 grams) 50% dextrose through a 22-gauge antecubital peripheral IV line, with fingerstick improving to 220 milligrams per deciliter after 10 minutes. Two hours later, extensive swelling and fluid-filled blisters were noted throughout her right forearm and hand, with Doppler ultrasound revealing the absence of a radial pulse (Figure 1). Her arm was elevated, a cold compress was applied, and a local subcutaneous injection of hyaluronidase was administered. Compartment pressures remained within normal limits, and a repeat Doppler ultrasound after one hour revealed reappearance of the right radial pulse. The patient's swelling and blisters improved gradually over the next few days.

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Dextrose 10% in the Treatment of Out-of-Hospital Hypoglycemia

Cited by 16 publications

References 14 publications

Altered Mental Status: Current Evidence-based Recommendations for Prehospital Care

Altered Mental Status: Current Evidence-based Recommendations for Prehospital Care

Emergency treatment of hypoglycaemia: a guideline and evidence review

All Sugars are Not Sweet

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