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Key points

  • We recommend to consult your poison centre with the use of this antidote.
  • Check blood glucose before starting treatment and at regular intervals thereafter.
  • Dextrose requirements are greater with beta blocker poisoning compared to calcium-channel blocker poisoning. The amount of dextrose required to maintain a normal blood glucose level will increase as the hemodynamic status improves. Administration of dextrose for 24 h or more following insulin discontinuation is sometimes required.
  • Given the acceptable maximum osmolarity of solutions for continuous IV infusion via a peripheral line is 850 mOsm/L, the dextrose solution concentration should not exceed 12.5%. A central line (IV or IO) should be inserted as soon as possible.

+ Synonyms and other terms

  • Glucose
  • D-glucose

+ Indications

  • Treatment of hypoglycemia.
  • Adjuvant therapy with high doses of insulin to maintain euglycemia in cases of severe cardiovascular toxicity due to calcium-channel blocker or a beta blocker poisoning.

+ Dosage

+ Pediatric Dose

  • Treatment of Hypoglycemia : 0.5 g/kg (maximum 25 g/dose) of dextrose by direct IV (dextrose at a final concentration of 25% [250 mg/ml] or less).

 

  • Adjuvant therapy with high doses of insulin to maintain euglycemia:
    • Loading dose:
      • When blood glucose levels are equal or equal to 22 mmol/l: do not administer dextrose.
      • When blood glucose levels are less than 22 mmol/L: 0.5 g/kg (maximum 25 g/dose) of dextrose by direct IV (dextrose at a final concentration of 25% [250 mg/ml] or less).
    • Maintenance dose:
      • 0.5 g/kg/h (or based on blood glucose levels) of dextrose by continuous IV infusion with central line (dextrose at a final concentration of 25% [250 mg/ml] or less) or by peripheral line (dextrose at a final concentration of 10% [100 mg/ml] or less).
      • WARNING: In patients with an unstable hemodynamic status, treat decrease in blood glucose levels by increasing the dextrose dose and not by decreasing the insulin dose.

+ Adult Dose

  • Treatment of Hypoglycemia : 0.5 g/kg (maximum 25 g/dose) of dextrose by direct IV (dextrose at a final concentration of 25% [250 mg/ml] or less).

 

  • Adjuvant therapy with high doses of insulin to maintain euglycemia:
    • Loading dose:
      • When blood glucose levels are equal or equal to 22 mmol/l: do not administer dextrose.
      • When blood glucose levels are less than 22 mmol/L: 0.5 g/kg (maximum 25 g/dose) of dextrose by direct IV (dextrose at a final concentration of 25% [250 mg/ml] or less).
    • Maintenance dose:
      • 0.5 g/kg/h (or based on blood glucose levels) of dextrose by continuous IV infusion with central line (dextrose at a final concentration of 25% [250 mg/ml] or less) or by peripheral line (dextrose at a final concentration of 10% [100 mg/ml] or less).
      • WARNING: In patients with an unstable hemodynamic status, treat decrease in blood glucose levels by increasing the dextrose dose and not by decreasing the insulin dose.

+ Renal Impairment

No data suggests that the dose should be modified for short-term use.

+ Hepatic Impairment

No data suggests that the dose should be modified for short-term use.

+ Hemodialysis Patient

No data suggests that the dose should be modified for short-term use.

+ Pregnancy

No data suggests that the dose should be modified for short-term use.

+ Obese or Overweight Patient

No data suggests that the dose should be modified for short-term use.

+ Adverse effects

  • Hyperglycemia, hypokalemia.
  • Hyponatremia (especially in pediatric patients).
  • Phlebitis, pain, venous irritation at injection site.
  • Tissue necrosis following soft-tissue infiltration or accidental intra-arterial injection of 50% dextrose.
  • Inappropriate administration of repeated loading doses (direct IV) of 50% dextrose in pediatric patients has been associated with seizures, brain hemorrhage and comas.
  • Administration of high doses of dextrose can lead to significant hyperglycemia and hyperosmolar syndrome.

+ Monitoring

  • Adjuvant therapy with high doses of insulin to maintain euglycemia:
    • Capillary blood glucose every 30 min. (maintain glucose levels above 5.5 mmol/L).
    • Serum potassium every 2 hours (maintain at approximately 3.0 mmol/L).
    • Fluid balance
    • State of consciousness
    • Neurological symptoms can be a sign of hyperosmolar syndrome, hyperglycemia or other potential complications associated with the treatment (e.g., hyponatremia).

+ End of treatment

  • If the infusion of concentrated dextrose needs to be ceased abruptly, the administration of D5W or D10W solution is recommended to avoid hypoglycemia and to wean gradually.
  • During adjuvant therapy with high doses of insulin to maintain euglycemia, the administration of dextrose may need to be continued for 24 h or more after the discontinuation of insulin.

+ Special Notes on Administration

Intravenous Route (IV)

  • Direct IV
    • Children weighing less than 50 kg:
      • Maximum concentration: 25% dextrose
      • Administer over 1 or 2 minutes, maximum of 200 mg/kg/min.
      • Suggested preparation method for 25% dextrose [250 mg/ml]:
        • 10 ml of 50% dextrose 50% [500 mg/ml] + 10 ml of SWFI (i.e., ratio of 1:1). Final volume = 20 ml Final concentration = 25% [250 mg/ml].
    • Children weighing greater than 50 kg, adults:
      • Maximum concentration: 50% dextrose
      • Administer over 1 minute, maximum 200 mg/kg/min.
  • Continuous IV Infusion
    • Administer using a volumetric pump.
    • To prevent glucosuria, use a maximum  rate of 0.5 g/kg/h when administering dextrose. A higher rate (e.g., 1 g/kg/h) can sometimes be necessary, depending on clinical circumstances.
    • The osmolarity of 10% dextrose (100 mg/ml) is 505 mOsm/l. The osmolarity of 25% dextrose is 1330 mOsm/L and the osmolarity of 50% dextrose (500 mg/ml) is 2520 mOsm/L.
    • The final maximum osmolarity of solutions for continuous IV infusion is set at 850 mOsm/L for administration by peripheral route (maximum 12.5% dextrose).
    • A central line (IV or IO) should be inserted as soon as possible.

Intraosseous Route (IO)

  • Possible alternative to IV route.

Subcutaneous Route (SC)

  • Not a recommended route.

Intramuscular Route (IM)

  • Not a recommended route.

Compatibility

Partial list only. Consult the pharmacist on duty at your health care facility.

  • Compatible solutions: SWFI.
  • Y-site compatibility: Varies based on dextrose concentration used.
  • Y-site incompatibility: Varies based on dextrose concentration used.

Stability

  • Store at room temperature (15°C to 25°C).
  1. Syringes and vials of 50% dextrose (500 mg/ml) are for single use only. They do not contain preservatives.
  • Discard any unused portion.

+ Available products

  • Dextrose 50 % injectable USP, Sol. Inj., 500 mg/ml, seringue (Lifeshield) ou fiole en verre de 50 ml, ICU Medical Canada INC, DIN 00037974
  • Dextrose 50 % injectable USP, Sol. Inj., 500 mg/ml, seringue ou fiole en verre de 50 ml, Pfizer Canada ULC, DIN 02468514
  • Dextrose 50 % injectable USP, Sol. Inj., 500 mg/ml, dans des sacs en plastique flexibles de 500 ml, ICU Medical Canada INC, DIN 00037974
  • Dextrose 10 % injectable USP, Sol. Inj., 100 mg/ml, dans des sacs en plastique excel de 250 ml, 500 ml ou 1000 ml, B. Braun Medical Inc, DIN 01924427
  • Dextrose 10 % injectable USP, Sol. Inj., 100 mg/ml, dans des sacs en plastique flexibles de 500 ml ou 1000 ml, Baxter Corporation, DIN 00060364
  • Dextrose 10 % injectable USP, Sol. Inj., 100 mg/ml, dans des sacs en plastique flexibles de 1000 ml, ICU Medical Canada INC, DIN 00037958

+ Amount required to treat a person weighting 70kg during 24 hours

  • At least 840 g.

+ References

Engebretsen, Kristin. 2016. “Euglycemic Insulin Therapy.” In Critical Care Toxicology, edited by Jeffrey Brent, Keith Burkhart, Paul Dargan, Benjamin Hatten, Bruno Megarbane, and Robert Palmer, 1–10. Springer International Publishing.



Sivilotti, Marco L. A. 2016. “Flumazenil, Naloxone and the ‘coma Cocktail.’” British Journal of Clinical Pharmacology 81 (3):428–36.


Last updated : 2022-12-13