10% dextrose IV v. 50% dextrose IV in hypoglycaemia
- Report By: S.A.Burke - ST4 Emergency Medicine
- Search checked by S.A.Burke - ST4 Emergency Medicine
- Institution: Cheltenham General Hospital
- Date Submitted: 19th May 2009
- Last Modified: 11th August 2009
-
Status:
Blue (submitted but not checked)
Three Part Question
[In adult diabetic patients presenting with hypoglycaemia]is [intravenous 10% dextrose solution more effective than 50% dextrose solution] for [increasing blood glucose]Clinical Scenario
A 38 year old man with insulin dependent diabetes presents with a reduced conscious level. Bedside BM stick test shows a blood glucose of 2.3. You want to know what concentration of dextrose to give him to restore his blood glucose quickly and safely.Search Strategy
Medline("50% dextrose".ti,ab) AND ("10% dextrose".ti,ab) AND (hypoglycaemia)
Search Outcome
2 papers found of which only one was relevant to the 3 part question.Relevant Paper(s)
| Author, date and country | Patient group | Study type (level of evidence) | Outcomes | Key results | Study Weaknesses |
|---|---|---|---|---|---|
| Moore C, Woollard M 2005 UK | Hypoglycaemic patients > 18 years with reduced conscious level preventing administration of oral glucose and BM <4 mmol/l | Randomised controlled trial. Patients received 5g aliquots of glucose as either 50% dextrose (10ml) or 10% dextrose (50ml) solution. 1 min between aliquots to maximum 25g. | Time to GCS 15 recorded from first dose dextrose and dose required to obtain a blood glucose level > 4.5 mmol/l | No significant difference between groups in time to recovery to GCS 15, median post-treatment GCS or number of further hypoglycaemic episodes in next 24 hours. Median total dose of dextrose administered and post-treatment blood sugar levels significantly higher in the 50% group. | Very small study n=54 |
Comment(s)
Avoidance of hyperglycaemia has a neuroprotective effect and reduces mortality and morbidity in the critically ill particulary those at risk of cerebral ischaemia for example patients with CVA, cardiac arrest or head trauma. It may therefore be safer to use 10% dextrose rather than 50% dextrose in these patients to avoid rebound hyperglycaemia.Clinical Bottom Line
10% dextrose is as effective as 50% dextrose in the treatment of hypoglycaemia whilst requiring smaller total doses of glucose and resulting in lower post-treatment blood glucose levels.References
- C Moore and M Woollard Dextrose 10% or 50% in the treatment of hypoglycaemia out of hospital? A randomised controlled trial. Emerg. Med.J. 2005;22;512-515