Hypoglycemia: Note: Doses may be repeated in severe cases:
IV: 0.2 g/kg/dose (2 mL/kg/dose of D10W); followed by a continuous IV infusion at a rate of 5 to 8 mg/kg/minute to maintain plasma glucose ≥40 to 50 mg/dL (Ref); if plasma glucose concentrations remain low, increase infusion in 2 mg/kg/minute increments; if rates >12 to 14 mg/kg/minute are required further work up may be needed (Ref).
PALS Guidelines (Ref): IV, IO: 0.5 to 1 g/kg/dose (5 to 10 mL/kg/dose of D10W).
Oral: Limited data available: Dextrose gel 40%: GA ≥35 weeks, PNA: ≤48 hours: Buccal: 0.2 g/kg/dose (0.5 mL/kg of 40% dextrose gel) massage into the buccal mucosa; if still hypoglycemic after 30 minutes or if hypoglycemia recurs later, repeat dose; may repeat up to 6 doses over 48 hours. Dosing is based on a randomized, double-blind, placebo-controlled trial of 237 at-risk neonates (treatment group: n=118); dextrose gel was shown to be a more effective hypoglycemic treatment than feeding alone during the first 48 hours; treatment failure rates in the dextrose group were 12% vs 24% in the placebo group (Ref).
Parenteral nutrition: Dextrose component (Ref):
Preterm neonates: IV: Initial: 6 to 8 mg/kg/minute; daily increase: 1.4 to 1.7 mg/kg/minute; usual goal: 10 to 14 mg/kg/minute; maximum daily rate: 18 mg/kg/minute.
Term neonates: IV: Initial: 6 to 8 mg/kg/minute; daily increase: 3.5 mg/kg/minute; usual goal: 10 to 14 mg/kg/minute; maximum daily rate: 18 mg/kg/minute.
Hyperkalemia, treatment: Limited data available: Note: Experts suggest using a ratio of 4 g of dextrose for every 1 unit of insulin when assessing bolus doses of dextrose (Ref); and for continuous IV dextrose infusion, a ratio range of 2 to 4 g of dextrose for every 1 unit of insulin (Ref).
IV: 0.4 g/kg/dose (4 mL/kg/dose of D10W) combined with regular insulin (Ref).
Continuous IV infusion: 0.2 g/kg/dose (2 mL/kg of D10W) in combination with regular insulin followed by a continuous infusion 0.2 to 0.4 g/kg/hour (2 to 4 mL/kg/hour of D10W) (Ref); dextrose in combination with insulin has been reported to decrease potassium levels in premature neonates (n=7; GA: ≤28 weeks) (Ref).
Hypoglycemia: Note: Doses may be repeated in severe cases:
IV, Intraosseous:
Infants and Children: Dextrose 25% solution: 0.5 to 1 g/kg/dose (2 to 4 mL/kg/dose of 25% solution); maximum dose: 25 g/dose (Ref).
Adolescents: Dextrose 50% solutions: 0.5 to 1 g/kg/dose (1 to 2 mL/kg/dose of 50% solution); maximum dose: 25 g/dose (Ref).
Oral: Children and Adolescents: 10 to 20 g as a single dose; repeat in 10 to 15 minutes if hypoglycemia persists (Ref).
Hyperkalemia, treatment: Infants, Children, and Adolescents: IV: 0.5 to 1 g/kg/dose (using 25% or 50% solution) combined with regular insulin over 15 to 30 minutes; dose may be repeated; in some cases, a continuous IV infusion may be necessary. Note: Usual ratio is 1 unit insulin for every 4 to 5 g dextrose. In adults, the usual dose is 10 units of insulin mixed with 25 g of dextrose (50 mL of D50W) administered over 15 to 30 minutes (Ref).
Parenteral nutrition: IV: Dextrose component (Ref):
Infants <1 year: Initial: 6 to 8 mg/kg/minute; daily increase: 3.5 mg/kg/minute increments; usual goal: 10 to 14 mg/kg/minute; maximum daily rate: 18 mg/kg/minute.
Children 1 to 10 years: Initial: 3 to 6 mg/kg/minute; daily increase: 2 to 3 mg/kg/minute; usual goal: 8 to 10 mg/kg/minute.
Children >10 years and Adolescents: Initial: 2.5 to 3 mg/kg/minute; daily increase: 1 to 2 mg/kg/minute; usual goal: 5 to 6 mg/kg/minute.
Glucose tolerance test (diagnostic test for diabetes): Oral liquid: Children and Adolescents: Oral: 1.75 g/kg as a single dose; maximum dose: 75 g/dose; assess plasma glucose 2 hours after dose (Ref).
(For additional information see "Instant glucose and intravenous dextrose: Drug information")
Calcium channel blocker or beta-blocker overdose/toxicity (adjunctive agent) (off-label use): Note: For use only as an adjuvant component of high-dose insulin therapy (HDIT). Optimal dosage regimen has not been determined; HDIT is used for patients who are refractory to initial therapies (eg, atropine, calcium, vasopressors). Monitor blood glucose and electrolytes frequently, especially at the initiation of therapy. Use of concentrated dextrose solutions may help to avoid fluid overload (Ref).
Patients with existing hypoglycemia: Note: Correct relative hypoglycemia (baseline blood glucose <200 mg/dL) prior to initiation of HDIT (Ref); some experts recommend a lower baseline blood glucose (<150 mg/dL) at which to correct hypoglycemia (Ref).
IV: 25 g (50 mL D50W) as a single bolus dose followed by a continuous infusion of 0.5 g/kg/hour when HDIT is initiated; titrate dextrose to maintain blood glucose concentration >100 mg/dL. Hold dextrose for blood glucose concentration ≥200 mg/dL (Ref).
Patients without existing hypoglycemia: Initiate a continuous infusion of 0.5 g/kg/hour when HDIT is initiated; titrate dextrose infusion to maintain blood glucose concentration >100 mg/dL. Hold dextrose for blood glucose concentration ≥200 mg/dL (Ref).
Glucose tolerance test (diagnostic test for diabetes): Glutol: Oral:
One-step (Ref): 75 g as single dose to a fasting patient; assess plasma glucose 2 hours after dose in nonpregnant adults or 1 and 2 hours after dose in pregnant women.
Two-step (Ref): Pregnant women:
First step: 50 g as a single dose to a nonfasting patient; assess plasma glucose 1 hour after dose; if levels ≥130 mg/dL proceed to 100 g oral glucose tolerance test (Note: Cutoffs of ≥135 or ≥140 mg/dL have also been recommended; increased sensitivity and decreased specificity have been associated with use of a lower cutoff).
Second step: 100 g as a single dose to a fasting patient; assess plasma glucose at 1, 2, and 3 hours after dose.
Hyperkalemia, severe/emergent (adjunctive agent) (off-label use): Note: Used as an adjunct to insulin therapy. Consider omitting dextrose from regimen if blood glucose is ≥250 mg/dL (Ref). Practice may vary; refer to institutional protocols.
IV: 25 to 50 g dextrose over 5 minutes; only administer along with separate administration of IV insulin (eg, regular insulin); repeat as needed (Ref). After initial dose of dextrose, some experts administer 10% dextrose continuous IV infusion at 50 to 100 mL/hour for ~5 hours (Ref). Note: Monitor blood glucose every hour for up to 6 hours after insulin has been administered (Ref).
Hypernatremia (off- label use):
Note: Use caution in patients with elevated intracranial pressure. Most patients with hypernatremia have chronic hypernatremia, including those who present with acute concerns (eg, change in mental status). Dosing requires individualization based on serum sodium levels and clinical factors (eg, presence of symptoms, duration of hypernatremia, volume status). Approach below provides a guide to initial therapy based on estimation of water deficit and appropriate rates of correction. Address sources of ongoing free water loss and reversible causes of hypernatremia. Patients with concurrent medical conditions may need additional therapies (eg, hypovolemic patients may require additional isotonic fluid; patients with diabetes insipidus may require desmopressin). Refer to institution-specific protocols where available (Ref).
Chronic (>48 hours or unknown duration):
Note: Goal rate of serum sodium decrease is ≤0.5 mEq/L per hour (~10 mEq/L/24 hours; no more than 12 mEq/L/24 hours). In clinically stable, asymptomatic patients, may consider enteral correction of hypernatremia (Ref).
5% dextrose: IV: Initial: ~1.35 mL/kg/hour up to a maximum of 150 mL/hour; add ongoing hourly water losses (eg, urinary or GI) to initial infusion rate, if known. Adjust rate based on repeat serum sodium levels (eg, every 4 to 6 hours initially, then every 12 to 24 hours after target rate of sodium decrease is attained) (Ref).
Acute ( ≤48 hours in duration):
Note: For use in patients with confirmed hypernatremia ≤48 hours in duration (eg, diabetes insipidus with abrupt cessation of water intake, acute salt poisoning). Goal rate of initial serum sodium decrease is ≤1 to 2 mEq/L per hour to reach a serum sodium of 140 mEq/L in <24 hours. In patients with hypernatremia secondary to correction of severe hyperglycemia, consider an alternative source of free water (eg, sodium chloride 0.45%); if treating hypernatremia secondary to correction of severe hyperglycemia in younger patients (eg, ≤40 years of age), some experts correct serum sodium more slowly (ie, with chronic regimen above) to prevent cerebral edema (Ref).
5% dextrose: IV: Initial: 3 to 6 mL/kg/hour up to a maximum of 666 mL/hour; add ongoing hourly water losses (eg, urinary or GI) to initial infusion rate, if known. Adjust dose based on frequent serum sodium monitoring (eg, every 1 to 3 hours). When serum sodium is ≤145 mEq/L, reduce rate to ~1 mL/kg/hour, monitor serum sodium every 2 to 4 hours, and continue until serum sodium reaches 140 mEq/L (Ref).
Hypoglycemia:
IV: 10 to 25 g (40 to 100 mL of 25% solution or 20 to 50 mL of 50% solution); repeat as needed in severe cases.
Note: The Society of Critical Care Medicine suggests that blood glucose <70 mg/dL (or <100 mg/dL in neurologic injury patients) be treated immediately by discontinuing insulin therapy (if receiving) and administering 10 to 20 g (20 to 40 mL of 50% solution) IV; repeat blood glucose measurement in 15 minutes with repeat dextrose administration as necessary; avoid overcorrection (Ref).
Oral: 15 to 20 g as a single dose; repeat in 15 minutes if self-monitoring of blood glucose (SMBG) shows continued hypoglycemia. Once the SMBG returns to normal, a meal or snack should be consumed to prevent recurrence of hypoglycemia (Ref).
There are no specific dosage adjustments provided in the manufacturer's labeling; however, dextrose is excreted by the kidney, and closer monitoring for adverse effects may be warranted in patients with renal impairment.
There are no dosage adjustments provided in the manufacturer's labeling.
Excipient information presented when available (limited, particularly for generics); consult specific product labeling. [DSC] = Discontinued product
Gel, Oral:
Glutose 5: 40% (12.5 g) [contains methylparaben, propylparaben]
Insta-Glucose: 40% dextrose (77.4% total carbohydrate) (31 g) [contains fd&c red #40 (allura red ac dye), methylparaben, propylparaben, sodium benzoate]
Liquid, Oral:
Glutol: 100 g/180 mL (180 mL) [lemon flavor]
Solution, Intravenous:
Generic: 250 mg/mL (10 mL); 5% (25 mL, 50 mL, 100 mL, 150 mL [DSC], 250 mL, 500 mL, 1000 mL); 10% (250 mL, 500 mL, 1000 mL); 20% (500 mL [DSC]); 30% (500 mL [DSC]); 40% (500 mL); 70% (500 mL [DSC], 2000 mL)
Solution, Intravenous [preservative free]:
Generic: 5% (100 mL, 150 mL, 250 mL, 500 mL, 1000 mL); 10% (250 mL, 500 mL, 1000 mL); 20% (500 mL); 30% (500 mL); 40% (500 mL [DSC]); 50% (50 mL, 500 mL); 70% (500 mL, 2000 mL)
Solution, Oral:
Glucose Nursette: 5% (59 mL)
Good Start 5% Glucose Water: 5% (88.7 mL)
Tablet Chewable, Oral:
Generic: 4 g [DSC]
May be product dependent
Excipient information presented when available (limited, particularly for generics); consult specific product labeling. [DSC] = Discontinued product
Liquid, Oral:
Glucodex: 250 mg/mL (300 mL)
Solution, Intravenous:
Generic: 5% (10 mL, 25 mL, 50 mL, 100 mL, 150 mL, 250 mL, 500 mL, 1000 mL); 10% (250 mL, 500 mL, 1000 mL); 20% (500 mL, 1000 mL); 40% ([DSC]); 50% (50 mL, 500 mL, 1000 mL, 2000 mL); 70% (500 mL, 1000 mL, 2000 mL, 3000 mL)
Oral: Must be swallowed to be absorbed
Parenteral: For IV administration only, not SubQ or IM. Maximum concentration for peripheral administration is 12.5% and for central administration is 25% (Ref); in emergency situations, 25% dextrose has been used peripherally in infants and children and 50% dextrose in adolescents (Ref).
Neonates: Continuous infusion rates vary with tolerance and range from 4 to 14 mg/kg/minute (Ref); hyperinsulinemic neonates may require up to 15 to 20 mg/kg/minute infusion rates (Ref); a more rapid administration of 0.2 g/kg bolus of D10W over 1 minute for treatment of hypoglycemia has been described (Ref).
Vesicant (at concentrations ≥10%); ensure proper needle or catheter placement prior to and during IV infusion. Avoid extravasation. If extravasation occurs, stop infusion immediately and disconnect (leave needle/cannula in place); gently aspirate extravasated solution (do NOT flush the line); initiate hyaluronidase antidote (see "Management of Drug Extravasations" for more details); remove needle/cannula; apply dry cold compresses (Ref); elevate extremity.
Buccal: Neonate: Dry mouth with gauze; massage gel into buccal mucosa (Ref).
Oral: Must be swallowed to be absorbed; buccal absorption has been shown to be minimal (Ref).
Intravenous: Injectable is not for SubQ or IM administration; concentrated dextrose solutions for peripheral venous administration must be diluted (maximum concentration: 12.5%); in emergency situations only, 25% and 50% dextrose have been used peripherally; for direct IV infusion, infuse at a maximum rate of 200 mg/kg over 1 minute; continuous infusion rates vary with tolerance and range from 4.5 to 15 mg/kg/minute. Refer to indication-specific infusion rates in dosing for detailed recommendations.
Dextrose 10% may be an irritant. Concentrated IV dextrose (>10%) may be an irritant or a vesicant; higher concentration (higher osmolarity) is associated with a higher risk. Ensure proper needle or catheter placement prior to and during IV infusion. Avoid extravasation.
Extravasation management: If extravasation occurs, stop infusion immediately and disconnect (leave needle/cannula in place); gently aspirate extravasated solution (do NOT flush the line); initiate hyaluronidase antidote; remove needle/cannula; apply dry cold compresses (Ref); elevate extremity.
Hyaluronidase:
Dextrose 10% to <50%: Intradermal or SubQ: Inject a total of 1 to 1.7 mL (15 units/mL) as five separate 0.2 to 0.3 mL injections (using a 25-gauge needle) into area of extravasation at the leading edge in a clockwise manner (Ref).
Dextrose 50%: Injection of a total of 1 mL (150 units/mL) as five separate 0.2 mL injections administered along the leading edge of erythema has been used successfully (Ref).
Stable at room temperature; protect from freezing and extreme heat. Store oral dextrose in airtight containers.
Fluid/calorie replacement: 5% and 10% injection: Provision of calories and fluid replacement (FDA approved in all ages)
Parenteral nutrition: ≥10% solutions: Infusion after admixture with amino acids for nutritional support (FDA approved for all ages)
Hypoglycemia:
Parenteral:
25% (Hypertonic) solution: Treatment of acute symptomatic episodes of hypoglycemia to restore depressed blood glucose levels (FDA approved in neonates and older infants)
50% (Hypertonic) solution: Treatment of insulin-induced hypoglycemia (hyperinsulinemia or insulin shock) (FDA approved in adults)
Oral: Treatment of hypoglycemia (OTC products [gel, liquid, tablets]: FDA approved in adults; refer to product specific information regarding FDA approval in pediatric patients)
Glucose tolerance test (Glutol): Oral glucose tolerance test for diagnosis of diabetes mellitus (OTC product: FDA approved in adults)
Has also been used in the treatment of hyperkalemia (25% and 50% injection in combination with insulin)
Glutose may be confused with Glutofac
The Institute for Safe Medication Practices (ISMP) includes this medication (hypertonic solutions ≥20%) among its list of drugs which have a heightened risk of causing significant patient harm when used in error.
Inappropriate use of low sodium or sodium-free intravenous fluids (eg D5W, hypotonic saline) in pediatric patients can lead to significant morbidity and mortality due to hyponatremia (ISMP 2009).
The following adverse drug reactions and incidences are derived from product labeling unless otherwise specified.
Frequency not defined:
Cardiovascular: Localized phlebitis, phlebitis, venous thrombosis
Central nervous system: Confusion, loss of consciousness
Endocrine & metabolic: Dehydration, glycosuria, hyperglycemia, hyperosmolar syndrome, hypervolemia, hypokalemia
Local: Local pain
Respiratory: Pulmonary edema
<1%, postmarketing, and/or case reports: Hypersensitivity reaction (including anaphylaxis)
Injectable: Hypersensitivity to dextrose, corn or corn products, or any component of the formulation; hypertonic solutions in patients with intracranial or intraspinal hemorrhage; delirium tremens (if dehydrated); severe dehydration; clinically significant hyperglycemia; anuria; hepatic coma; dextrose solutions without electrolytes should not be administered simultaneously with blood through the same infusion set because of the possibility that pseudoagglutination of red cells may occur. Contraindications may vary by product (also refer to manufacturer's labeling).
Concerns related to adverse effects:
• Extravasation: Dextrose 10% may be an irritant. Concentrated IV dextrose (>10%) may be an irritant or a vesicant; higher concentration (higher osmolarity) is associated with a higher risk. Ensure proper catheter or needle position prior to and during infusion. Avoid extravasation.
• Hepatobiliary effects: Hepatobiliary disorders (eg, cholecystitis, cholelithiasis, cholestasis, cirrhosis, hepatic steatosis, fibrosis) may occur in patients without liver disease who receive parenteral nutrition and may lead to hepatic failure. Increase in blood ammonia levels and hyperammonemia may also occur. Monitor liver function and ammonia levels.
• Hyperglycemia or hyperosmolar hyperglycemic state: Use of dextrose infusions with impaired glucose intolerance may worsen hyperglycemia. Administration of dextrose at a rate exceeding the patient's utilization rate may lead to hyperglycemia, coma, and death. Patients with underlying CNS disease and renal impairment may be at greater risk of developing hyperosmolar hyperglycemic state. Monitor blood glucose levels.
• Hypersensitivity: Hypersensitivity/infusion reactions, including anaphylaxis, have been reported. Stop infusion immediately and treat patient accordingly if any signs or symptoms of a hypersensitivity reaction develop.
• Hypokalemia: Administration of potassium free IV dextrose solutions may result in significant hypokalemia, particularly if highly concentrated dextrose solutions are used; monitor closely and/or add potassium to dextrose solutions for patients with adequate renal function.
• Hyponatremia/sodium disorders: Administration of low sodium or sodium-free IV dextrose solutions may result in excessive reduction of serum sodium, significant hyponatremia, or water intoxication. Risk is increased in pediatric and elderly patients, postoperative patients, and those with psychogenic polydipsia. Avoid dextrose injection in patients with or at risk for hyponatremia; if used, monitor serum sodium concentration. Use high-volume infusion with caution in patients with cardiac or pulmonary failure and in patients with nonosmotic vasopressin release (ie, syndrome of inappropriate antidiuretic hormone secretion) due to the risk of hospital-acquired hyponatremia. Rapid correction of sodium disorders is potentially dangerous (eg, may cause cerebral edema or osmotic demyelination syndrome); monitor serum sodium/chloride, fluid status, acid-base balance, and signs of neurologic complications (Kraft 2005; manufacturer's labeling).
• Infection: Patients requiring parenteral nutrition may be at high risk of infection, including sepsis. Risk of infection is increased with malnutrition, hyperglycemia exacerbated by dextrose infusion, or catheters required for administration. Proper aseptic technique should be followed; monitor for signs of early infection. Diabetic patients are at a greater risk of developing catheter-related infections compared with nondiabetic patients (McMahon 1996).
• Parenteral nutrition-associated liver disease: Has been reported in patients receiving parenteral nutrition for extended periods of time, especially preterm infants, and can present as cholestasis or steatohepatitis. Consider discontinuation or dose reduction in patients who develop LFT abnormalities.
• Refeeding syndrome: Refeeding severely undernourished patients may result in refeeding syndrome (eg, intracellular shift of potassium, phosphorus, and magnesium as the patient becomes anabolic); thiamine deficiency and fluid retention may also develop. Carefully monitor severely undernourished patients and slowly increase dextrose and other nutrient intakes.
Disease-related concerns:
• Diabetes: Use with caution in patients with diabetes mellitus; hyperglycemia and glycosuria may be functions of the rate of administration of dextrose; to minimize these effects, reduce the rate of infusion; addition of insulin may be necessary.
• Hyperkalemia: The use of dextrose with insulin for the treatment of hyperkalemia achieves a rapid reduction in serum potassium concentrations by redistributing serum potassium intracellularly; however, this effect is transient (lasts up to 2 hours) and does not remove potassium body stores. Other therapies can be used to increase potassium elimination (eg, sodium polystyrene sulfonate, hemodialysis) (Elliott 2010; Khilnani 1992; Kraft 2005).
• Pulmonary edema: Use with caution in patients with pulmonary edema; these patients are susceptible to excessive fluid accumulation.
• Renal impairment: Use with caution in patients with renal impairment; may be at risk of electrolyte and fluid volume overload, and in developing hyperosmolar hyperglycemic state. May contain aluminum, which may accumulate following prolonged administration in patients with renal impairment.
Special populations:
• Very low birth weight infants: Excessive or rapid dextrose administration in very low birth weight infants has been associated with increased serum osmolality and possible intracerebral hemorrhage.
Dosage form specific issues:
• Aluminum: The parenteral product may contain aluminum; toxic aluminum concentrations may be seen with high doses, prolonged use, or renal dysfunction. Premature neonates are at higher risk due to immature renal function and aluminum intake from other parenteral sources. Parenteral aluminum exposure of >4 to 5 mcg/kg/day is associated with CNS and bone toxicity; tissue loading may occur at lower doses (Federal Register 2002). See manufacturer's labeling.
• Oral dosage forms: In patients with impaired consciousness, oral dextrose administration may increase the risk of aspiration; use only when no alternatives (eg, parenteral dextrose, glucagon) are available (Desimone 2018).
• Precipitates: Periodically inspect solution, infusion set, and catheter for precipitates. Pulmonary vascular precipitates causing pulmonary vascular emboli and pulmonary distress have been reported (some fatal). If signs of pulmonary distress occur, stop the infusion.
Other warnings/precautions:
• Abrupt withdrawal: Rebound hypoglycemia may occur when a concentrated dextrose infusion is abruptly withdrawn.
• Administration: Hypertonic solutions (>10%) may cause thrombosis if infused via peripheral veins; administer hypertonic solutions via a central venous catheter.
None known.
Note: Interacting drugs may not be individually listed below if they are part of a group interaction (eg, individual drugs within “CYP3A4 Inducers [Strong]” are NOT listed). For a complete list of drug interactions by individual drug name and detailed management recommendations, use the Lexicomp drug interactions program
There are no known significant interactions.
Some products may contain potassium and/or sodium.
Appropriate use of dextrose injection would not be expected to cause adverse developmental outcomes to the fetus when used during pregnancy. Maternal hyperglycemia or malnutrition may be associated with adverse pregnancy outcomes.
In patients with nausea and vomiting of pregnancy who cannot tolerate oral liquids for prolonged periods or who are clinically dehydrated, intravenous hydration that includes dextrose is recommended. Due to potential maternal complications, enteral therapy is preferred over parenteral if nutrition support is required. Parenteral nutrition (which may include dextrose) should be reserved for use in patients with severe nausea and vomiting not responsive to enteral therapy (ACOG 189 2018). Medications used for the treatment of cardiac arrest in pregnancy are the same as in the non-pregnant patient. Doses and indications should follow current Advanced Cardiovascular Life Support guidelines. Appropriate medications should not be withheld due to concerns of fetal teratogenicity (Jeejeebhoy [AHA] 2015).
Oral dextrose is used for the screening and diagnosis of gestational diabetes mellitus in pregnant patients not previously diagnosed with diabetes (ADA 2021).
Serum and urine glucose concentrations; serum electrolytes, I & O, caloric intake. Monitor infusion site.
Hypoglycemia in diabetes (ADA 2018; ISPAD [Abraham 2018]): Children and Adolescents:
Clinical hypoglycemia alert value: ≤70 mg/dL; initiate hypoglycemic treatment with fast acting carbohydrates (ie, glucose tablets, liquid, or gels or ingestion of glucose or carbohydrate containing food) to prevent further decrease in plasma glucose
Clinically serious hypoglycemia: <54 mg/dL; neurogenic symptoms and cognitive dysfunction occur below this concentration; increased risk for severe hypoglycemia; treat with glucagon
Severe hypoglycemia: No specific glucose value; hypoglycemia associated with severe cognitive impairment (including coma and seizures) requiring external assistance for recovery
Glucose tolerance test (diagnostic test for diabetes) (ISPAD [Mayer-Davis 2018]): Children and Adolescents:
2 hour post-dose plasma glucose (Oral glucose tolerance test [OGTT]):
140 to 200 mg/dL: Impaired glucose tolerance
≥200 mg/dL: Provisional diagnosis of diabetes; diagnosis must be confirmed with repeat and/or additional testing
Dextrose, a monosaccharide, is a source of calories and fluid for patients unable to obtain an adequate oral intake; may decrease body protein and nitrogen losses; promotes glycogen deposition in the liver. When used in the treatment of hyperkalemia (combined with insulin), dextrose stimulates the transient uptake of potassium by cells, especially in muscle tissue, lowering serum potassium.
Onset of action: Treatment of hypoglycemia: Oral: 10 minutes
Maximum effect: Treatment of hyperkalemia: IV: 30 minutes
Absorption: Oral: Rapidly from the small intestine by an active mechanism; Buccal: negligible (Gunning 1978)
Metabolism: Metabolized to carbon dioxide and water
Time to peak, serum: Oral: 40 minutes
1 g dextrose IV = 3.4 kcal
1 g glucose monohydrate = 1 g anhydrous dextrose
Osmolarity: Dextrose 10%: 505 mOsm/L; Dextrose 25%: 1,330 mOsm/L; Normal body fluid: 310 mOsm/L
Gel (Glutose 15 Oral)
40% (per gram): $0.11
Gel (Glutose 5 Oral)
40% (per gram): $0.21
Gel (Insta-Glucose Oral)
77.4% (per gram): $0.10
Solution (Dextrose Intravenous)
5% (per mL): $0.05 - $0.19
10% (per mL): $0.01 - $0.02
20% (per mL): $0.03
30% (per mL): $0.03
40% (per mL): $0.03
50% (per mL): $0.09 - $0.37
70% (per mL): $0.01
Solution (Glucose Nursette Oral)
5% (per mL): $0.03
Solution (Good Start 5% Glucose Water Oral)
5% (per mL): $0.02
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