I rate Dextrose (D50) 7 out of the 33 Drugs we carry.
We use D50 for altered mental status due to hypoglycemia (where the patient is too altered to drink juice).
I live in a big diabetic town. I gave D50 19 times last year. I sometimes joke that I am known as King Sugar to the diabetic ladies in my town.
If I didn’t have D50, a few of these patients I might be able to arouse with oral glucose, but certainly not all of them. Some would probably be all right on the transport into the hospital with just supportive care until the hospital could give the D50, but some clearly would not. There are the seizing diabetics, the combative diabetics, the out cold gurlging diabetics and the three-hundred pound plus dead weight out cold diabetics all with sugars way below the level needed to keep their brain mentating.
An IV, some D50 (or as I have been doing more and more often, either D25 or D10 to cut down on vein injury and to make their post D50 hangover less severe. Also, some of my patients I can only get a 24 in, and pushing D50 through a 24 in a tiny hand vein is a workout – D25 goes easier), and a few moments of waiting and their eyes are open, and they look around and apolgize for inconviniencing us.
When we arrive, a first responder may say, “You are going to need the stair chair.” I say, “No, I’m just going to wake them up.”
Here’s one of my favorite diabetic stories I posted in February of 2006:
The snow is coming down in near white out conditions. At one point we lose the road the snow bank kicking up snow that completely obliterates our view through the windshield. We arrive at a townhouse apartment complex where we have been called for an unresponsive diabetic. Carrying our blue house bag, heart monitor, and 02 tank, we wade through drifts up to our waist to get to the door.
An old Jamaican woman meets us at the door in her bathrobe and says her sister is upstairs on the bed. We have been to this house many times before. The sister is in her eighties. She is supine across the bed, snoring, her skin cool and clammy. We check her sugar. Our glucometer reads “LO” which means less than 20. I get a line and push in an amp of D50. She opens her eyes to a sternal rub now, but is still mostly out of it. I give her another half an amp and she now has her eyes fully open and looks around at us quizzically. “What hap’en?” she asks.
“Your sugar was low,” I say. “Less than 20.”
“No, my sugar is high,” she says, “I write it right down dere in de book.”
“No, it was less than twenty.”
“No, it isn’t low. Me write it down in de book before me go to bed.”
“You sugar went down. You must not have eaten.”
She listens seemingly intently to what I say. I think I am getting through, but then she says again, “My sugar high. I write it down in de book.”
Finally her sister says, “Dis is anothder day now dear.”
We finally got her straightened out and have her sitting at the kitchen table eating a big Jamaican meal of stew chicken and rice and peas.
“What do you think of the snow storm?” I ask.
She looks at me with one eye cocked, uncertain what I am saying.
“Look outside,” I say.
My partner opens the door for her to see.
It is a winter wonderland outside, nothing but white powder.
Her eyes widen. Her mouth opens, but no words come out. She looks like a little five-year old Jamaican girl seeing snow for the first time.
I always try to talk the now alert patients into going to the hospital, but if they have a good story why their sugar dropped (forgot to eat), they live with someone else, they are on insulin, and this has happened to them before, then as long as their friend or family member agrees to watch them, they agree to follow up with their doctor, and I watch them eat something, taking a refusal is okay. It is the noninsulin dependent diabetics, the first time hypoglycemic shock patients, the people with no reason for their sugar to have dropped and the person who lives alone, you need to be careful about.
On quite a few occasions I have gotten a person back with D50, persuaded them to go to the hospital, and had them crash again on me in the ambulance. You can never be too careful.
I don’t really know at what point having low blood sugar starts to cause irreversable harm, but I have worked cardiac arrests and presumed a number of patients who were diabetics and had low blood sugar at the time of their death.
This is the account of one such death:
Dextrose (D50W) or (D25W)
Action: Raises the blood sugar
Indication: Diabetic patients with low blood sugar level (<70 mg/dL in adults)
Altered mental states
Contraindication: acute strokes with normal finger stick blood glucose i.e. neurotoxic
Precaution: Tissue necrosis if infiltration occurs
Side effects: As above-infiltration
Intracerebral hemorrhages in neonates with undiluted D50
Dose: 25 Gms Slow IV push, may repeat
Route: IV slow, confirm IV placement prior to and during administration.
Pedi Dose: 1ml/kg of D50W slow IV push. Dilute 1 to 4 in those less than 1 week old and dilute 1 to 2 (D25W) in those 1 week to 16 years.