July/August Pearl #2: D10 vs D50 for hypoglycemia
Pearl: D10 might be a safer and non-inferior alternative to D50 for hypoglycemia patients in the pre-hospital and ED setting.
Pearl by John E. Schneider MD PGY4.
Summary:
D10 might be safer than D50 for hypoglycemia…
Avoid potential extravasation injury. D50 is 2500 mOsm/L. Compare that to sodium bicarbonate, which is 2000 mOsm/L. With a 10-30% extravasation rate for “pushes” of D50 this could cause harm in patients. While infusing D50 slower over 5 minutes has been shown to cause less extravasation, one could infuse approximately 268ml (or 26g) of D10 in 4 minutes through a 20g catheter (67ml/min). Note that its suggested that unless there is an emergency that a central line ought to be used for solution > 900 mOsm/L. Given D10 can be given safer in a nearly negligent amount of time compared to D50 perhaps we should be using this. This was my go to during the D50 shortage experienced in the fallout of hurricane Maria.
Avoid rebound hypoglycemia: A large bolus of D50 might temporarily fool the body into stopping gluconeogenesis and glycogenolysis by infusing 25g of glucose at one time. Normal circulating levels in the body are 5g.
Hyperglycemia: In some brittle diabetics hyperglycemia rates are shown to be higher in D50 compared to D10.
The articles below have more details including several studies on the topic.
Blog Post by: John E. Schneider MD PGY4
RESOURCES:
#FOAM