Question: Im a recent graduate from the paramedic program and was wondering if I can get some feedback regarding the hypoglycemia treatment. The new protocol that came into play that now includes D10, I was curious what the reasoning was for choosing D10 over D50? Is there anything specific separating the 2 options of treatment?
This is a very good question. Traditionally, the standard dose of 50 mls of D50 (25 grams of dextrose in 50 ml of water) was used to treat hypoglycemia in adults. As of 2015, most American EMS Services used this preparation (1). Anecdotally, this has worked well and there were no concerns about providing too much glucose. Recently concerns have been raised that the dose is far above what is needed to treat most cases of hypoglycemia. In addition, the potential neurotoxicity of hyperglycemia especially in children, and the accidental tissue necrosis from extravasation of a large amount of hypertonic D50 into soft tissues have started Services to use less concentrated dextrose (D10) solutions to treat hypoglycemia (2).
1. Hern, HG, et. al., D10 in the Treatment of Prehospital Hypoglycemia: A 24 Month Observational Cohort Study. Prehosp Emerg Care. 2017 Jan-Feb;21(1):63-67. doi: 10.1080/10903127.2016.1189637. Epub 2016 Dec 5.
2. Rostykus, P, et. al.. Variability in the Treatment of Prehospital Hypoglycemia: A Structured Review of EMS Protocols in the United States. Prehosp Emerg Care. 2016 Jul-Aug;20(4):524-30. doi: 10.3109/10903127.2015.1128031. Epub 2016 Mar 1.