Question: A couple questions with regards to D10. We have used D10 a few times now to treat hypoglycemia and have noticed some issues. It seems that for anyone with a BLG that is very low (say less than 2.0 for argument sake) the max dose of 10g will not get them over 4.0 mmol/L. Is there plans in the future to increase the dose? Perhaps something like if the patient is < 2.0 mmol/L then a 20g max or 4ml/kg loading dose followed by a 10g or 2ml/kg maintenance dose if necessary?
Second, with regards to Buretrol administration of D10, the process is very slow. Both the setup of the Buretrol and the infusion take quite a bit of time obviously more so if a second dose is required. Is there any reason a 60ml syringe can't be used (draw up and push 60cc and follow up with 40cc) as a push administration instead of the Buretrol? For most situations the slow drip is okay but in the case of an agitated or aggressive patient the quicker option would be nice. I realize the benefits of D10 over D50 in not sky rocketing BGL but the way it is laid out now seems that we have gone too far the other way in not raising BGL enough.
Thank you for the question. In regards to increasing the max dose of D10 based on the patients blood glucose level we will discuss this potential issue at the OBHG MAC during the next review of the medical directives.
In regards to pushing IV D10 - Pushing D10 via syringe is an acceptable practice. The Buretrol acts as a safety device to prevent larger volumes of fluids being inadvertently infused into children. Using a syringe to push D10 is the same mechanics as a Buretrol, only can be given quicker which is of no concern.