Question: With regards to the administration of D50W. I was just curious if it has ever been to considered for us to titrate this drug for effect. By this I mean, if you are pushing the 10ml of D50 then flushing and repeating this until the entire 50ml is given it is assumed that you will likely notice positive effects of the drug before it is all given. So would we be better off to stop the infusion and re-check a blood sugar at this point to see if we have achieved a blood glucose above 4 or within normal range as opposed to giving the whole dose and pushing their blood sugars usually above 10.
Great question! The short answer is that for whatever the reason, the "standard" dose of D50 that has been used to treat hypoglycemia in an adult has been 25g or 50ml of D50. Quite honestly, you have astutely picked up that this standard "shot gun" approach may not be what is required for every patient, and in some cases may be too much and in others too little.
Interestingly, the actual dose recommended has been 0.5g/kg, and thus 25g would in theory be appropriate for an adult who is 50kg. Not a lot of adults out their weighing less than 110lbs (50kg) so in fact, for many; this dose may be too small.
Balancing this dosing decision is the fact that we know that hypoglycemia is a serious condition for the brain, whereas transient hyperglycemia while not desirable, could be considered the lesser of two evils.
Finally, administering the D50 so slowly so that the response to treatment can be determined could possibly result in a longer time to euglycemia since not every patient responds to the full dose of D50.
So, bottom line, titration of D50 although considered, is not supported at this time and paramedics are to administer the dose of D50 as per the medical directive.