Dextrose 50% (D50)
D50W
Hypertonic dextrose for emergency hypoglycemia
Concentrated glucose (50 g per 100 mL = 25 g per 50 mL amp/syringe). Direct serum glucose elevation by passive distribution; insulin-independent immediate availability to brain.
Indications
- •Symptomatic hypoglycemia (BG < 70 with neuroglycopenia, < 40 always)
- •Hyperkalemia treatment (paired with insulin)
- •Suspected hypoglycemic coma (empirical 1 amp before naloxone in undifferentiated AMS)
- •Beta-blocker / calcium-channel-blocker overdose with hypoglycemia
Dosing
| Context | Adult | Pediatric |
|---|---|---|
| Adult hypoglycemia | 1 amp (25 g / 50 mL of 50%) IV push; recheck BG in 15 min | — |
| Pediatric hypoglycemia (NEVER 50% peripherally) | 0.5–1 g/kg as D10 (5–10 mL/kg) or D25 IV | |
| Hyperkalemia (with insulin) | 1 amp D50 IV push with 10 U regular insulin | — |
Pharmacokinetics
Onset 1 min. Effect lasts 15–60 min. Hepatic + tissue uptake.
Hemodynamic effects
Transient minimal volume expansion.
Respiratory effects
None directly.
Side effects
- !Phlebitis — high osmolality (2520 mOsm/kg); central line preferred for repeated doses
- !Tissue necrosis with extravasation (osmotic injury)
- !Hyperglycemia rebound
- !Wernicke's precipitation in alcoholic / malnourished patients (give thiamine 100 mg IV first)
Contraindications
- ×Hyperglycemic state without confirmed hypoglycemia
Clinical pearls
- ★ALWAYS PRECEDE WITH THIAMINE: 100 mg IV thiamine before or simultaneously with D50 in any alcoholic / malnourished / unknown-history patient. D50 alone in B1-deficient patients can precipitate Wernicke's.
- ★PERIPHERAL LINE WITH CARE: 50% dextrose has 2520 mOsm/kg osmolality. Single push through 18-gauge antecubital is OK; repeated dosing or extravasation causes severe injury.
- ★PEDIATRICS — NO D50 PERIPHERALLY: use D10 or D25 instead. Dose 0.5–1 g/kg.
- ★DURATION TRAP: 1 amp D50 raises BG transiently. Patient on long-acting hypoglycemic agent (sulfonylurea, glargine) WILL re-drop. Follow with D10 infusion + admit.
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Other drugs in Sugar Control
- Insulin (Regular / Humulin R)
Binds insulin receptors → tyrosine kinase cascade → GLUT4 translocation in muscle/fat (glucose uptake), glycogen + lipid synthesis, K+ shift intracellularly.
- Glucagon
Binds Gs-coupled glucagon receptors → ↑cAMP → activates phosphorylase, drives glycogenolysis + gluconeogenesis. In cardiac tissue, the cAMP rise produces inotropic + chronotropic effects independent of β-receptors.
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