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Poisoning Information for the Public & Health Care Professionals

Atlantic Canada Poison Centre
Antidote Kit Manual

1-800-565-8161 or 902-470-8161 | atlanticcanadapoisoncentre.ca
Last updated: 09/2020
Pediatric Adult
Last updated: 09/2020
Antidote
Adult

Dextrose

Glucose, d-glucose

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Antidote
Adult

Dextrose

Glucose, d-glucose

Indications

  • Treatment of hypoglycemia
  • Concurrent treatment with high dose insulin for beta blocker or calcium channel blocker toxicity 

Dosage

For Hypoglycemia:

  • IV Direct: 20-50 mL (10-25 g) dextrose 50%. Repeat as needed.

For Beta Blocker and/or Calcium Channel Blocker Toxicity:

  • IV Direct:  50 mL of dextrose 50%

Infusion:

  • 0.25-0.5 g/kg/hour . Titrate to maintain serum glucose 6-14 mmol/L
    • Peripheral IV:  2.5 – 5 mL/kg/hour of dextrose 10%
    • Central Line:  0.5-1 mL/kg/hour of dextrose 50%
  • In the context of high dose insulin treatment for beta blocker or calcium channel blocker toxicity: dextrose infusion may need to continue for approximately 24 hours after insulin is discontinued, as rebound hypoglycaemia may occur

Administration

IV Direct: Use pre-filled syringes of dextrose 50% or withdraw from 50 mL vial

Infusion 

For a central line, place 50% dextrose in an empty IV bag. 

For a peripheral line, use dextrose 10%. 

If dextrose 10% is not available, dextrose 9.5% can be prepared and used in place of dextrose 10% according to the following instructions:

  • Remove 50 mL dextrose 5% from a 500 mL bag.  Add 50 mL dextrose 50%. Label bag appropriately.

       OR

  • Remove 100 mL dextrose 5% from a 1000 mL bag.  Add 100 mL dextrose 50%. Label bag appropriately.

Compatibility, Stability

  • Dextrose 50% has an acidic pH (3.5-5) and therefore specific compatibility information should be consulted when dextrose 50% is injected into an IV line containing another drug.
  •  Store at room temperature. Do not use cloudy solutions.

Potential Hazards of Administration

  • Pain, phlebitis and/or thrombosis at injection site.
  • Tissue necrosis may result if extravasation occurs.
  • Hyperglycemia and glycosuria.
  • Hyperosmolar syndrome. Signs include mental confusion and loss of consciousness especially in patients with chronic uremia or carbohydrate intolerance.
  • May cause fluid or solute overload leading to fluid and electrolyte disturbances (especially phosphate and potassium), overhydration or fluid congestion.
  • May cause vitamin B complex deficiency.

Miscellaneous

  • Consider the administration of thiamine in potential thiamine-deficient patients (e.g., alcoholic malnourished) 
  • Draw blood glucose or check Chemstrip® before administering. In emergency situations administer without waiting for lab results.
  • Dextrose 50% has an osmolarity of 2526 mOsm/L. 

 

Azendour, H., Belyamani, L., Atmani, M., Balkhi, H., & Haimeur, C. (2010). Severe amlodipine intoxication treated by hyperinsulinemia euglycemia therapy. The Journal of Emergency Medicine, 38(1), 33.

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Doepker, B., Healy, W., Cortez, E., & Adkins, E. J. (2014). High-dose insulin and intravenous lipid emulsion therapy for cardiogenic shock by intentional calcium-channel blocker and beta-blocker overdose: A case series. The Journal of Emergency Medicine, 46(4), 486-490.

Holger, J. S., Stellplug, S. J., Cole, J. B., Harris, C. R., & Engebretsen, K. M. (2011). High-dose insulin: A consecutive case series in toxin-induced cardiogenic shock. Clinical Toxicology (Philadelphia, Pa.), 49, 653-658.

IWK Regional Poison Centre. (2011). Beta-adrenergic antagonists (beta-blockers): A brief overview for emergency departments. Unpublished manuscript.

IWK Regional Poison Centre. (2011). Calcium channel blockers: A brief overview for emergency departments. Unpublished manuscript.

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Page, C. B., Hacket, L. P., & Isbister, G. K. (2009). The use of high-dose insulin-glucose euglycemia in beta-blocker overdose: A case report. Journal of Medical Toxicology, 5(3), 139.

Patel, N. P., Pugh, M. E., & Goldburg, S. (2007). Hyperinsulinemic euglycemia therapy for verapamil poisoning: A review. American Journal of Critical Care, 16, 498-503.

Phelps SJ, C. C. (2013).  Teddy bear, pediatric injectable drugs. Retrieved from http://www.pharmpress.com/product/MC_PED/pediatric-injectable-drugs

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Smollin, C. G. (2010). Toxicology: Pearls and pitfalls in the use of antidotes. Emergency Medicine Clinic of North America, 28, 149-161.

Trissel, Lawrence, A,. (2013). Handbook on injectable drugs (17th ed.). Bethesda, Maryland: American Society of Health-System Pharmacists

Yuan, T. H., Kerns, I. W. P., & Tomaszewski. (1999). Insulin-glucose as adjunctive therapy for severe calcium channel antagonist poisoning. J Toxicol Clin Toxicol, 37, 463.