Dextrose

Glucose, d-glucose

Antidote

Pediatric

Dextrose

Glucose, d-glucose

Indications

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

Dosage

For Hypoglycemia:

IV Direct:

0.25 g/kg (1 mL/kg of dextrose 25%). Repeat as needed

For Beta Blocker and/or Calcium Channel Blocker Toxicity:

IV Direct:

0.25 g/kg (1 mL/kg of dextrose 25%).

Infusion: Titrate to maintain serum glucose 6-14 mmol/L

Peripheral IV: 0.25 to 0.5 g/kg/hour (2.5 to 5 ml/kg/hour of dextrose 10%)

Central line: 0.25 to 0.5 g/kg/hour (1 to 2 ml/kg/hour of dextrose 25%)

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

NOTE:

Dextrose 10% = dextrose 0.1 g/mL
Dextrose 25% = dextrose 0.25 g/mL

Administration

IV Direct: To prepare dextrose 25% - use a 1:1 dilution of dextrose 50% and sterile water for injection (equal volumes of each)

Example: For a final volume of 50 mL, dilute 25 mL of dextrose 50% with 25 mL of sterile water for injection

Infusion:

For a central line, prepare dextrose 25% as above.

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.

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

Dextrose 25% has an osmolarity of 1263m/L.

References…

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.

Bailey, B., Blais, R., Gaudreault, P., Gosselin, S., & Laliberte, M. (2009). Antidotes en toxicologie d'urgence (3rd ed.). Quebec, Canada: Centre antipoison du Quebec.

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.

Micromedex, T. H. A. (2014). Micromedex health care systems. Retrieved from http://www.micromedexsolutions.com

Olson, K. R. (2007). Poisoning & drug overdose (Sixth ed.). New York: McGraw Hill.

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

Shannon, M. W., Borron, S. W., & Burns, M. J. (2007). Haddad and Winchester's clinical management of poisoning and drug overdose (Fourth ed.). Philadelphia: Saunders Elsevier.

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.