An adult with severe hypoglycemia may be comatose and is at risk for hypoglycemic injury. A bolus dose of concentrated dextrose (50% weight for weight) can quickly reverse the hypoglycemia.
Glucose content of D50W: 500 mg (0.5 g) per mL
Caloric content: 1.7 kcal per mL
Osmolality: 2,525 mOsm per kg water (8 times that of plasma)
Patient selection: adult with severe hypoglycemia (< 60 mg/dL)
Various recommendations for a bolus dose to infuse over 1-3 minutes:
(1) 10 to 25 mL.
(2) (100 - (blood glucose in mg/dL)) * 0.3
(3) (100 - (blood glucose in mg/dL)) * 0.4
The infusate should be given through a central line. Peripheral infusion can result in venous thrombosis or extravasation injury.
The patient should respond within 1 to 5 minutes after the bolus infusion.
Once the bolus infusion has been given, an infusion of D5W-normal saline should be started.
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