D10 vs D50 Science or Tradition?

D10 vs D50
Science or Tradition?
Paul S. Rostykus, MD, MPH
[email protected]
No disclosure$
(unfortunately)
911 “Person Down”
S  unconscious
PMH – IDDM
Took insulin
Didn’t eat & exercised
O  GCS = 3
CBG = 35
A  Hypoglycemia – severe
P  ?
D50?
D50 (25 g/50 ml)
Effective
Textbooks
Tradition
WHERE’S THE!
SCIENCE?!!
Blood volume 70 ml/kg
Blood glucose 100 mg/dl
Body glucose 70 mg/kg
5 g Adult blood glucose
Overkill?
EMS glucose
10X
10X
Blood Glucose Content
Glucose dose
PALS
5X
5X
CBG ~ 100
1X
1X
00 0
Adult 25 g
0.5g/kg
1 g/kg
Glucose Transporter
GLUT
Glucose uptake rate (% of max) Glucose uptake vs Blood glucose GLUT3 (brain)
0
36
72
108 144
Glucose (mg/dl)
180
Glucose Uptake (maximal)
6 mg/kg/min = 0.006 g/kg/min
0.36 g/kg/hour
D50 dose IV
Adult: 0.33 g/kg/1-3 minutes
PALS: 0.5-1 g/kg/1-3 minutes
Stroke
pediatric med
calculation errors
D50 à D25 à D12.5 à D10
Hoyle, Jr. JD, Davis AT, Putman KK, Trytko JA, Fales WD.
Medication Dosing Errors in Pediatric Patients Treated by
Emergency Medical Services.
Prehospital Emergency Care 2012;16:59-66
250 mL
NDC 0409-7930-02
10% DEXTROSE
Packaging
Graphics Art
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List
3
V
CONTAINS DEHP
50
100
Commodity
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CR
06-1968
Editor
CK
Date
6/27/06
Artist
SP
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Page 1 of 3
RCT – D10 vs D50
Hypoglycemic adults
Aliquots of 5g IV – maximum 25 g
Similar time to GCS = 15
D10 less total glucose
D10 less hyperglycemia afterwards*
Moore C, Woollard M.
Dextrose 10% or 50% in the treatment of hypoglycaemia out
of hospital? A randomized controlled trial.
Emerg Med J 2005;22:512–515
JEMS March 2007
D10 vs D50 Review
D50 better than glucagon
D50 & D10 equally effective
D10 causes less hyperglycemia
D10 safer
Nehme Z, Cuidni D. A review of the efficacy of 10% glucose
as alternative to high concentration glucose in the treatment
of out-of-hospital of hypoglaecemia.
Journal of Emergency Primary Health Care 2009:7(3)
D10?
UK Ambulance Service
• D10 since ~2000
Adults - 10g = 100 ml
(~0.1g/kg)
Pediatrics < 40 kg
0.5 g/kg = 5 ml/kg
Jackson County EMS
Hypoglycemia protocol
(started July 1, 2013)
D10
Adults 5g = 50 ml (<0.1 g/kg)
Pediatric 0.1 g/kg = 1 ml/kg
Repeat every 3-5 minutes based on:
CBG & GCS
D10 Experience
• ~200 hypoglycemic adults/18 weeks
• 100 ml of D10 IV – 18% repeated dose
• Effective
• No adverse events
Kiefer MV , Hern HG , Alter HJ , Barger JB . Dextrose 10% in the treatment
of out-of-hospital hypoglycemia. Prehosp Disaster Med 2014;29(2):1-5
D50 Retirement?
D10 – 0.1 g/kg
Effective – titrate
Safer – less hypertonic
Easier – no dilutions
Thanks for attending!