D10 vs D50 Science or Tradition?

Transcription

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
(01) 0 030409 793002 9
Injection, USP
EACH 100 mL CONTAINS DEXTROSE,
HYDROUS 10 g IN WATER FOR
INJECTION.
505 mOsmol/LITER (CALC.)
pH 4.3 (3.2 to 6.5)
DEXTROSE SOLUTIONS WITHOUT
SALTS SHOULD NOT BE USED IN BLOOD
TRANSFUSIONS BECAUSE OF POSSIBLE
ROULEAU FORMATION. ADDITIVES MAY
BE INCOMPATIBLE. CONSULT WITH
PHARMACIST, IF AVAILABLE. WHEN
INTRODUCING
ADDITIVES,
USE
ASEPTIC
TECHNIQUE,
MIX
THOROUGHLY AND DO NOT STORE.
SINGLE-DOSE CONTAINER. USUAL
DOSAGE:
SEE
INSERT.
FOR
INTRAVENOUS
USE.
STERILE,
NONPYROGENIC. USE ONLY IF
SOLUTION IS CLEAR AND CONTAINER
IS UNDAMAGED. MUST NOT BE USED
IN SERIES CONNECTIONS.
Rx ONLY
LATEX
©HOSPIRA 2004
IM-0239 (5/04)
PRINTED IN USA
HOSPIRA, INC., LAKE FOREST, IL 60045 USA
7930
List
3
V
CONTAINS DEHP
50
100
Commodity
IM-0239v4
CR
06-1968
Editor
CK
Date
6/27/06
Artist
SP
Label Control 095N, Approval
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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!

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