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 Approved By 150 Date *Not Valid Unless Final Proofs Carry 095N Approval Signature COLOR Blue BWR 5 MIL 200 HOT STAMP Process 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!