Hypoglycemia treatment · Hyperkalemia treatment
Dextrose 50%
Also called D50
Indications
- Hypoglycemia when oral glucose is unsafe; the label names insulin-induced hypoglycemia in adults and children 2 years and older
- With IV insulin for hyperkalemia, to prevent hypoglycemia (off-label)
- Glucose support during high-dose insulin therapy for poisoning (off-label)
- Bulk 50% as the carbohydrate source in compounded parenteral nutrition
Dosing
| Where | Dose |
|---|---|
| Metabolic and electrolyte boluses | Dextrose 50%: 25 g (50 mL) IV for hypoglycemia; D10 250 mL is gentler on veins |
| Hypertonic and concentrated fluids | Dextrose 50% (D50): 0.5 g/mL (25 g in 50 mL); 2,525 mOsm/L. Label: 10–25 g for hypoglycemia into a central or large peripheral vein; necrosis if it leaks |
| Hypertonic and concentrated fluids | Dextrose 10% (D10): 0.1 g/mL (25 g in 250 mL); 505 mOsm/L; 340 kcal/L. A peripheral IV is fine; bolus, or infusion to prevent repeat lows |
On the quick cards
- Dextrose (D10, D25, D50)EMS Field Drugs: Endocrine and metabolic: IV glucose for hypoglycemia
- Metabolic and electrolyte bolusesPush and Emergency Meds: Hyperkalemia, glucose, calcium, magnesium, thiamine
- Hypertonic and concentrated fluidsIV Fluids: Strength per mL, osmolarity and which line
Mechanism of action
Dextrose is D-glucose. It enters cells through GLUT transporters: insulin-independent GLUT1 and GLUT3 in brain and red cells, GLUT2 in liver and β-cells, and insulin-dependent GLUT4 in muscle and fat. Hexokinase traps it as glucose-6-phosphate, which is stored as glycogen or oxidized to CO₂ and water to make ATP. The brain depends on blood glucose, so raising it reverses neuroglycopenia within minutes; the load also releases insulin, which moves potassium into cells.
Pharmacology
- CNS: reverses hypoglycemic confusion, seizures and coma; in thiamine deficiency it can precipitate Wernicke encephalopathy
- Metabolic: 25 g raised glucose about 160 mg/dL at 5 min in healthy adults (Balentine 1998); about 8% of hypoglycemic patients were low again within an hour (Al Saidi 2025)
- Metabolic: the insulin it releases moves potassium, phosphate and magnesium into cells (the refeeding pattern); supplies 3.4 kcal/g
- Renal: glucose above about 180 mg/dL spills into urine and causes an osmotic diuresis
Pharmacokinetics
| Onset | Within a minute IV; consciousness returned at a median 8 min (Moore 2005) |
|---|---|
| Peak | About 5 min after a 25 g push (Balentine 1998) |
| Duration | Near baseline by 30 min in healthy adults (Balentine 1998); recheck at 15 min while insulin or a sulfonylurea is still acting |
| Distribution | Extracellular fluid, then cells via GLUT transporters |
| Protein binding | None |
| Metabolism | Glycolysis and oxidation to CO₂ and water (label), or storage as glycogen and fat |
| Elimination | Used, not excreted, unless glucose passes the renal threshold of about 180 mg/dL |
Chemistry
- D-glucose monohydrate (C₆H₁₂O₆·H₂O, MW 198.2), an aldohexose; dextrose is the dextrorotatory D-isomer, the form the body uses
- 50% is 0.5 g/mL: 25 g in 50 mL supplies about 85 kcal (3.4 kcal/g for the hydrate)
- About 2,525 mOsm/L (label), nearly nine times plasma, with pH 3.2–6.5; above 900 mOsm/L it irritates veins, so the label wants a central or large peripheral vein
- Up to 600 mcg/L of aluminum, so not for children under 2 (label); never in the same set as blood (pseudoagglutination)
- D10 (505 mOsm/L) in median 10 g doses worked as fast as 25 g of D50 and left lower glucose (Moore 2005)
Adverse effects and cautions
In the one-pagers
- Impella Heart PumpPurge system: Base: dextrose in water (D5W recommended; 5–20% allowed). Never saline.
- Toxidromes and AntidotesCardiotoxic drugs: Beta-blockers, CCBs: High-dose insulin 1 unit/kg, then 1–10 units/kg/h: Give dextrose; check glucose, K
- Electrolyte ImbalancesHyperkalemia: stabilize, shift, remove: Shift: regular insulin 10 units IV with dextrose 25–50 g. K falls within 15 min, lowest at 30–60 min.
- Pediatric Vital Signs and Drug Doses for EMSCommon prehospital pediatric doses: Dextrose: Glucose 60 mg/dL or less: 0.5-1 g/kg: D10 5-10 mL/kg (newborn 2 mL/kg): Adult 25 g
- ABG Interpretation in 6 StepsVenous gases and sampling errors: Flush in the sample: Values diluted; glucose high if dextrose: Discard volume per protocol
- BurnsChildren, referral and transfer: Children have more surface area per kilogram, thinner skin that burns deeper at lower temperatures, small glycogen stores and narrow airways: 1 mm of edema in a 4 mm infant trachea halves the radius and raises resistance 16-fold. Formula resuscitation starts at smaller burns (over 10% TBSA in JTS 2025, 15% in some protocols) at 3 mL/kg/%TBSA plus untitrated mainten
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In the algorithms
- New Confusion or Agitation
- Agitated or Violent Patient
- Status Epilepticus
- Hyperkalemia
- Malignant Hyperthermia
- Impella Alarms
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Sources
- FDA label: Dextrose 50% syringe (Hospira, 2026)
- Balentine 1998 (glucose after D50)
- Moore 2005 (D10 vs D50)
- Al Saidi 2025 (D50 in hypoglycemia)
For education and exam preparation only. Follow your institution’s protocols. Typical adult values for study. Follow your local protocols and medical direction.