Dextrose in Water (50%)

Other Names: D50W

Classification: Caloric Agent

Action: •Rapidly increases blood glucose levels •Transient osmotic diuretic

Indications: •Documented hypoglycemia (¡Ü 4 mmol) •Seizures of unknown etiology

•Cerebral/meningeal edema related to eclampsia

Contraindications: No significant contraindications in the emergency setting

Precautions 
1. •Extravasation of the tissue
2. •Suspected intracranial hemorrhage, CVA
3. •Wernicke’s encephalopathy in the alcoholic patient due to probable thiamine deficiency

Adverse Reactions
1. •Pain, phlebitis at injection site
2. •Hyperglycemia and glycosuria
3. •Fluid overload

Interactions/Compatibility/Stability
Dextrose 50% has an acidic pH  (3.5 - 5) and therefore specific compatibility information should be
consulted when Dextrose 50% is injected into an IV line containing another drug

Special Considerations 
1. •Rapid rates of administration predisposes the patient to pain and may cause phlebitis if a
peripheral vein is used; to minimize this effect administer slowly
2. •Excessive IV administration may cause fluid overload, water intoxication, +/or CHF
3. •D50W and Thiamine 100 mg IV (mini bag or IVP) should be given together when
alcoholism or malnutrition are suspected

Dosages 
Preparation: 25 g/50 ml preload (D50W)
Adult: 12.5 - 25 gm D50W slow IV, repeat PRN x 1
Pediatric:  0.5 gm/kg D25W slow IV to a maximum of 25 gm (dilute D50W 1:1 with NS), repeat
PRN x 1

Kinetics 
Onset           < 1 minute
Peak             Depends on degree of hypoglycemia
Duration      Depends on degree of hypoglycemia
This medication is used to treat people with severely low blood sugar who have symptoms such as loss of
consciousness. This medication rapidly restores your blood sugar levels. Dextrose is a natural sugar
found in the body and serves as a major energy source.This medication may also be diluted to prepare
nutritional injections for patients who cannot get enough nutrients from food or who are unable to eat by
mouth. It may also be used as part of the treatments for other conditions. When used as an energy
source, dextrose allows the body to preserve its muscle mass.

Contents Dextrose
Indications Treatment of carbohydrate & fluid depletion; hypoglycemia; to reduce
cerebrospinal pressure & cerebral edema caused by delirium tremens or acute
alcohol intoxication.
Dosage Individualized dosage based on patient requirements. Max rate of glucose
utilization: 500-800 mg/kg/hr. Emergency treatment of hypoglycemia 3
mL/min slow IV via peripheral vein.
Contraindications Patients w/ anuria, intracranial or intraspinal hemorrhage, delirium tremens w/
dehydration. Glucose-galactose malabsorption syndrome. Acute ischemic strokes.
Special Precautions Diabetes insipidus.

Adverse Drug Local pain, vein irritation, thrombophlebitis & tissue necrosis in the event of
Reactions
extravasation. Fluid & electrolyte imbalance eg hypokalemia, hypomagnesemia &
hypophosphatemia; edema or water intoxication.
View ADR Monitoring Website

 Insulin (e.g. intravenous injection of 10-15 units of regular insulin along with 50ml of 50%

dextrose to prevent hypoglycemia) will lead to a shift of potassium ions into cells, secondary to

increased activity of the sodium-potassium ATPase. Note that, glucose should be given first, before

insulin is given. It is also advised to check serum glucose levels via accucheck 30 minutes and 60

minutes after to ensure that the patient does not become hypoglycemic. The duration of action of this

treatment is 3-4 hours, and may be repeated as needed. Note that insulin-D50 acts with 15 minutes,

and acts via trasnferring potassium ions from serum to inracellular space.

 Bicarbonate therapy (e.g. 1 ampule (45mEq) infused over 5 minutes) is effective in cases

of metabolic acidosis. The bicarbonate ion will stimulate an exchange of cellular H + for Na+, thus

leading to stimulation of the sodium-potassium ATPase.