A review of the efficacy of 10% dextrose as an alternative to high concentration glucose in the treatment of out-of-hospital hypoglycaemia

Abstract

Introduction

Dextrose 50% is commonly accepted as the primary management of severe hypoglycaemia, however its position seems to be by default rather than clinical or research significance. The use of 10% dextrose by some prehospital care providers has demonstrated greater practical and physiological advantages, with less clinical implications than higher concentrations. The objective of this study was to review the literature into the efficacy of intravenous 10% dextrose in the management of out-of-hospital hypoglycaemia.

Methods

A review of select electronic databases was conducted from their commencement to the end of March 2008. Inclusion criteria was any article which evaluated the administration of intravenous glucose within any setting/discipline, or when compared to any alternative intervention. Exclusion criteria were articles pertaining to the administration of glucose other than in the emergency management of hypoglycaemia.

Results

The search yielded 3,651 potential articles, with 24 meeting the inclusion/exclusion criteria. Dextrose 10% has demonstrated equal time to restoration of conscious state at smaller doses, with reductions in post-treatment blood sugar levels than the higher 50% concentration. The risk of extravasation injuries and potential clinical ramifications in paediatrics are compelling reasons to consider a shift away from higher concentrations of glucose. The titration of 10% dextrose to patient conscious state has been utilised by other prehospital care providers in replacement of bolus doses of 50% preparations.

Conclusion

There is evidence to suggest that the titration of 10% dextrose to conscious state in severe hypoglycaemia is as efficacious as the administration of 50% dextrose, while reducing associated risks and producing better post-treatment outcomes.