Dosing and uses of Dextrose (antidote)
Adult dosage forms and strengths
IV solution
- D50W
Acute Alcohol Intoxication
25-50 g (50-100 mL); administer with thiamine (50-100 mg IV) to prevent Wernicke's encephalitis
Sulfonylurea Overdose
10-25 g (40-100 mL of 25% solution; 20-50 mL of 50% solution) IV; may require repeated boluses
Insulin Overdose
400-600 mg of glucose/kg/hr needed for most insulin overdoses
Hyperkalemia
25-50 g (250-500 mL D10W) plus 10 units regular insulin IV over 30-60 min
Other Indications & Uses
Hypoglycemia (sulfonylurea poisoning, excess exogenous or endogenous insulin, alcohol, nutritional deprivation, metabolic derangement)
Known diabetic, alcoholic or patient with unknown history all manifesting confusion/delirium in absence of focal neurologic findings, but normal accucheck
Hyperkalemia (given with insulin) to force K+ intracellularly
Pediatric dosage forms and strengths
IV solution
- D50W
Insulin Induced Hypoglycemia
Neonates (<28 days old): 250-500 mg/kg/dose (1-2 mL/kg/dose D25W)
Children: 0.5-1g/kg/dose (2-4 mL/kg/dose D25W)
Geriatric dosage forms and strengths
Acute alcohol intoxication
25-50 g (50-100 mL); administer with thiamine (50-100 mg IV) to prevent Wernicke's encephalitis
Sulfonylurea overdose
10-25 g (40-100 mL of 25% solution; 20-50 mL of 50% solution) IV; may require repeated boluses
Insulin overdose
400-600 mg of glucose/kg/hr needed for most insulin overdoses
Hyperkalemia
25-50 g (250-500 mL D10W) plus 10 units regular insulin IV over 30-60 min
Dextrose (antidote) adverse (side) effects
Frequency not defined
Possibility of intracellular lactic acid production in setting of ischemic brain cells & hyperglycemia
Hypokalemia
Edema
Phlebitis
Venous thrombosis
Metabolic acidosis
Diarrhea
Polydipsia
Vein irritation
Extravasation can result in tissue damage
Pharmacology of Dextrose (antidote)
Mechanism of action
Substrate for ATP production for aerobic metabolism; promotes glycogen deposition in the liver
In hyperkalemia dextrose in combination with insulin stimulates the uptake of potassium by cells (especially in muscle tissue), which in turn lowers serum potassium
Pharmacokinetics
Onset of action: 10 min (PO; treatement of hypoglycemia)
Absorption: Rapid from the small intestine
Time to peak: 40 min (PO)
