Dextrose 10%

Provider Level

AEMT/RN/Paramedic

Class

Carbohydrate solution / antihypoglycemic agent

Mechanism of Action

Provides exogenous glucose to increase serum glucose concentration; dextrose is metabolized to produce ATP via glycolysis, supplying rapid energy substrate to tissues, particularly the central nervous system, which relies on glucose as its primary energy source.

Indications

Symptomatic hypoglycemia; altered mental status of suspected or confirmed hypoglycemic origin; adjunct in management of suspected hyperkalemia (in conjunction with insulin per protocol); unresponsive patients with unknown etiology when hypoglycemia cannot be excluded.

Contraindications

Known hyperglycemia without evidence of symptomatic low glucose; intracranial hemorrhage (relative, per local protocol); known allergy to corn or corn products (rare); avoid in patients with adequate oral intake tolerance where oral glucose is appropriate alternative.

Routes

IV, IO

Onset / Duration

Onset typically within 1-5 minutes via IV/IO administration; duration of effect variable depending on underlying cause of hypoglycemia and concurrent carbohydrate intake, generally lasting 20-60 minutes before reassessment and possible redosing may be required.

Adverse Effects

Local venous irritation or phlebitis; extravasation may cause tissue necrosis due to hypertonicity; hyperglycemia; rebound hypoglycemia; possible exacerbation of neurological injury in ischemic stroke or hypoxic brain injury; nausea; local site pain; rare hypersensitivity reactions.

Precautions & Interactions

Confirm IV/IO patency prior to administration due to risk of extravasation and tissue injury; obtain blood glucose measurement before and after administration when feasible; use with caution in neonates and pediatric patients due to differing concentration requirements and risk of hyperglycemia; use cautiously in patients with known or suspected stroke; monitor for rebound hypoglycemia, especially with sulfonylurea-induced hypoglycemia; consider underlying etiology requiring further glucose support or additional interventions.

Special Considerations

Reassess mental status and repeat blood glucose after administration; consider concurrent thiamine administration in patients with suspected chronic alcohol use or malnutrition to reduce risk of precipitating Wernicke encephalopathy; pediatric and neonatal patients may require different concentrations (e.g., D10 preferred over higher concentrations in neonates) per local protocol; document response to treatment and transport for further evaluation of underlying cause of hypoglycemia.