50% dextrose solution (D50) typically comes as a 50 cc prefilled syringe containing 25 grams of dextrose. As an anesthesiologist and intensivist, I most commonly administer D50 to treat profound hypoglycemia or in conjunction with insulin to cause an intracellular shift of potassium in patients with hyperkalemia. Fortunately, these syringes are readily available in all crash/code carts.

Such a concentrated glucose solution can potentially suppress our the body’s normal way of mobilizing stored glucose (gluconeogenesis and glycogenolysis) such that when D50 is withdrawn, a “rebound hypoglycemia” effect can ensue. Clinically, I don’t think I’ve actually seen this to any appreciable degree, and the literature is full of skepticism as well.

D50 is an extremely hypertonic solution (~2500 mOsm/L) even when compared to a 8.4% sodium bicarbonate (~2000 mOsm/L)! Infusion through a peripheral IV can therefore result in pain, thrombophlebitis, extravasation, and even tissue necrosis! Care must be exercised when “pushing an amp of D50” through peripheral lines or consider using D5/D10 solutions instead. If concerned and the situation isn’t emergent, you can also give it PO! After all, it’s just sugar water.

Drop me a comment below with questions! 🙂

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