50% dextrose solution (D50W) typically comes as a 50 cc pre-filled syringe containing 25 grams of dextrose. As a cardiac anesthesiologist and intensivist, I most commonly administer D50W to treat profound hypoglycemia or in conjunction with insulin to induce 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suppress the body’s usual way of mobilizing stored glucose (gluconeogenesis and glycogenolysis) such that when D50W is withdrawn, a “rebound hypoglycemia” effect can ensue. Clinically, I don’t think I’ve seen this to any appreciable degree, and the literature is full of skepticism as well.
D50W is an extremely hypertonic solution (~2500 mOsm/L) even when compared to an 8.4% sodium bicarbonate (~2000 mOsm/L)! Infusion through a peripheral IV can result in pain, thrombophlebitis, extravasation, and even tissue necrosis! Care must be taken when “pushing an amp of D50” through peripheral lines, or consider using D5W/D10W solutions instead. The hyperosmolar nature of D50W may also explain why some patients experience transient hypotension upon rapid administration (a mechanism that likely involves osmoreceptor neural reflexes).
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