Hypoglycaemia
IV/IO Dextrose Rule of 50!
How to correct hypoglycaemia:
- Neonate 5 ml/kg of 10% Dextrose (10×5=50)
- Infant 2 ml/kg of 25% Dextrose (25×2=50)
- Older child or Adult 1 ml/kg of 50% Dextrose (50×1=50)
How to make different Dextrose solutions:
- 50 ml of 50% Dextrose + 50 ml NS = 25% Dextrose
- 50 ml of 50% Dextrose + 150 ml NS = 12.5% Dextrose
Adrenal Crisis
Adrenal crisis is a life-threatening emergency due to an acute deficiency of adrenocortical hormones, namely cortisol and aldosterone, which can be fatal if not diagnosed early and treated aggressively. Classically it presents as severe hypotension refractory to IV fluids and vasopressors.
Diagnostic Criteria:
- Hypoglycemia
- Hyponatremia (<135mEq/L)
- Hyperkalemia (>5mEq/L)
- Non-anion gap metabolic acidosis
- Low bicarbonate (15-20mEq/L)
- Elevated BUN and creatinine
Did you know?
- Saline’s designation as “normal” was based on an erroneous calculation of the salt concentration in human blood as 0.9% back in 1882 (it’s actually 0.6%)
- Hypoglycemia is a common finding in malaria. Malaria parasitized red blood cells utilize glucose 75 times faster than uninfected cells.
Hyperkalemia Management: Preventing Hypoglycemia From Insulin
DID YOU KNOW: The hypoglycemic effects of IV insulin last longer than a bolus of dextrose when correcting hyperkalaemia. 50 mL (25 gm) of 50% Dextrose is not enough to counteract the hypoglycemic effect of insulin in patients with normoglycemia to start. Make sure to check glucose at the hour mark after administering IV insulin. Insulin’s peak effect occurs at about 60 minutes and this is when hypoglycemia has most often been reported in the literature.
5/2/1 – 50! Dextrose volume for hypoglycemia
There is a quick memory aid that will help you remember how much dextrose to give to patients with hypoglycemia. It is commonly known as the 5/2/1 rule, or the rule of 50.
D10 5 mL/kg
D25 2 mL/kg
D50 1 mL/kg
Note that all three, when multiplied, equal 50 (e.g. 5ml/kg x 10 = 50)
Given the hypertonicity of D50 it can be dangerous to give through a peripheral IV. It can cause phlebitis and thrombosis and in pediatric patients it is rarely indicated, especially when D10 or D25 (in bigger kids) will work just as well.