Bedside Snapshot
  • Core dose: Severe hypoglycemia: 25 g IV (D50W 50 mL OR D10W 250 mL); moderate hypoglycemia or fragile access: D10W 100–250 mL; with insulin for hyperkalemia: 25 g dextrose + 10 units regular insulin IV
  • Onset/duration: Onset within minutes; duration depends on underlying cause, hepatic glycogen stores, and ongoing insulin/sulfonylurea effects
  • Key danger: D50W is highly sclerosing/vesicant → severe phlebitis and tissue necrosis with extravasation; rebound hypoglycemia (especially with sulfonylureas); overshoot hyperglycemia
  • Special: D10W = 0.1 g/mL, D25W = 0.25 g/mL, D50W = 0.5 g/mL; prefer D10W for fragile access or pediatrics; monitor glucose every 15–30 min initially; may need dextrose infusion for recurrent hypoglycemia
Brand & Generic Names
  • Generic Name: dextrose (glucose) injection; concentrations 5%, 10%, 25%, 50% (w/v)
  • Brand Names: Dextrose injection (various premix bags/syringes: D10W, D25W, D50W)
Medication Class

Carbohydrate; hypertonic IV solution; antidote for hypoglycemia; substrate with insulin therapy

Pharmacology

Mechanism of Action:

  • Provides exogenous glucose to rapidly raise plasma glucose and reverse neuroglycopenic symptoms
  • Hypertonic solutions (D25W, D50W) exert osmotic effects and are sclerosing to veins
  • With insulin (e.g., hyperkalemia therapy, high-dose insulin euglycemia for CCB/β-blocker toxicity), dextrose prevents hypoglycemia while insulin drives intracellular glucose and potassium shifts

Key Pharmacokinetics / Product Facts:

  • Onset IV: minutes; effect duration depends on underlying cause and hepatic glycogen
  • Distribution: Largely extracellular initially; rapidly taken up by insulin-sensitive tissues
  • Metabolism: Glycolysis and oxidative pathways; excess filtered → osmotic diuresis if severe hyperglycemia occurs
  • Concentrations: D10W = 100 mg/mL (0.1 g/mL); D25W = 250 mg/mL (0.25 g/mL); D50W = 500 mg/mL (0.5 g/mL)
  • Elemental "grams per typical dose": 25 g = 250 mL of D10W, 100 mL of D25W, or 50 mL of D50W
  • Extravasation risk: Increases with concentration; D50W has the highest risk of tissue injury/necrosis
Indications
  • Symptomatic hypoglycemia (altered mental status, seizures, coma)
  • Prevention/treatment of hypoglycemia during insulin therapy for hyperkalemia or high-dose insulin euglycemia therapy in CCB/β-blocker toxicity
  • Adjunct to dextrose-containing maintenance fluids (e.g., D10W infusion) in refractory/recurrent hypoglycemia (e.g., sulfonylurea overdose with octreotide)
  • Neonatal and pediatric hypoglycemia using age-appropriate concentrations (prefer D10W)
Conditions Treated
  • Symptomatic hypoglycemia (all causes)
  • Sulfonylurea-induced hypoglycemia
  • Insulin overdose
  • Prevention of hypoglycemia during insulin therapy (hyperkalemia, CCB/β-blocker toxicity)
  • Neonatal/pediatric hypoglycemia
Dosing & Administration

Available Forms:

  • D10W (10% dextrose): 100 mg/mL (0.1 g/mL)
  • D25W (25% dextrose): 250 mg/mL (0.25 g/mL)
  • D50W (50% dextrose): 500 mg/mL (0.5 g/mL)

Adult Dosing:

Indication Dose Notes
Severe symptomatic hypoglycemia 25 g IV (D50W 50 mL IV push OR D10W 250 mL) Reassess glucose and mental status in 5–10 min; repeat to effect
Moderate hypoglycemia or fragile peripheral access D10W boluses (100–250 mL) or short infusion Reduces overshoot hyperglycemia and extravasation risk vs D50W
Recurrent/sulfonylurea-associated hypoglycemia Initial correction as above, then D10W infusion + octreotide Titrate to maintain glucose ~100–150 mg/dL
Hyperkalemia (insulin/dextrose regimen) Regular insulin 10 units IV with 25 g dextrose IV Omit dextrose if initial glucose markedly elevated; monitor glucose ≥4–6 h

Pediatric Dosing:

  • Avoid D50W; prefer D10W
  • Typical dosing: 0.25 g/kg (2.5 mL/kg D10W) IV
  • Some protocols use 0.5 g/kg (5 mL/kg D10W) based on severity

Neonatal Dosing:

  • D10W 2 mL/kg IV bolus then infusion (e.g., 4–8 mg/kg/min) titrated to glucose and clinical status
  • Avoid D25W/D50W due to risk of intracranial hemorrhage and rebound hyperglycemia

Administration:

  • Use a large, patent vein; monitor site
  • For D50W, push slowly through a running line
  • Consider D10W when only small fragile peripheral veins are available
Contraindications

Contraindications:

  • Hyperglycemia without hypoglycemic symptoms/treatment indication
  • Known hypersensitivity to dextrose (rare)

Precautions:

  • Ischemic stroke or intracranial hemorrhage—treat hypoglycemia promptly but avoid hyperglycemia after correction (worsens neurologic outcomes)
  • Chronic alcohol use/malnutrition: give thiamine 100 mg IV before or with dextrose to reduce risk of precipitating Wernicke encephalopathy—do not delay correction of hypoglycemia
  • Electrolytes: dextrose with insulin can cause hypokalemia; monitor potassium, especially in renal or cardiac patients
  • Vascular access: D25W/D50W are vesicants—prefer lower concentrations, secure IV access, and monitor for extravasation
Thiamine: Give thiamine 100 mg IV before or with dextrose in chronic alcohol use/malnutrition to reduce risk of Wernicke encephalopathy. Do not delay hypoglycemia correction.
Adverse Effects
  • Hyperglycemia
  • Hypokalemia (with insulin)
  • Fluid shifts/osmotic diuresis
  • Phlebitis
  • Extravasation injuries with concentrated solutions (pain, induration, skin necrosis)
  • Rebound hypoglycemia, especially after short-acting carbohydrates or with sulfonylurea ingestion
Clinical Pearls
D10W vs D50W Strategy: D10W bolus strategy (e.g., 100–250 mL) achieves euglycemia with less overshoot and lower extravasation risk than D50W; both deliver the same grams when doses are matched.
Sulfonylurea-Induced Hypoglycemia: Repeated dextrose boluses alone are a setup for rebound—start octreotide early.
Insulin-Based Hyperkalemia Therapy: Continue glucose monitoring for several hours; delayed hypoglycemia is common, especially with renal failure.
D50W Extravasation: If D50W extravasates: stop infusion, leave catheter, aspirate residual drug, elevate limb; consider hyaluronidase and warm compress per institutional protocol.
Documentation: Document grams delivered, not just volume—helps reconcile D10 vs D50 dosing across settings.
References
  • 1. Papadopoulos, J. (2008). Pocket guide to critical care pharmacotherapy. Humana Press.
  • 2. Medscape. (n.d.). Dextrose injection (IV) – drug monograph and dosing. Retrieved 2025-11-12, from https://reference.medscape.com
  • 3. Medscape. (n.d.). Hypoglycemia: Treatment & management. Retrieved 2025-11-12, from https://emedicine.medscape.com
  • 4. Medscape. (n.d.). Sulfonylurea toxicity: Treatment. Retrieved 2025-11-12, from https://emedicine.medscape.com
  • 5. DrugBank Online. (n.d.). Dextrose (glucose). Retrieved 2025-11-12, from https://go.drugbank.com
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