Abstract
Design: Randomised controlled trial.
Setting: Out of hospital patients attended by paramedics from a large UK ambulance service.
Participants: 51 unresponsive adult patients with blood glucose levels ⩽4 mmol/l.
Intervention: 5 g (50 ml) intravenous aliquots of 10% dextrose or 5 g (10 ml) intravenous aliquots of 50% dextrose to a maximum dose of 25 g.
Main outcome measures: To compare for each dextrose concentration the time to achieve a Glasgow Coma Scale (GCS) score of 15, and the dose required to obtain a blood glucose level of ⩾4.5 mmol/l.
Results: There were no statistically significant differences between the groups with regard to age or sex, median pretreatment GCS, pretreatment blood glucose level, or proportion of patients with insulin dependent diabetes. Following treatment, there were no statistically significant differences in median time to recovery (8 minutes), median post-treatment GCS, or number of subjects experiencing a further hypoglycaemic episode within 24 hours (four per group). The median total dose of dextrose administered was significantly less with the 10% concentration (10% = 10 g, 50% = 25 g, p<0.001) and median post-treatment blood sugar levels were also significantly lower (10% = 6.2 mmol/l and 50% = 9.4 mmol/l, p = 0.003). There were no reports of extravasation injuries in either group.
Conclusions: Dextrose 10% delivered in 5 g (50 ml) aliquots is administered in smaller doses than dextrose 50% delivered in 5 g/10 ml aliquots, resulting in lower post-treatment blood glucose levels. We therefore recommend it as the intravenous treatment of choice for adult hypoglycaemia.
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Selected References
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- Browning R. G., Olson D. W., Stueven H. A., Mateer J. R. 50% dextrose: antidote or toxin? Ann Emerg Med. 1990 Jun;19(6):683–687. doi: 10.1016/s0196-0644(05)82479-5. [DOI] [PubMed] [Google Scholar]
- Carstens S., Sprehn M. Prehospital treatment of severe hypoglycaemia: a comparison of intramuscular glucagon and intravenous glucose. Prehosp Disaster Med. 1998 Apr-Dec;13(2-4):44–50. [PubMed] [Google Scholar]
- Collier A., Steedman D. J., Patrick A. W., Nimmo G. R., Matthews D. M., MacIntyre C. C., Little K., Clarke B. F. Comparison of intravenous glucagon and dextrose in treatment of severe hypoglycemia in an accident and emergency department. Diabetes Care. 1987 Nov-Dec;10(6):712–715. doi: 10.2337/diacare.10.6.712. [DOI] [PubMed] [Google Scholar]
- Gault D. T. Extravasation injuries. Br J Plast Surg. 1993 Mar;46(2):91–96. doi: 10.1016/0007-1226(93)90137-z. [DOI] [PubMed] [Google Scholar]
- Hans P., Bonhomme V. The rationale for perioperative brain protection. Eur J Anaesthesiol. 2004 Jan;21(1):1–5. doi: 10.1017/s0265021504001012. [DOI] [PubMed] [Google Scholar]
- Howell M. A., Guly H. R. A comparison of glucagon and glucose in prehospital hypoglycaemia. J Accid Emerg Med. 1997 Jan;14(1):30–32. doi: 10.1136/emj.14.1.30. [DOI] [PMC free article] [PubMed] [Google Scholar]
- MacCuish A. C., Munro J. F., Duncan L. J. Treatment of hypoglycaemic coma with glucagon, intravenous dextrose, and mannitol infusion in a hundred diabetics. Lancet. 1970 Nov 7;2(7680):946–949. doi: 10.1016/s0140-6736(70)92126-4. [DOI] [PubMed] [Google Scholar]
- Patrick A. W., Collier A., Hepburn D. A., Steedman D. J., Clarke B. F., Robertson C. Comparison of intramuscular glucagon and intravenous dextrose in the treatment of hypoglycaemic coma in an accident and emergency department. Arch Emerg Med. 1990 Jun;7(2):73–77. doi: 10.1136/emj.7.2.73. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Robinson Lindsay E., van Soeren Mary H. Insulin resistance and hyperglycemia in critical illness: role of insulin in glycemic control. AACN Clin Issues. 2004 Jan-Mar;15(1):45–62. doi: 10.1097/00044067-200401000-00004. [DOI] [PubMed] [Google Scholar]
- Steel J. M., Allwinkle J., Moffat R., Carrington D. J. Use of Lucozade and glucagon by ambulance staff for treating hypoglycaemia. BMJ. 1992 May 16;304(6837):1283–1284. doi: 10.1136/bmj.304.6837.1283. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Vukmir R. B., Paris P. M., Yealy D. M. Glucagon: prehospital therapy for hypoglycemia. Ann Emerg Med. 1991 Apr;20(4):375–379. doi: 10.1016/s0196-0644(05)81658-0. [DOI] [PubMed] [Google Scholar]