By Philip Neuwirth, BS, MICP, CCEMTP, FP-C
If your “standing orders” or “protocols” are anything like we have in New Jersey, they probably haven’t been updated in quite some time; in some cases years. Why do we still give 25g of D50 in patients who are hypoglycemic [Adults with BS<60]?
Just recently, I had an unconscious diabetic patient. My partner was starting an IV, and I was checking the patients BS. As soon as I noticed the patient’s blood sugar was 24 mg/dl, I through my partner that big blue box of D50. Why? Because (1) that’s what we have always done, and (2) it’s written in our states “standing orders.” The patient became alert and oriented to person, place and time and refused transport [as they normally do]. The repeat blood sugar was 180mg/dl. We explained to the patient, before you sign “RMA,” you must agree to eat some complex carbohydrates, etc. because the dextrose won’t last that long and you could have rebound hypoglycemia. The patient agreed, signed “RMA” and we left.
What is wrong with that? After all, we treated our hypoglycemic patient, woke the patient up, assured he was AxOx3, had stable vital signs and went back into service. The problem, which other states have already recognized is D50 is not necessarily the correct concentration. What about overshooting glycemic targets, rebound hypoglycemia, local skin irritation, thrombophlebitis, and the risk of extravasation with subsequent tissue necrosis.
It may be reasonable to consider other treatment approaches that may be less likely to complicate patients blood sugar variability.
EVIDENCE FOR USE OF 10% DEXTROSE (D10)
The following article was written by Paul Rostykus, MD, MPH who has been an EMS medical director in Southern Oregon for 25 years and has a subspecialty certification in EMS.
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