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Dextrose 50% versus Dextrose 10% or Dextrose Titration for the Treatment of Out-of-Hospital Hypoglycemia: A Systematic Review

Published online by Cambridge University Press:  04 October 2021

Marissa Hurtubise
Affiliation:
Emergency Health Services, Dartmouth, Nova Scotia, Canada
Jeffery Stirling
Affiliation:
Emergency Health Services, Dartmouth, Nova Scotia, Canada
Jennifer Greene*
Affiliation:
Emergency Health Services, Dartmouth, Nova Scotia, Canada Dalhousie University Department of Emergency Medicine, Division of Emergency Medical Services, Halifax, Nova Scotia, Canada Nova Scotia Health, Department of Emergency Medicine, Halifax, Nova Scotia, Canada
Alix JE Carter
Affiliation:
Emergency Health Services, Dartmouth, Nova Scotia, Canada Dalhousie University Department of Emergency Medicine, Division of Emergency Medical Services, Halifax, Nova Scotia, Canada Nova Scotia Health, Department of Emergency Medicine, Halifax, Nova Scotia, Canada
Janel Swain
Affiliation:
Emergency Health Services, Dartmouth, Nova Scotia, Canada Dalhousie University Department of Emergency Medicine, Division of Emergency Medical Services, Halifax, Nova Scotia, Canada
Ryan Brown
Affiliation:
Dalhousie University Department of Emergency Medicine, Division of Emergency Medical Services, Halifax, Nova Scotia, Canada Nova Scotia Health, Department of Emergency Medicine, Halifax, Nova Scotia, Canada
Dana Fidgen
Affiliation:
Emergency Health Services, Dartmouth, Nova Scotia, Canada Dalhousie University Department of Emergency Medicine, Division of Emergency Medical Services, Halifax, Nova Scotia, Canada
Judah P. Goldstein
Affiliation:
Emergency Health Services, Dartmouth, Nova Scotia, Canada Dalhousie University Department of Emergency Medicine, Division of Emergency Medical Services, Halifax, Nova Scotia, Canada
*
Correspondence: Jennifer Greene, ACP, MSc(c) Dalhousie University Department of Emergency Medicine Division of Emergency Medical Services Halifax Infirmary, Suite 3021 1796 Summer Street Halifax, Nova ScotiaB3H 3A7Canada E-mail: j.greene@dal.ca

Abstract

Introduction:

Paramedics commonly administer intravenous (IV) dextrose to severely hypoglycemic patients. Typically, the treatment provided is a 25g ampule of 50% dextrose (D50). This dose of D50 is meant to ensure a return to consciousness. However, this dose may cause harm and lead to difficulties regulating blood glucose levels (BGLs) post-treatment. It is hypothesized that a lower concentration, such as 10% dextrose (D10), may improve symptoms while minimizing harm.

Methods:

PubMed, Embase, CINAHL, and Cochrane Central were systematically searched on September 15, 2020. The PRISMA guidelines were followed. GRADE and risk of bias were applied to determine the certainty of the evidence. Primary literature investigating the use of IV dextrose in hypoglycemic diabetic patients presenting to paramedics or the emergency department was included. Outcomes of interest included safety, efficacy (symptom resolution), and BGL.

Results:

Of 680 abstracts screened, 51 full-text articles were reviewed, with eleven studies included. Data from three randomized controlled trials (RCTs) and eight observational studies were analyzed. A single RCT comparing D10 to D50 was identified. The primary significant finding of the study was an increased post-treatment glycemic profile by 3.2mmol/L in the D50 group; no other outcomes had significant differences between groups. When comparing pooled data from all the included studies, there was greater symptom resolution in the D10 group (95.9%) compared to the D50 group (88.8%). However, the mean time to resolution was approximately four minutes longer in the D10 group (4.1 minutes [D50] versus 8.0 minutes [D10]). There was a greater need for subsequent doses with the use of D10 (19.5%) compared to D50 (8.1%). The post-treatment glycemic profile was lower in the D10 group at 6.2mmol/L versus 8.5mmol/L in the D50 group. Both treatments had nearly complete resolution of hypoglycemia: 98.7% (D50) and 99.2% (D10). No adverse events were observed in the D10 group (0/1057) compared to 13/310 adverse events in the D50 group.

Conclusion:

Studies show D10 may be as effective as D50 at resolving symptoms and correcting hypoglycemia. Although the desired effect can take several minutes longer, there appear to be fewer adverse events. The post-D10-treatment BGL may result in fewer untoward hyperglycemic episodes.

Type
Systematic Review
Copyright
© The Author(s), 2021. Published by Cambridge University Press on behalf of the World Association for Disaster and Emergency Medicine

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