# Rectal D50



## crotchitymedic1986 (Jan 10, 2009)

I am new here, and have been active in another ems forum.  Recently a question was posted about the use of Glucagon in the hypoglycemic patient that you can not get IV access for.  The question was about what you should do next, if glucagon doesnt work ?

I was shocked to realize that most new medics did not know that D50 can be given orally (but soda is better -- a 12oz coke has 39 gms of sugar versus 25 gms in D50), and that D50 can be given rectally via an ETT tube.  

Thought I would share the info in case some in this forum were not aware.


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## fma08 (Jan 10, 2009)

Some first responders thought that oral gucose could be given IV (and V in this case does not mean venous) :blink:


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## ffemt8978 (Jan 10, 2009)

fma08 said:


> some first responders thought that oral gucose could be given iv (and v in this case does not mean venous) :blink:



tmi!!!!!!!!!


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## reaper (Jan 10, 2009)

Yes, I have given it rectal. I did not use an ETT, I use a foot long piece of O2 tubing. It is smaller, slide up easy and the connector fits the syringe good.


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## medic_charli (Jan 10, 2009)

Yup - knew that - have used d50 via iv, oral, and rectal.  Kinda like the honey bear theory.  Or a large sized tootsie roll.   We can get pretty ingenious.


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## emtjack02 (Jan 11, 2009)

Those are all great ideas and wow musta been _interestingtimes. To bad my protocols don't specify those as routes for my d50_


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## Bosco578 (Jan 11, 2009)

I prefer the intra ocular route.:usa:


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## rhan101277 (Jan 11, 2009)

Well what if they have some stool up in there?


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## Ridryder911 (Jan 11, 2009)

Although going past the rectal vault is the best method it is doubtful that most EMS units carry proper tubing to do such, as well remembering one has to administer 50ml of fluid which is equivalent to an enema. I give it blunt (without tubing) personally, don't care to cause a rectal tear or lacerated bowel. Yes, it works and can be given, just expect other results as well. 

In regards to the stool it will loosen and dissolve it and again as mentioned above. 

R/r 911


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## DrankTheKoolaid (Jan 11, 2009)

*re*

sweet and sour enema anybody?

Corky


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## mikeylikesit (Jan 12, 2009)

Yeah i have done rectal once and it was on a longer transport....bad idea, I bet the guy felt relieved and a little dirty at the same time. anyways you can and some do but i would go oral first, and airway is much easier and more pleasant to watch than the other way.


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## lizhiniatsos (Jan 13, 2009)

........intra ocular....good one!


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## WiFi_Cowgirl (Jan 20, 2009)

Isn't Dextrose caustic to tissues? Wouldn't that cause some sort of damage to the rectum?


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## Emtgirl21 (Jan 20, 2009)

Our medical director doesnt encourage us to administer anything rectally. We have even went to versed intra-nasal in seizures vs using diazpam rectally.


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## marineman (Jan 20, 2009)

mikeylikesit said:


> and airway is much easier and more pleasant to watch than the other way.



Especially when "the other way" becomes and airway.


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## emtbill (Jan 20, 2009)

Uhhh...Glucagon anyone??


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## reaper (Jan 20, 2009)

Glucogon will not work if their peripheral circulatory system is shut down.


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## Ridryder911 (Jan 20, 2009)

WiFi_Cowgirl said:


> Isn't Dextrose caustic to tissues? Wouldn't that cause some sort of damage to the rectum?


Probably not. It is caustic internally because of the concentration level and being colloid. Remember, mucosa membrane also has aciditic secretions as well. 




Emtgirl21 said:


> Our medical director doesnt encourage us to administer anything rectally. We have even went to versed intra-nasal in seizures vs using diazpam rectally.



Versed is a much better medication as it actually ceases the seizure activity itself; Valium only relaxes the muscles and truly does not stop the seizure. Diastat is Valium specifically made for rectal insertion. A syringe type device that has a long tube on the end and has a gel type medication. 

R/r 911


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## emtjack02 (Jan 22, 2009)

Why will glucagon not work if peripheral is shut down? How shut down, like blue arms and legs?


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## JPINFV (Jan 22, 2009)

Glucagon is a hormone that acts on the liver to break down glycogen into glucose and release said glucose into the blood stream (side note: muscle cells also have a stock pile of glycogen, but can't release it. Glycogen is broken down into glucose-6 phosphate and the muscle cells lack the enzyme needed to change G-6P into glucose). If the injected glucagon doesn't reach the liver because there isn't enough bloodflow, then it won't have an effect.


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## emtjack02 (Jan 22, 2009)

So the statement that glucagon will not work isn't entirely accurate...the route is the problem.  If one was to give it nasally it should still work.


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## reaper (Jan 22, 2009)

It might work fine nasally, but I have never seen a protocol that allows it to be given nasally. Anyone out there have one?


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## emtjack02 (Jan 22, 2009)

Ours does. Also, diazepam, Versed, narcan, morphine.


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## reaper (Jan 22, 2009)

Morphine nasally? I would like to see your protocols, if they are online?


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## GonnaBeEMT (Jan 22, 2009)

Would IO administration be out of the question?


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## emtjack02 (Jan 22, 2009)

Sorry, they are not online. I can try to answer any questions for you.  
IO: I dont' believe would be totally out of line if we're considering intranasal glucagon.  I would probably be more apt to use IO if the pt was in a shock type state.


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## Dobby (Jan 22, 2009)

This is not dobby but another paramedic looking over her shoulderh34r:. Glucogon is awesome and will work in most cases. If it does not and IVI access is not available I would rather insert a NG tube and keep the pt lateral. Then place Dex 50% down the tube (keep suction handy). Bucal application of glucogel will also give you some time. Not sure i want to go down THERE!! Please referance research to the administration of dextrose rectally and its efficacy. This does sound interisting and I have no evidence to discredit it and have not heard about it, but if i dont have to "drop em" I wont.:blush:


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## mycrofft (Jan 22, 2009)

*Hyperosmotic solution to the lower GI tract causes diarreah.*

Any questions?


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## JPINFV (Jan 22, 2009)

Sure, I've got a question for you. Which is worse, diarrhea or dead brain cells?


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## WiFi_Cowgirl (Jan 22, 2009)

I dunno, I'm not a fan of anything that involves the word Rectal, or inserting anything into said Rectum.


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## JPINFV (Jan 22, 2009)

While I'm all for the anus being a one way road, in an emergency even one way roads can be utilized 'against traffic.'


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## mikeylikesit (Jan 22, 2009)

ideally nasally should work do to the amount of mucous membranes in that route!


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## Emtgirl21 (Jan 22, 2009)

We have protocols for nasal administeration of versed.


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## maxwell (Jan 31, 2009)

crotchitymedic1986 said:


> I am new here, and have been active in another ems forum.  Recently a question was posted about the use of Glucagon in the hypoglycemic patient that you can not get IV access for.  The question was about what you should do next, if glucagon doesnt work ?
> 
> I was shocked to realize that most new medics did not know that D50 can be given orally (but soda is better -- a 12oz coke has 39 gms of sugar versus 25 gms in D50), and that D50 can be given rectally via an ETT tube.
> 
> Thought I would share the info in case some in this forum were not aware.



Absolutely not.  Rectal D50?  Zero rationale.  Sorry.  I mean, you can give anything rectally.  Rectal valium I understand for infantile seizures that require tx.  But D50?  A hypertonic, viscous, nasty drug?  Just give glucagon IM!  If you're ja pressed to get access, go I/O and give the dextrose through there. No reason for rectal D50.  I'd venture to say it's stupid.  Just repeat the glucagon!

My favorite saying goes as follows:
"It's not that the medicine doesn't work, it's that you're not giving enough of it."


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## medic417 (Jan 31, 2009)

maxwell said:


> Absolutely not.  Rectal D50?  Zero rationale.  Sorry.  I mean, you can give anything rectally.  Rectal valium I understand for infantile seizures that require tx.  But D50?  A hypertonic, viscous, nasty drug?  Just give glucagon IM!  If you're ja pressed to get access, go I/O and give the dextrose through there. No reason for rectal D50.  I'd venture to say it's stupid.  Just repeat the glucagon!
> 
> My favorite saying goes as follows:
> "It's not that the medicine doesn't work, it's that you're not giving enough of it."



And if you were going rectal use oral glucose as it actually has more sugar than D-50 and is thicker so more likely to have time to be absorbed, rather than oozing out.


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## maxwell (Jan 31, 2009)

Or don't give anything rectally!  But yes, with respect to concentration - PO glucose is much more concentrated.


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## reaper (Jan 31, 2009)

Rectal D50 has been around for ever. It is another way to administer it.

You can give all the Glucagon you want, when the stores run out, it will not work and the pt will crash hard!


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## GonnaBeEMT (Jan 31, 2009)

I agree with you.... What is with all the butt bandits on here? lol 




maxwell said:


> Absolutely not.  Rectal D50?  Zero rationale.  Sorry.  I mean, you can give anything rectally.  Rectal valium I understand for infantile seizures that require tx.  But D50?  A hypertonic, viscous, nasty drug?  Just give glucagon IM!  If you're ja pressed to get access, go I/O and give the dextrose through there. No reason for rectal D50.  I'd venture to say it's stupid.  Just repeat the glucagon!
> 
> My favorite saying goes as follows:
> "It's not that the medicine doesn't work, it's that you're not giving enough of it."


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## rmellish (Jan 31, 2009)

reaper said:


> You can give all the Glucagon you want, when the stores run out, it will not work and the pt will crash hard!



Exactly, some folks tend to forget that.


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## maxwell (Jan 31, 2009)

rmellish said:


> Exactly, some folks tend to forget that.



I remember this quite well.  If you're worried :glare: about this (for example, for patients who have recently recieved a lot of epinephrine - recall epi breaks down hepatic glycogen) - push 50 g of 50% Dextrose IO!


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## medic417 (Jan 31, 2009)

GonnaBeEMT said:


> I agree with you.... What is with all the butt bandits on here? lol



Actually in my area oral glucose rectally was a way for basics to get patients sugar levels up when oral was not an option.  I have no idea why a paramedic would ever choose the rectal route when there are other options including IO.


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## marineman (Jan 31, 2009)

medic417 said:


> Actually in my area oral glucose rectally was a way for basics to get patients sugar levels up when oral was not an option.  I have no idea why a paramedic would ever choose the rectal route when there are other options including IO.



We don't have much in the way of IO's at the service where I do ride alongs. We only carry 2 Jam-sheedy needles on each truck and our only standing protocol for using them is on peds. Rectal D50 is easier and quicker than going through the hassle of getting orders then getting the jam sheedy in place etc. I've never seen anyone do rectal D50 but it's a fair and viable option as a last resort.


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## Wyoming Medic (Feb 2, 2009)

IO IO IO, its away from the rectum I go.

We turn towards the IO.  Rectal is bad news IMO.  IO (especially the EZIO) is so. . . . .Easy  that it is my 3 defense.  Peripheral Iv (including EJ, too many people are scare to shoot for the EJ) if no workey then I go Glucagon and if that falls apart I shoot straight for the IO.

Protocol here is that we can use the IO at our discretion.  So drill away.


Wy medic


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## Aidey (Feb 2, 2009)

TBH I would probably never put D50 in an EJ. It's just too risky. Plus then they wake up and you've got an IV in their neck! If I couldn't get an IV I would go for IO before rectal.


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## maxwell (Feb 2, 2009)

Why not?  As long as it's a working EJ, push whatever the hell you want through it!  D50, WD40!  Don't be afraid of the EJ.  The EJ is your friend.  Worst thing that can happen is you blow it.  Put some pressure on it (don't stroke them out, though) - treat it like any other vein if it infiltrates.  I put in at least 5 EJs in daily.  Never had ANYTHING bad happen.  If you can't get that, go I/O.  But - nothing PR.  EJs are frequently a saving grace.  Use them!  A/w problems never happen.


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## Ridryder911 (Feb 2, 2009)

Aidey said:


> TBH I would probably never put D50 in an EJ. It's just too risky. Plus then they wake up and you've got an IV in their neck! If I couldn't get an IV I would go for IO before rectal.



Your kidding right? Either you have not established many EJ's or do not understand anatomy. EJ is one of the largest veins, as well it is just another peripheral IV. No big deal, I start them on conscious patients with no problem. I much rather see D50w pushed through an EJ than a hand IV, in fact many drug inserts suggest against hand veins. 

Patient awake up, so what? The IV should be secured, well before administering the glucose. After awaking, place pressure bandage just alike any other IV. 

Quit making an EJ a big deal... it's not. 

R/r 911


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## reaper (Feb 2, 2009)

Ridryder911 said:


> Your kidding right? Either you have not established many EJ's or do not understand anatomy. EJ is one of the largest veins, as well it is just another peripheral IV. No big deal, I start them on conscious patients with no problem. I much rather see D50w pushed through an EJ than a hand IV, in fact many drug inserts suggest against hand veins.
> 
> Patient awake up, so what? The IV should be secured, well before administering the glucose. After awaking, place pressure bandage just alike any other IV.
> 
> ...





The only problem I ever have with EJ's, is how to keep the tourniquet tight enough!h34r:


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## Veneficus (Feb 2, 2009)

reaper said:


> The only problem I ever have with EJ's, is how to keep the tourniquet tight enough!h34r:



use a BP cuff


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## maxwell (Feb 2, 2009)

reaper said:


> The only problem I ever have with EJ's, is how to keep the tourniquet tight enough!h34r:



AWESOME!!!

EJs are my favorite line to give anything rough...especially Adenosine...but now we're getting off topic...


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## Ridryder911 (Feb 2, 2009)

Just be sure to point them the right way


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## medic417 (Feb 3, 2009)

Ridryder911 said:


> Just be sure to point them the right way



LOL.  I have seen a medic that was so proud of herself walk into the ER with the patient.  We were there doing paperwork.  Nurse got a funny look and came over and got me and my partner and said is this how you guys do IV's.  We looked and burst out laughing.  The medic on the ambulance that had started it came over and started argueing that we were wrong.  That an IV could face either direction and work just fine.  A year later she still says she did nothing wrong.  Sad that a person is to stubborn to learn from a mistake.


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## Ridryder911 (Feb 3, 2009)

medic417 said:


> Sad that a person is to stubborn to learn from a mistake.



No, what is sad is that person is stupid & dangerous. Ignorant is not knowing, stupid is refusing to learn.

R/r 911


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## medic417 (Feb 3, 2009)

Ridryder911 said:


> No, what is sad is that person is stupid & dangerous. Ignorant is not knowing, stupid is refusing to learn.
> 
> R/r 911



True.

10 word rule line.


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## fma08 (Feb 4, 2009)

Ridryder911 said:


> Just be sure to point them the right way



There's a right way? h34r: lol


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