# D10 vs D50



## JJR512 (Sep 23, 2011)

I believe I have read some comments here in the past about D10 being better than D50.

In my EMT-I introductory class next week, we are going to start getting into diabetic emergencies, including the administration of D50.

We do not carry D10 here in Maryland, but I'd like to know why some of you feel that D10 is better and is what progressive EMS systems are, or will be, switching to.

Try to keep your answers simple enough for an EMT-B without A&P, etc. to understand, if possible.


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## usalsfyre (Sep 23, 2011)

Osmolarity. Read what it is, how it pertains to and damages tissues and then what the osmolarity of D10 vs D50 is.

If you get stuck, feel free to ask any questions.


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## 46Young (Sep 23, 2011)

We have within our protocols an option to dilute an amp of D50% in a 250cc bag for admin if we feel that the pt has delicate peripheral vasculature, and that the admin will run the risk of extravasation.


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## EMS Patient Care Advocate (Sep 23, 2011)

In short- D50 is harsh on the veins. Also its beginning to be recognized that pumping a blood sugar from 20-300mg/dL might not be good either. Diluting your solution -you don’t need premixed d10, you can dilute your own solution, maybe not at EMTI level though I’m not sure. If you plan on administering to pediatrics you might want to learn as d50 is contraindicated. The are also a few studies available by Google search regarding the efficiency of d10 over d50, how it effects ALS time on scene, and how it effects to hospital. It is at this time to my understanding not clear that one is absolutely safer or more effective at this time. However the my common since side of things says one day we will be titrate so BS doesn’t shoot up so fast, dilute to make less caustic, and osmolatirty certainly is another consideration.
I can probably dig up some of the studies and other ref material on this subject matter if you need.


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## dixie_flatline (Sep 23, 2011)

Take a look at the protocol page for D50 (it's 222-1 in the newest edition).



> *g) Dosage*
> (1) Adult: Administer 25 grams in 50 mL IV (1 ampule of 50% solution)
> (2) Pediatric:
> (a)	If less than 2 months of age - Administer 5–10 mL/kg D10W IV/IO (D10W is prepared by mixing one part of D50W with four parts LR).
> ...


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## usalsfyre (Sep 23, 2011)

D10 for infants has been standard for a long time. What's being discussed lately is D10 for everyone, including adults.


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## ArcticKat (Sep 23, 2011)

Also, a rapid rise in blood glucose results in a rapid rise in LOC.  Often this rapid increase results in a violent reaction because the brain isn't quite able to interpret what is going on around it.   Providing D10 would better control the increase in LOC to the point that the client becomes more aware of his surroundings at a pace which the brain can interpret.

To create D10, just inject the contents of your D50 into a 500ml bag if D5W or, if you prefer, D5NS.  Voila, D10



46Young said:


> We have within our protocols an option to dilute an amp of D50% in a 250cc bag for admin



A 250cc bag of what?  If it's a 250 bag of NS you're creating a D10NS, but if it's a 250cc bag of D5W you're creating D15W.


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## 46Young (Sep 23, 2011)

ArcticKat said:


> Also, a rapid rise in blood glucose results in a rapid rise in LOC.  Often this rapid increase results in a violent reaction because the brain isn't quite able to interpret what is going on around it.   Providing D10 would better control the increase in LOC to the point that the client becomes more aware of his surroundings at a pace which the brain can interpret.
> 
> To create D10, just inject the contents of your D50 into a 500ml bag if D5W or, if you prefer, D5NS.  Voila, D10
> 
> ...



NS. We don't carry D5W, as all of our transport times are relatively short, average 5-10 mins, and there are no meds given that would need to be in D5%W given that brief time interval of tx and txp.


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## 46Young (Sep 23, 2011)

usalsfyre said:


> D10 for infants has been standard for a long time. What's being discussed lately is D10 for everyone, including adults.



I don't see why not, the pt will still get the dseired dose of dextrose, just in a much safer manner that will greatly reduce the incidence of iatrogenic injury. I would monitor L/S when giving a pt with CHF or a reported poor EF (typically go hand in hand) a 250 cc bolus with the dextrose.


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## usalsfyre (Sep 23, 2011)

Typically you'd be pulling 50mls at a time out of the bag and pushing it, not running it as an infusion.

The idea is the patient gets a lower dose of a safer concentration. Most patients don't need 25gms of dextrose.


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## the_negro_puppy (Sep 23, 2011)

We replaced all our D50 with Glucose 10%


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## rhan101277 (Sep 24, 2011)

Ours is administer 1/2 amp D50 and re-assess mental status.  Hang D5W at TKO.  If mental status improves and CBG is 80 or greater monitor and leave D5W running TKO


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## 18G (Sep 24, 2011)

In PA, the new protocols changed and gave us a range to choose from. Protocol states D10-D50 for adults. 

As others have stated, D50 is highly irritating to the vein and tissues should extravasation occur. Also, the goal in treating hypoglycemia is to make the patient normoglycemic and not overshoot and make them hyperglycemic which is what happans frequently with D50. 

Plus, studies have compared D50 to D25 and D10 and found that the lesser concentrated is as effective and safer. 

To make D25 you just waste half the amp of D50 and replace it with NSS from an IV bag. D10 comes prefilled that way but you can also make it yourself by wasting and diluting D50.


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## systemet (Sep 25, 2011)

18G said:


> I
> 
> Plus, studies have compared D50 to D25 and D10 and found that the lesser concentrated is as effective and safer.



Does anyone have citations for the relevant studies?


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## usalsfyre (Sep 25, 2011)

The landmark paper on prehospital D10 vs D50 http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1726850/pdf/v022p00512.pdf

Safety wise it's not something that particularly requires study, it's well established D10 is only slightly hypertonic and far less dangerous in cases of extravasation.


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## systemet (Sep 26, 2011)

usalsfyre said:


> The landmark paper on prehospital D10 vs D50 http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1726850/pdf/v022p00512.pdf
> 
> Safety wise it's not something that particularly requires study, it's well established D10 is only slightly hypertonic and far less dangerous in cases of extravasation.



Thanks for the link!


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