D10 from D25 or D50

[Seaboss]

Hello,
Does any one know if or how you can make D10 from D25 or D50. D10 appears in my protocols for neonatal coma of unknown etiology/seizure/diabetic emergencies but my department doesn't carry it on the truck.

Thanks.

 

[Shishkabob]

If using D50 and you want D10, for every 1 part of D50, you do 4 parts of NS. 1ml of D50, 4ml of NS.

If you want D25, it's 1:1.

 

[NomadicMedic]

Put 4ml of D50 in a 20ml syringe. Draw up 16ml of saline. That gives you 2g in 20ml. Also known as D10.

 

[Seaboss]

Great thanks

Our protocols say d10 is 0.5mg/kg if the pt is 2kg (2x0.5=1mg), with the concentration of 2g/20ml in order to give 1 mg you have to change the concentration to 2000mg/2ml doing the math out 2000/1x20 would be 0.01 ml in order for the pt to get the 1mg. Does that seem correct?

 

[Medic Tim]

Great thanks

Our protocols say d10 is 0.5mg/kg if the pt is 2kg (2x0.5=1mg), with the concentration of 2g/20ml in order to give 1 mg you have to change the concentration to 2000mg/2ml doing the math out 2000/1x20 would be 0.01 ml in order for the pt to get the 1mg. Does that seem correct?

no it doesn't.
does your protocol read 0.5mg/kg or 0.5 ml/kg of d10w.
The last time I gave d10 was in the hospital and the dose I used was 2ml/kg of d10

 

[Seaboss]

@medic Tim thank you, I reviewed the protocol and it is 0.5 grams/kg. which makes a lot more sense if the pt was to receive 1g in that concentration it would be 10ml

 

[Seaboss]

@Linuss with that configuration of 1ml D50 and 4ml normal saline do you know what the concentration at hand would be, how many grams per ml?

 

[NomadicMedic]

Interesting that the protocols for D10 would be in grams and not ml. Its really the same thing, 0.5g/5ml ... But I'm still used to seeing pedi doses expressed in ml. :/

Ours are 5ml/kg, and we only dilute down to D10 for neonates.

 

[Christopher]

Interesting that the protocols for D10 would be in grams and not ml. Its really the same thing, 0.5g/5ml ... But I'm still used to seeing pedi doses expressed in ml. :/

Ours are 5ml/kg, and we only dilute down to D10 for neonates.

Ours are in ml/kg as well. I've become a big fan of using D10W for adults as well. Similar speed of recovery (anecdotal), less of a spike in BGL, less headache, less problems with glucose maintenance for the next few days.

 

[Seaboss]

Yeah defiantly is in grams/kg protocol is as follows
Dextrose 10% 0.5g/kg IV bolous (for neonates)
Dextrose 25% 0.5g/kg IV bolous (if estimated body weight is less then 50kg)
Dextrose 50% 0.5g/kg IV bolous ( if estimated body weight is greater then 50kg)

 

[mycrofft]

I use the Betty Crocker Cook Book.
Dumb question, but doesn't dilution of a packaged intravenous solution constitute "pharmacy", requiring a separate license and school? Just saying...

 

[Hunter]

I use the Betty Crocker Cook Book.
Dumb question, but doesn't dilution of a packaged intravenous solution constitute "pharmacy", requiring a separate license and school? Just saying...

By that logic I couldn't use the glucagon we cary since it's not premixed.

 

[Christopher]

I use the Betty Crocker Cook Book.

I found it funny at first, but one of our Lt's routinely cooks our diabetics breakfast, lunch, or dinner if we wake them up in their house. He's a big fan of making sure they've got longer term dextrose on board.

That being said, like a true firefighter he also fixes himself a plate...

 

[the_negro_puppy]

We don't carry dextrose at all. It was binned for glucose 10% in 500ml bags

 

[mycrofft]

Glucose is dextrose.

There is a difference when you have premeasured quantities to mix then administer (such as reconstituting a vaccine or spiking a bag of IV NS with an ampule of potassium), versus having to calculate quantities, then actually measure them out, and then perform the mix, requiring relabeling of the consequent container with name, strength, date and time of admixture, etc. You lose the lot number.

HOWEVER....the calculation is no more complicated than some IV rate calcs. I raise the question more as a matter of liability and legality, not practicality. Or can the conditions above be met?

 

[the_negro_puppy]

Glucose is dextrose.

There is a difference when you have premeasured quantities to mix then administer (such as reconstituting a vaccine or spiking a bag of IV NS with an ampule of potassium), versus having to calculate quantities, then actually measure them out, and then perform the mix, requiring relabeling of the consequent container with name, strength, date and time of admixture, etc. You lose the lot number.

HOWEVER....the calculation is no more complicated than some IV rate calcs. I raise the question more as a matter of liability and legality, not practicality. Or can the conditions above be met?

Well I'll be damned, I actually thought dextrose/glucose were different molecules haha, so why do they call it Glucose 10% instead of Dextrose 10%? Just a nomenclature thing I guess.

 

[mycrofft]

Wait a minute, there is a hitch...

http://answers.yahoo.com/question/index?qid=20080430193013AAf6xIp


"Two stereoisomers (isomeric molecules whose atomic connectivity is the same but whose atomic arrangement in space is different.) of the aldohexose sugars are known as glucose, only one of which (D-glucose) is biologically active. This form (D-glucose) is often referred to as dextrose monohydrate, or, especially in the food industry, simply dextrose (from dextrorotatory glucose[1]). This article deals with the D-form of glucose. The mirror-image of the molecule, L-glucose, cannot be metabolized by cells in the biochemical process known as glycolysis."

So if it is labelled just"glucose" it could actually contain some bio-inert levodextrose? That's not right!