D50 and CVA

akflightmedic

Forum Deputy Chief
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Isn't that reason enough?
 

JPINFV

Gadfly
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Is there really any reason to push D50 for anything instead of diluting it to D25 or D10?

If a patient is confirmed to be hypoglycemic, how do you know the patient has a CVA instead of the symptoms of hypoglycemia mimicing a CVA? There's a reason why some stroke scales, such as LAPHSS, are automatically negative in a hypoglycemic patient.
 
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usalsfyre

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Is there any other reason not to push D50 on a possible CVA pt besides the fact that D50 is necrotic?

D50 is not "necrotic" as in necroses neural tissue one it reaches the brain if there is a bleed. D50 can cause/worsen cerebal edema, which is needless to say undesirable in any type of stroke. However, hypoglycemia should be corrected immediately.

That said, why would you be giving dextrose to a patient with a normal BGL, and why would be withholding dextrose from the hypoglycemic pt?
 

18G

Paramedic
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D50 is contraindicated in CVA's due to it contributing to increased swelling. The glucose molecules in high concentration pull fluid. With glucometers this shouldn't be an issue where D50 is given to a CVA. Guess its always possible to have both going on at the same time.

I agree with JP though... a full amp of D50 or D50 at all isn't always necessary. I had a hypoglycemic pt. the other evening with BG level of 40mg/dl, just started new oral hypoglycemic meds, and was found semi-responsive. While pushing the D50 pt. became fully conscious and alert after about 10-15mL so I did not see the need to push the full amp and really overshoot the BG level. I stopped at 25mL (half) which yielded BG of 102 and full return to baseline.
 

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