D50 D10 math

[Bullets]

Ok so ive used like 3 pages of scrap paper trying to do this math and i can figure out how to get what i am looking for.

Right now i carry D50 25g/50ml (0.5g/ml). We also have D10 50g/500ml (0.1g/ml) AND 100ml and 250ml of D5W (0.05g/ml) . My protocol says we can give 25g of glucose to adult hypoglycemics and we regularly give 250ml of D10 for all the reasons one would give D10 instead of D50, however this ends in us throwing out half the 500 bag since we rarely need it. Recently we started getting the D50 in vials we have to draw up ourselves due to shortage. Im trying to put together a way to give this more efficiently given all that i have on hand.

I have access to bags of 100ml and 250ml of D5W, 500ml NSS and 1000 LR. If i put 25ml(12.5g) of the D50 into the 250ml of D5W that would make 25g in 275ml. so slightly less than D10, like 9% Dextrose.

Right?

 

[mgr22]

Yes, 25ml of D50 has the same amount of dextrose (12.5g) as 250ml of D5W. Combine them and you have 25g of dextrose.

 

[Gurby]

If i put 25ml(12.5g) of the D50 into the 250ml of D5W that would make 25g in 275ml. so slightly less than D10, like 9% Dextrose.

Right?

 

[DesertMedic66]

Are you unable to get or carry D10 25g/250? That is pretty much the standard for D10.

 

[Bullets]

Are you unable to get or carry D10 25g/250? That is pretty much the standard for D10.

So far when I've asked for 250 D10 I'm told it's "too expensive" or "we have D50".

So I'm torn between spitefully wasting half the 500 bag or saving the weight and mixing it up myself

 

[Peak]

So far when I've asked for 250 D10 I'm told it's "too expensive" or "we have D50".

So I'm torn between spitefully wasting half the 500 bag or saving the weight and mixing it up myself

I don't know your specific supply costs, but I would guess that the 500 bag of D10 is substantially cheaper than amp of D50.

Plus you can leave the extra string up and if the patient drops their BGL you just open it up and give a bit more.

 

[Carlos Danger]

I think the best way to deal with this, as Peak says, is to hang the 500ml bag of D10 as a secondary and give half of it. This way you might get them responsive enough to eat something before you even give them the whole 25gm, which in my mind is the main advantage of giving dextrose this way vs. just slowly pushing it. And also then you've got the other half ready if you need it.

But if wasting half the 500 bag really gives you heartburn, another perhaps simpler option (simpler if you still have the pre-filled amps of D50, anyway) is to use the 50ml syringe of D50 and simply push it very slowly into a running IV line. Every few ml's you can backfill the syringe with IVF, which will dilute the remaining D50 into a lower concentration. If you have 60ml syringes, then draw up the D50 and add 10ml of fluid from the bag before you even start to push it. Personally this is what i would probably do, because I am very used to drawing concentrated drugs into a syringe, diluting them with IVF, and giving them slowly that way. The problems with pushing D50 really relate to the solute concentration at the time the drug enters the bloodstream and the total dose of dextrose given, both of which are primarily functions of how quickly the syringe is pushed.

 

[Akulahawk]

I'm also off the opinion that if you have D10/500 ml bags, use them. It's probably cheaper and easier to control. Besides, if you need to push it fast, just attach a 50 ml syringe to the line and go to town. Just 5 pushes is your 25g of dextrose. Another way to think of it is each push is 5g dextrose. Have I mentioned just how much I hate pushing D50 through a 22g catheter? D10/250 is just much easier...

 

[FiremanMike]

We give d10 100ml (10gm) at a time.. many folks wake up after the first 100ml..

I wouldn't really worry about wasting half (or even 80%) of the 500cc bag of d10, it's not an expensive drug..

 

[medic2EMSdoc]

Rapid weight based dosing for Dextrose for hypoglycemia for all ages is best with the "rules of 50" or the 5/2/1 rule
What ever concentration you use you want the volume per kg x the concentration to = 50.

D10 x 5 ml/kg = 50 (infants, bigger kids, and adults)
D25 x 2 ml/kg = 50 (bigger kids and adults)
D50 x 1 ml/kg = 50 (adults)

So if you created a D9 solution it would make its weight based dose ~ 5.5 ml/kg

 

[Peak]

Most infants only need 2-4 mL/kg of D10.