D50 for a Stroke patient?

[matt.shoemaker]

Okay, just for personal curiosity, what is everyone's opinion on giving a stroke patient, suffering from hyperglycemia, D50? According to my standing orders I am to consider pushing D50, but what is there to consider? Patient has a low enough blood sugar to indicate the drug. What, if any, would the contraindications be not to give the drug in a stroke victim?

Thanks
Matt
EMT-I

 

[DT4EMS]

Hyperglycemia does not get D50. Hypoglycemia does. What kind of a CVA? With the hypertonic solution like D50, I would be nervous about giving it to a stroke patient.

Remember that hypoglycemia can mimic a stroke so check their glucose level.

Hope that helps.

 

[akflightmedic]

You have to be careful with the administration of D50 to a stroke patient due to the fact you don't know what kind of CVA they are having.

Remember what happens to the surrounding tissues if your IV infiltrates while pushing D50? It is necrotic to the surrounding tissue. Now apply that same principle to someone that is having a hemmorhagic stroke(they have a leak in their brain)..what is that D50 going to do once it enters the bloodstream and then leaks out into the brain tissue...hmmmm, what do you think?

So your safest bet is to dump it on medical control. I have always had very liberal protocls, even when I was a ground medic in Florida, however this one time I had a pt that was presenting signs of CVA, but his BGL was in the mid 50's. I didnt think it was low enough to be affecting him like it was, so I was leaning towards a stroke. However, protocols state I should give D50 based on his sugar level. So to cover my arse, I called med control and asked what I should do and presented my case. He thanked me for calling and said, give only half an amp of D50 and see what happens. See how simple that was. I now shifted liability to med control. For the record, the pts sugar got better, but not his defecits, he was having a CVA and no it wasnt hemmorhagic.

 

[dhpd9807]

What about the fact that the D-50 enters the the venous circulation, is it not significantly diluted, not to mention metabolized a bit by the time it finally reaches the the point of injury? Also, if you pt. is unc. unresp. due to a bleed the least of their worries might be your D-50. Before we had the capability to check BG levels everybody got sugar and I am not aware of any bad outcomes due to D-50.

 

[Ridryder911]

For about 20 years now, hypertonic solutions have been contrindicated in conditions of inner cranial pressure or bleeds. As AK discussed, cellular gradients across the semi-permable membrane, thus decreasing interstial spaces and increasing pressure.

The role of glucose in brain perfussion is essential, but such large concentration of glucose is harmful.

Be sfe,
R/R 911

 

[Jon]

I had this discussion with my Doc.... He was VERY adamant that you MUST check BgL before giving D50 if CVA is even possible.... if BgL is less than 60 - then give D50... if greater than 60 and Pt. is having Stroke-like symptoms, hold off.

Jon