Hypoglycemic scenerio question

unleashedfury said:
In my experience I have never been able to hammer the patient with D50.. stuff is like cement. So it takes some time to push it through a 18 or 20g.. 22 seems damn near impossible.

I got my pee pee smacked for running fluid on a Diabetic call than needed some sugar. it was told to me start a saline lock give them the D50 if they wake up eat and sign off fine, If they don't transport. I still think that giving some fluid to get that D50 diluted and moving along is better than just flushing with a 5ml saline flush.

OP I usually give half and see what kind of results I get, it isn't going to hurt to give it all, since the rest will go to waste anyways can't exactly box up a half used D50 and save it for later. If it takes a little or a lot to get them to wake up so be it.

The key is if your going to Treat and Street ensure they get a much more long lasting carbohydrate. PB&J sandwiches are great for this. I always tell my patient afterwards they must eat before I leave.
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Well, if you have any 60 mL or 100 mL syringes... just fill and do a slow flush with the big syringe and gently push the D50. Why not?

Also, if the patient wakes up with half, why not pop the top and have the patient suck down the rest of the D50 orally? It gets the full dose on board and the uptake is a lot slower than IV, followed by a PB&J chaser. :cool:
 
We had a nurse extravascularly inject most of a big BristoJect of D50. Subject lost a lot of bicep, cost us thousands of dollars in plastic surgery and therapy to rehab the pt…who had placed himself in hypoglycemia on purpose to evade trial.
 
I think a big issue people don't take into account is how that patient feels after you pump a whole amp of D50 into them. I'll give you a hint: it's not great. Typically end up with a headache and shakes. Titrate to effect.

As an aside, and I don't remember who said it, but I have seen many many people wake up in the midst of that amp being given.

Even better is D10. We carry pre-mixed 250 ml bags that we can run in and shut off when the patient starts to come around. Again, titrating to effect leaves the patient feeling better and you don't jack their sugar sky high.

And as to the whole hyperosmotic issue, if you are administering D50 appropriately (either with a running IV or by drawing back every 10 cc's to get blood return and assure you haven't extravasated) you shouldn't run into any problems. It's the idiots who slam a whole amp, blowing the vein in the process, or give it IM (yes, it's happened) that cause problems.
 
It's been a while, but every unconcious hypoglycemic patient I have seen, we gave a full BristoJet of D50. Usually a couple minutes later, the person regains conciousness, doesn't want to go, and eats a PB&J and some OJ.

We have even done it on a couple hypoglycemic AMS who weren't coming around quickly enough after the PB&J and OJ.

Never had a bad reaction, always pushed it SLOWLY, always used a large cath and followed the d50 wiht thyamine (I think, it's been a while)

I would imagine, if the patient woke up mid push, we would disconnect the BristoJet, flush the line, and recheck the BGL. But I don't remember seeing that happen.

I mean, all in all, hypoglycemia needs to be fixed now or else the person is going to die very soon. hyperglycemia sucks, and the person might die, but they aren't going to die in the very near future.
 
TheLocalMedic said:
I think a big issue people don't take into account is how that patient feels after you pump a whole amp of D50 into them. I'll give you a hint: it's not great. Typically end up with a headache and shakes. Titrate to effect.
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The problem with "titrating to effect" with D50 is that the offset of action can be very quick, especially if the patient is on certain combinations of insulins and oral meds. We might not notice that because we are usually able to get the patient some food right away, but 25g of dextrose isn't much at all in someone with a BG low enough to cause unresponsiveness. And these people feel like crap pretty much no matter what you give or how you give it, so that concerns me a lot less than the potential for rapid rebound hypoglycemia because I only gave them 12g of dextrose which was rapidly absorbed by the brain and muscles.

If you are using D10 it is a little different, because you can keep the infusion running while they eat something, so you may end up needing less than the whole 25g of IV dextrose.

Of course I'm not saying it's wrong to give less than the whole amp of D50, but I just don't see any benefit at all in giving less than the full amp. As long as they don't have a bleed and as long as you aren't injecting into tissue, D50 is extremely safe. I think it's far better to give a little more than you need than to not give enough.
 
DrParasite said:
It's been a while, but every unconcious hypoglycemic patient I have seen, we gave a full BristoJet of D50. Usually a couple minutes later, the person regains conciousness, doesn't want to go, and eats a PB&J and some OJ.

We have even done it on a couple hypoglycemic AMS who weren't coming around quickly enough after the PB&J and OJ.

Never had a bad reaction, always pushed it SLOWLY, always used a large cath and followed the d50 wiht thyamine (I think, it's been a while)

I would imagine, if the patient woke up mid push, we would disconnect the BristoJet, flush the line, and recheck the BGL. But I don't remember seeing that happen.

I mean, all in all, hypoglycemia needs to be fixed now or else the person is going to die very soon. hyperglycemia sucks, and the person might die, but they aren't going to die in the very near future.
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After six years working with diabetics , this is the most pragmatic and effective approach I've read in many months.
 
Halothane said:
Of course I'm not saying it's wrong to give less than the whole amp of D50, but I just don't see any benefit at all in giving less than the full amp. As long as they don't have a bleed and as long as you aren't injecting into tissue, D50 is extremely safe. I think it's far better to give a little more than you need than to not give enough.
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Sure, there's nothing wrong with giving a whole amp, but (and I can't for the life of me find the journal article discussing this, although I've seen it enough to anecdotally confirm it) sometimes giving that whole amp will leave your patient feeling ill. Headache, confusion, shakiness and pain are a few of the symptoms that were discussed. Why not give the amp slowly, or give D10% instead, and titrate? Once they're up and moving you can get them some carbs and then pull the IV and leave. And you'll leave them feeling better than you would by spiking their sugar.
 
Its the way you feel after eating 4 pieces of birthday cake. (Not that I've ever done that...) But many diabetics like to keep their sugar within a tight range. It doesn't do them any good to go from 20 to 350 with a full amp of dextrose, while getting them conscious and allowing them to eat will get the job done and be a little less stressful. Just my thoughts, YMMV.
 
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