Reasons NOT to Switch to D10

[Tigger]

This article recently appeared in my newsfeed. http://epmonthly.com/article/d10-may-be-better-than-d50-for-acute-hypoglycemia/

For a time, we were unable to order D50 prefills, so we switched to 250ml 10% Dextrose bags. I only gave it twice (its in the EMT scope in Colorado), but both patients mentioned that it was not as harsh. N=2 there, though I have heard similar comments from other providers patients. It's also the same price as D50 prefills and would negate having to carry D25 as well.

Is there any reason to not push for only stocking D10?

 

[teedubbyaw]

I don't see a reason not to. D50 via IO is a PITA anyways.

 

[DPM]

I worked for a D50 agency and interned with a D10 agency. Aside from not being able to push it through a lock, there's no downside. Our protocol was to give the first 200cc, reassess, then give the remainder if BG was still low.

Only speaking from experience, but I didn't see a significant or noticeable time difference between the two. I thought it was weird that with a BG of 59 or a BG of 8, we still gave the same amount. I preferred titrating my dose to avoid sudden hyperglycaemia.

 

[Tigger]

I don't see a reason not to. D50 via IO is a PITA anyways.

Indeed it is.

For better or worse our non-ambulance EMTs can now start IOs and give dextrose as well. I'm picturing some sort of horror show one of these days when we have a forty minute response to a diabetic problem and ten call a year ricky rescue is chasing the patient around brandishing an IO gun shouting "ya'll will comply!"

 

[TransportJockey]

Gave D10 close to a dozen times and myself and other medics at my old AMR op had such better results that even after the shortage was over, we stocked nothing but D10 and had protocols changed accordingly

 

[Tigger]

Gave D10 close to a dozen times and myself and other medics at my old AMR op had such better results that even after the shortage was over, we stocked nothing but D10 and had protocols changed accordingly

We wouldn't have to change anything either, our protocol just says IV Dextrose at 1g/kg until mentation improves, then check BGL and evaluate.

 

[DesertMedic66]

We switched from D50 to D10 about a year ago (you can still find some D50 on the units). Our medical director only wants us to be carrying the D10. The reasons why (if I remember correctly) is that you don't have to dilute it for pedis and it's better if you give it to stroke patient than D50.

 

[TXmed]

D10 is great. I used it more times than I can count at my old job. Even through a 24g its starts working when going in. It helps keep them from vomiting, easier on the veins, and helps prevent reflex hyperglycemia because the body can adjust to it easier.

 

[Chewy20]

All we carry is D10, switched for the same reasons Txmed described.

 

[Grozler]

My old job switched from D50 to D10 and everyone swore it wouldn't be as effective as D50 due to a protocol change. After a few months, everyone I talked to had good things to say about it. Now at another place that does D50 but is pretty old school and people look at me like I'm from Mars when I mention D10. Or something crazy like an Amiodarone drip after ROSC post VT arrest.

 

[triemal04]

My old job switched from D50 to D10 and everyone swore it wouldn't be as effective as D50 due to a protocol change. After a few months, everyone I talked to had good things to say about it.

It's always funny when someone says that. Because you know...the sugar in D50 is different than the sugar in D10...

Now at another place that does D50 but is pretty old school and people look at me like I'm from Mars when I mention D10. Or something crazy like an Amiodarone drip after ROSC post VT arrest.

Maybe because it's not needed...

 

[Carlos Danger]

Why bother with a "switch" when you can just squirt the D50 into a 250 or 500 bag that you already carry?

 

[NomadicMedic]

Why bother with a "switch" when you can just squirt the D50 into a 250 or 500 bag that you already carry?

They looked at me like I was INSANE IN THE MEMBRANE when I did that here. (Why you tryin' to dilute that dextrose Esse?...)

I always dilute d50 in a bag with brittle diabetics. Not exactly protocol, but sugar is sugar. Document a concurrent administration of 25g of Dextrose and 500ml of NS.

 

[18G]

I am a fan of D10. There are many benefits and it carries reduced risks. Efficacy of D10 vs D50 has been proven the same.

This article lays out all of the supporting reasons to opt for D10 (Academic Life in Emergency Medicine)

Another article posted 8/27/15 in Emergency Physician Monthly outlining the benefits of D10 over D50

STUDIES:
Dextrose 10% or 50% in the treatment of hypoglycaemia out of hospital? A randomised controlled trial

Dextrose 10% in the treatment of out-of-hospital hypoglycemia (California Contra Costa County Emergency Medical Services (EMS) system)

 

[Chewy20]

Why bother with a "switch" when you can just squirt the D50 into a 250 or 500 bag that you already carry?

Less steps, same result?

 

[DesertMedic66]

Why bother with a "switch" when you can just squirt the D50 into a 250 or 500 bag that you already carry?

Or you can be my service and only carry 1000 or 50 bags with nothing in between :/

 

[Carlos Danger]

Less steps, same result?

But if you already have a bunch of D50 and carry IV bags anyway, it could mean carrying fewer drugs.

 

[bizzy522]

D50 seems to be overkill. I usually only give 12.5g vs the whole amp, followed with d5w tko. I'd be interested to try a 10% solution.

 

[Tigger]

Why bother with a "switch" when you can just squirt the D50 into a 250 or 500 bag that you already carry?

Eventually we will run out of D50 amps in the supply room, the replacements could certainly be D10. D10 premix bags are also cheaper than a D50 amp and a 250NS bag used concurrently. The easiest justification is usually financial, for better or worse.

 

[TransportJockey]

And we rewrote protocols because we were out. This is back when prefills were on backorder for months. We went with D10 rather than vials of D50