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

Objective: To investigate whether 10% dextrose given in 5 g (50 ml) aliquots is more effective than 50% dextrose given in 5 g (10 ml) aliquots in the treatment of out of hospital hypoglycaemia. Design: Randomised controlled trial. Setting: Out of hospital patients attended by paramedics from a large UK ambulance service. Participants: 51 unresponsive adult patients with blood glucose levels (4 mmol/l. Intervention: 5 g (50 ml) intravenous aliquots of 10% dextrose or 5 g (10 ml) intravenous aliquots of 50% dextrose to a maximum dose of 25 g. Main outcome measures: To compare for each dextrose concentration the time to achieve a Glasgow Coma Scale (GCS) score of 15, and the dose required to obtain a blood glucose level of >4.5 mmol/l. Results: There were no statistically significant differences between the groups with regard to age or sex, median pretreatment GCS, pretreatment blood glucose level, or proportion of patients with insulin dependent diabetes. Following treatment, there were no statistically significant differences in median time to recovery (8 minutes), median post-treatment GCS, or number of subjects experiencing a further hypoglycaemic episode within 24 hours (four per group). The median total dose of dextrose administered was significantly less with the 10% concentration (10%=10 g, 50%=25 g, p,0.001) and median posttreatment blood sugar levels were also significantly lower (10%=6.2 mmol/l and 50%=9.4 mmol/l, p = 0.003). There were no reports of extravasation injuries in either group. Conclusions: Dextrose 10% delivered in 5 g (50 ml) aliquots is administered in smaller doses than dextrose 50% delivered in 5 g/10 ml aliquots, resulting in lower post-treatment blood glucose levels. We therefore recommend it as the intravenous treatment of choice for adult hypoglycaemia.