Glucose (concentrated, IV)
Glukos Fresenius Kabi · Glukos Baxter Viaflo · Glukos APL
The first-line treatment for severe hypoglycaemia in a patient who cannot swallow and in whom intravenous access is available. The effect arrives within a minute but is also short-lived — the bolus reverses unconsciousness but does not treat the cause. What determines management is the underlying aetiology: long-acting insulin and in particular sulphonylurea require follow-up infusion and hours of monitoring, whereas a missed meal in a type 1 diabetic can be managed with a sandwich.
Concentrated glucose is strongly hypertonic and vascular-irritant — 500 mg/ml causes thrombophlebitis and tissue necrosis on extravasation and should be given via a central line. Always verify the cannula is patent before injection. In a malnourished or alcohol-intoxicated patient, thiamine must be given before or simultaneously with glucose; a glucose bolus without thiamine can precipitate Wernicke's encephalopathy.
Dosing in adults
| Indication | Regimen | Comment |
|---|---|---|
| Severe hypoglycaemia, adult | Glucose 300 mg/ml, 30–50 ml iv until the patient wakes (corresponding to 9–15 g glucose) | check blood glucose after 10 minutes; give oral carbohydrates as soon as the patient can swallow |
| Severe hypoglycaemia, child | Glucose 100 mg/ml, 2 ml/kg iv (0,2 g/kg); some regional protocols specify 1–2 ml/kg glucose 300 mg/ml via a reliable access point | avoid concentrated solutions in a peripheral vein in small children |
| Follow-up infusion | Glucose 50–100 mg/ml, 1000 ml over 4–6 hours, rate guided by blood glucose | mandatory after long-acting insulin or sulphonylurea |
| Sulphonylurea intoxication | Glucose infusion as needed, supplemented with octreotide 50–100 μg sc every 6–8 hours | a glucose bolus stimulates insulin secretion and may worsen the course |
| Hyperkalaemia, acute | 25 g glucose (50 ml of 500 mg/ml) iv together with 10 units of rapid-acting insulin | glucose is given to protect against hypoglycaemia, not as a treatment in its own right |
No dose adjustment. Consider the fluid volume in anuria and dialysis-dependent patients.
No dose adjustment. In hepatic failure glycogen stores are absent, causing hypoglycaemia to recur rapidly — this requires continuous infusion rather than repeated boluses.
2 ml/kg glucose 100 mg/ml iv as the acute dose (0,2 g/kg), followed by maintenance infusion with glucose 50–100 mg/ml. Neonatal management follows the paediatric unit's own protocol. Concentrations above 100 mg/ml should be avoided peripherally.
Do not settle for a single bolus in a patient who has received sulphonylurea or long-acting insulin — hypoglycaemia returns hours later, often overnight, and the patient must not be discharged from the emergency department. Also avoid giving concentrated glucose through a doubtful peripheral cannula; extravasation of 500 mg/ml causes tissue damage that may require surgical intervention.
Pharmacokinetics
- ONSET
- 1–3 minutes iv
- EFFECT DURATION
- short, minutes to an hour or so
- ENERGY CONTENT
- 300 mg/ml approximately 1,2 kcal/ml
- OSMOLALITY (300 MG/ML)
- approximately 1 660 mosmol/kg
- OSMOLALITY (500 MG/ML)
- approximately 2 775 mosmol/kg
- METABOLISM
- Glycolysis and glycogen storage, insulin-dependent
- EXCRETION
- Renal when the renal threshold is exceeded
- GLUCOSE RISE
- 30 ml of 300 mg/ml raises blood glucose approximately 3–5 mmol/l in an adult