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50% dextrose: antidote or toxin?

R G Browning, D W Olson, H A Stueven

Journal of Emergency Nursing

|September 1, 1990

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Empiric dextrose administration for altered mental status may harm patients. Glucose should only be given if hypoglycemia is confirmed by bedside testing, especially in patients at risk for cerebral ischemia.

Area of Science:

Emergency Medicine
Neurology
Clinical Pharmacology

Background:

Empiric 50% dextrose administration for altered mental status is standard care, assuming it is harmless in nonhypoglycemic patients.
Emerging evidence challenges this assumption, indicating potential harm from glucose administration.
Previous studies often used rodent models or high glucose doses, limiting clinical applicability.

Purpose of the Study:

To review evidence regarding the safety and efficacy of empiric dextrose administration.
To evaluate the rationale for altering the standard of care for altered mental status patients.
To provide recommendations for glucose administration in emergency settings.

Main Methods:

Review of experimental animal studies (rodent, primate) and human clinical data.

Related Experiment Videos

Analysis of studies using clinically relevant glucose doses.

Consideration of bedside hypoglycemia screening availability.

Main Results:

Glucose administration before or during cerebral ischemia worsens neurologic and histologic outcomes in experimental models.
Primate and human studies corroborate detrimental effects with clinically relevant doses.
Bedside glucose testing is readily available.

Conclusions:

Empiric dextrose administration should be avoided in patients at risk of cerebral ischemia (e.g., stroke, cardiac arrest, hypotension, CPR).
Immediate bedside glucose testing is recommended for all patients with altered mental status.
50% dextrose should be reserved for confirmed hypoglycemia to prevent iatrogenic harm.