Maryland made smart changes to their protocols because of the drug shortages.
Switching to 10% dextrose is an obvious solution, but not used by everyone.
Sedgwick County EMS workers administer about 80 doses of the stuff (50% dextrose) a month, but the county has only received 30 pre-filled doses so far this year through its normal vendor, Braithwaite said.
We have research that shows that 10% dextrose is a better choice for EMS, but we continue to use the inferior treatment.
We have trouble obtaining the inferior treatment, but we refuse to change to the better treatment.
Is there a state law that prevents the use of different concentrations of dextrose?
If so, go to the government, explain the problem, and get the law changed. If that does not work, go to the press and point out that the failure to act by the legislature is endangering patients.
“We’re now looking at compounding of those medications,” he said.
But that’s an expensive alternative. A pre-filled dose of dextrose costs $6.99. A vial costs $1.81. Pre-filled doses are preferred, Hadley said, because there is one less step for emergency personnel.
Compound dextrose costs $14 per dose and has a much shorter shelf life, 90 days compared with two years.
50 ml of 50% dextrose contains 25 grams of dextrose.
A 250 ml bag of 10% dextrose contains 25 grams of dextrose.
The cost of the bag of 10% dextrose is about $2.50, which is much less than the $7 cost of and amp of 50% dextrose.
Is there a difference in shelf life? If they are giving 80 doses a month, how much does that matter?
The only advantage to the 50% dextrose is familiarity, which is due to our failure to change to a better treatment when it becomes the right thing to do.
The drug shortages do not affect 10% dextrose.
Isn’t it time we cut costs, improved safety, improved care, and eliminated 50% dextrose?
 Images in emergency medicine. Dextrose extravasation causing skin necrosis.
Levy SB, Rosh AJ.
Ann Emerg Med. 2006 Sep;48(3):236, 239. Epub 2006 Feb 17. No abstract available.
PMID: 16934641 [PubMed - indexed for MEDLINE]
 Dextrose 10% or 50% in the treatment of hypoglycaemia out of hospital? A randomised controlled trial.
Moore C, Woollard M.
Emerg Med J. 2005 Jul;22(7):512-5.
PMID: 15983093 [PubMed - indexed for MEDLINE]
 A review of the efficacy of 10% dextrose as an alternative to high concentration glucose in the treatment of out-of-hospital hypoglycaemia
Ziad Nehme, Daniel Cudini
2009; Volume 7 : Issue 3; Article Number: 990341
Journal of Emergency Primary Health Care
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