Without evidence of benefit, an intervention should not be presumed to be beneficial or safe.

- Rogue Medic

Dextrose 10% or 50%: EMS Research Episode 10

ResearchBlogging.org

Also posted over at Paramedicine 101 (now at EMS Blogs) and at Research Blogging.

On the EMS Research Podcast Harry Mueller, Dr. Bill Toon, and I discuss this paper. Go listen to the podcast. Dextrose 10% or 50%: EMS Research Episode 10.

1. Is 50% dextrose as safe as 10% dextrose?

No.

    1 a. Can cautious administration eliminate that difference in safety?

Probably not.

2. Is 50% dextrose as efficacious as 10% dextrose?

Maybe.

3. Is 50% dextrose as affordable as 10% dextrose?

No.

Out of 3 criteria, 50% dextrose fails two of the criteria.

If 10% dextrose is cheaper and it is safer to switch to 10% dextrose, why do so many of us in EMS resist this simple change?

Two of the subjects contacted by the researchers after treatment reported that before the study they had often had difficulty bringing their blood glucose back to their expected usual level after being treated by paramedics using 50% dextrose.[1]

While this may indicate idiosyncratic responses, there is no mention of any similar negative responses to 10% dextrose. this might require a larger study to examine, but this is a great start.


The picture is one I found labeled as being from Annals of Emergency Medicine of 50% Dextrose extravasation, but I do not know anything about which issue it is from or any other details. Issue information.[2]

Go listen to the podcast..

I have also written about this in –

Should EMS Still Use 50% Dextrose – 5/03/2011

Dextrose 10% or 50% in the treatment of hypoglycaemia out of hospital? A randomised controlled trial. – 5/04/2011

Comment on 10% Dextrose vs 50% Dextrose – 5/05/2011

Footnotes:

[1] 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]

Free Full Text from PubMed Central           Free Full Text PDF Download from PubMed Central

A review of the research on this topic, which is predominantly about the above paper.

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
Free Full Text with link to PDF Download

[2] 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]

Moore, C. (2005). Dextrose 10% or 50% in the treatment of hypoglycaemia out of hospital? A randomised controlled trial Emergency Medicine Journal, 22 (7), 512-515 DOI: 10.1136/emj.2004.020693

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Comments

  1. So, here’s my question, and maybe my problems is I’m too literal, or don’t think “big picture” enough or something. But, if the evidence is there, why don’t we all switch to dextrose 10% instead of 50%? Is there a big pharma connection? Or, the stupid, “we’ve always done it that way”? OR something else I am totally missing.

  2. Probably a combination of all three. Drug companies typically think more about about money, so naturally they would push a more expensive product. They play on ignorance that if 10% is good then 50% must be better. That thought has been ingrained, so it leads to “we’ve always done it this way.” D10 in 250mL or D5 in 500 mL contains the same amount of dextrose as an amp of D50 in a package that is 1/3 the unit cost bought in bulk and easier to use on smaller veins without risk of extravasation.

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