Dextrose (D10, D25, D50) | Medication Reference

Bedside Snapshot

Core dose: Severe hypoglycemia: 25 g IV (D50W 50 mL OR D10W 250 mL); moderate hypoglycemia or fragile access: D10W 100–250 mL; with insulin for hyperkalemia: 25 g dextrose + 10 units regular insulin IV
Onset/duration: Onset within minutes; duration depends on underlying cause, hepatic glycogen stores, and ongoing insulin/sulfonylurea effects
Key danger: D50W is highly sclerosing/vesicant → severe phlebitis and tissue necrosis with extravasation; rebound hypoglycemia (especially with sulfonylureas); overshoot hyperglycemia
Special: D10W = 0.1 g/mL, D25W = 0.25 g/mL, D50W = 0.5 g/mL; prefer D10W for fragile access or pediatrics; monitor glucose every 15–30 min initially; may need dextrose infusion for recurrent hypoglycemia

Brand & Generic Names

Generic Name: dextrose (glucose) injection; concentrations 5%, 10%, 25%, 50% (w/v)
Brand Names: Dextrose injection (various premix bags/syringes: D10W, D25W, D50W)

Medication Class

Carbohydrate; hypertonic IV solution; antidote for hypoglycemia; substrate with insulin therapy

Pharmacology

Mechanism of Action:

Provides exogenous glucose to rapidly raise plasma glucose and reverse neuroglycopenic symptoms
Hypertonic solutions (D25W, D50W) exert osmotic effects and are sclerosing to veins
With insulin (e.g., hyperkalemia therapy, high-dose insulin euglycemia for CCB/β-blocker toxicity), dextrose prevents hypoglycemia while insulin drives intracellular glucose and potassium shifts

Key Pharmacokinetics / Product Facts:

Onset IV: minutes; effect duration depends on underlying cause and hepatic glycogen
Distribution: Largely extracellular initially; rapidly taken up by insulin-sensitive tissues
Metabolism: Glycolysis and oxidative pathways; excess filtered → osmotic diuresis if severe hyperglycemia occurs
Concentrations: D10W = 100 mg/mL (0.1 g/mL); D25W = 250 mg/mL (0.25 g/mL); D50W = 500 mg/mL (0.5 g/mL)
Elemental "grams per typical dose": 25 g = 250 mL of D10W, 100 mL of D25W, or 50 mL of D50W
Extravasation risk: Increases with concentration; D50W has the highest risk of tissue injury/necrosis

Indications

Symptomatic hypoglycemia (altered mental status, seizures, coma)
Prevention/treatment of hypoglycemia during insulin therapy for hyperkalemia or high-dose insulin euglycemia therapy in CCB/β-blocker toxicity
Adjunct to dextrose-containing maintenance fluids (e.g., D10W infusion) in refractory/recurrent hypoglycemia (e.g., sulfonylurea overdose with octreotide)
Neonatal and pediatric hypoglycemia using age-appropriate concentrations (prefer D10W)

Conditions Treated

Symptomatic hypoglycemia (all causes)
Sulfonylurea-induced hypoglycemia
Insulin overdose
Prevention of hypoglycemia during insulin therapy (hyperkalemia, CCB/β-blocker toxicity)
Neonatal/pediatric hypoglycemia

Dosing & Administration

Available Forms:

D10W (10% dextrose): 100 mg/mL (0.1 g/mL)
D25W (25% dextrose): 250 mg/mL (0.25 g/mL)
D50W (50% dextrose): 500 mg/mL (0.5 g/mL)

Adult Dosing:

Indication	Dose	Notes
Severe symptomatic hypoglycemia	25 g IV (D50W 50 mL IV push OR D10W 250 mL)	Reassess glucose and mental status in 5–10 min; repeat to effect
Moderate hypoglycemia or fragile peripheral access	D10W boluses (100–250 mL) or short infusion	Reduces overshoot hyperglycemia and extravasation risk vs D50W
Recurrent/sulfonylurea-associated hypoglycemia	Initial correction as above, then D10W infusion + octreotide	Titrate to maintain glucose ~100–150 mg/dL
Hyperkalemia (insulin/dextrose regimen)	Regular insulin 10 units IV with 25 g dextrose IV	Omit dextrose if initial glucose markedly elevated; monitor glucose ≥4–6 h

Pediatric Dosing:

Avoid D50W; prefer D10W
Typical dosing: 0.25 g/kg (2.5 mL/kg D10W) IV
Some protocols use 0.5 g/kg (5 mL/kg D10W) based on severity

Neonatal Dosing:

D10W 2 mL/kg IV bolus then infusion (e.g., 4–8 mg/kg/min) titrated to glucose and clinical status
Avoid D25W/D50W due to risk of intracranial hemorrhage and rebound hyperglycemia

Administration:

Use a large, patent vein; monitor site
For D50W, push slowly through a running line
Consider D10W when only small fragile peripheral veins are available

Contraindications

Contraindications:

Hyperglycemia without hypoglycemic symptoms/treatment indication
Known hypersensitivity to dextrose (rare)

Precautions:

Ischemic stroke or intracranial hemorrhage—treat hypoglycemia promptly but avoid hyperglycemia after correction (worsens neurologic outcomes)
Chronic alcohol use/malnutrition: give thiamine 100 mg IV before or with dextrose to reduce risk of precipitating Wernicke encephalopathy—do not delay correction of hypoglycemia
Electrolytes: dextrose with insulin can cause hypokalemia; monitor potassium, especially in renal or cardiac patients
Vascular access: D25W/D50W are vesicants—prefer lower concentrations, secure IV access, and monitor for extravasation

Thiamine: Give thiamine 100 mg IV before or with dextrose in chronic alcohol use/malnutrition to reduce risk of Wernicke encephalopathy. Do not delay hypoglycemia correction.

Adverse Effects

Hyperglycemia
Hypokalemia (with insulin)
Fluid shifts/osmotic diuresis
Phlebitis
Extravasation injuries with concentrated solutions (pain, induration, skin necrosis)
Rebound hypoglycemia, especially after short-acting carbohydrates or with sulfonylurea ingestion

Clinical Pearls

D10W vs D50W Strategy: D10W bolus strategy (e.g., 100–250 mL) achieves euglycemia with less overshoot and lower extravasation risk than D50W; both deliver the same grams when doses are matched.

Sulfonylurea-Induced Hypoglycemia: Repeated dextrose boluses alone are a setup for rebound—start octreotide early.

Insulin-Based Hyperkalemia Therapy: Continue glucose monitoring for several hours; delayed hypoglycemia is common, especially with renal failure.

D50W Extravasation: If D50W extravasates: stop infusion, leave catheter, aspirate residual drug, elevate limb; consider hyaluronidase and warm compress per institutional protocol.

Documentation: Document grams delivered, not just volume—helps reconcile D10 vs D50 dosing across settings.

References

1. Papadopoulos, J. (2008). Pocket guide to critical care pharmacotherapy. Humana Press.
2. Medscape. (n.d.). Dextrose injection (IV) – drug monograph and dosing. Retrieved 2025-11-12, from https://reference.medscape.com
3. Medscape. (n.d.). Hypoglycemia: Treatment & management. Retrieved 2025-11-12, from https://emedicine.medscape.com
4. Medscape. (n.d.). Sulfonylurea toxicity: Treatment. Retrieved 2025-11-12, from https://emedicine.medscape.com
5. DrugBank Online. (n.d.). Dextrose (glucose). Retrieved 2025-11-12, from https://go.drugbank.com