Effect of 50 milliliters of 50% dextrose in water administration on the blood sugar of euglycemic volunteers.
OBJECTIVE
To evaluate the effect of administration of 1 ampule of 50% dextrose in water solution (D50W) on serum glucose levels in healthy adult volunteers, the authors set out to determine whether a pre-D50W serum glucose level can be predicted from the ED sample.


METHODS
This was a prospective, interventional study conducted from the ED of an urban, university-affiliated hospital. All subjects were healthy employee volunteers between 25 and 40 years of age. Baseline serum glucose levels were determined and all subjects were given an i.v. bolus of 25 grams of 50% dextrose solution. The main outcome measures were post-D50W serum glucose levels (observed) at 5 predetermined time intervals (5 min, 15 min, 30 min, 1 hr, and 2 hr). An expected change in serum glucose was calculated using the volume of distribution formula for glucose.


RESULTS
Twenty-five volunteers (17 males and 8 females) participated in the study. The mean baseline serum glucose was 82.3 +/- 13.5 mg/dL. The mean post-infusion levels were: 244.4 +/- 44.6 mg/dL (5 min), 145.8 +/- 52.3 mg/dL (15 min), 88.1 +/- 28.8 mg/dL (30 min), 77.6 +/- 13.6 mg/dL (60 min), and 83.2 +/- 11.4 mg/dL (120 min). Using a mixed-effect regression model, statistically significant increases in serum glucose levels were found at 5 minutes (p < 0.001) and 15 minutes (p < 00001) following administration of D50W. There was a return to baseline serum glucose by 30 minutes. The expected change based on the volume of distribution formula (53.7 +/- 34.9) did not correlate with the observed changes at any measured time interval.


CONCLUSIONS
Without pre-intervention blood drawing by emergency medical services, it is not possible to accurately predict pre-D50W serum glucose levels based on post-D50W glucose levels. The diagnosis of hypoglycemia as the etiology of altered mental status must therefore remain a diagnosis of exclusion. In addition, the return of serum glucose to baseline after 30 minutes suggests the duration of the effect of 1 ampule of D50W. Frequent re-evaluation of the serum glucose levels of suspected or proven hypoglycemic patients after administration of D50W should be considered.
Department of Emergency Medicine, St. Barnabas Hospital, Bronx, NY 10457, USA. jbalentine@pol.net
J R
JR
Balentine
T J
TJ
Gaeta
D
D
Kessler
E
E
Bagiella
T
T
Lee
D000328:Adult; D001786:Blood Glucose; D004632:Emergency Medical Services; D004638:Emergency Treatment; D005260:Female; D005947:Glucose / Q000008:administration & dosage*; D006801:Humans; D007003:Hypoglycemia / Q000175:diagnosis*; D008297:Male; D011446:Prospective Studies; D012996:Solutions / Q000008:administration & dosage; D014867:Water / Q000008:administration & dosage
D001786:Blood Glucose; D012996:Solutions; D014867:Water; D005947:Glucose