title: Blood glucose response to rescue dextrose in hypoglycemic, critically ill patients receiving an insulin infusion.
abstract: BACKGROUND
  There is inadequate guidance for clinicians on selection of the optimal dextrose 50% (D50W) dose for hypoglycemia correction in critically ill patients.
  
  
  OBJECTIVE
  The purpose of this study was to determine the blood glucose (BG) response to D50W in critically ill patients.
  
  
  METHODS
  A retrospective analysis was conducted of critically ill patients who received D50W for hypoglycemia (BG < 70 mg/dL) while on an insulin infusion. The primary objective of this study was to determine the BG response to D50W. The relationship between participant characteristics and the dose-adjusted change in BG following D50W was analyzed using simple and multiple linear mixed-effects models.
  
  
  RESULTS
  There were 470 hypoglycemic events (BG < 70 mg/dL) corrected with D50W. The overall median BG response was 4.0 (2.53, 6.08) mg/dL per gram of D50W administered. Administration of D50W per protocol resulted in 32 episodes of hyperglycemia (BG > 150 mg/dL), resulting in a 6.8% rate of overcorrection; 49% of hypoglycemic episodes (230/470) corrected to a BG >100 mg/dL. A multivariable GEE analysis showed a significantly higher BG response in participants with diabetes (0.002) but a lower response in those with recurrent hypoglycemia (P = 0.049). The response to D50W increased with increasinginsulin infusion rate (P = 0.022). Burn patients experienced a significantly larger BG response compared with cardiac, medical, neurosurgical, or surgical patients.
  
  
  CONCLUSIONS
  The observed median effect of D50W on BG was approximately 4 mg/dL per gram of D50W administered. Application of these data may aid in rescue protocol development that may reduce glucose variability associated with hypoglycemic episodes and the correction.
authors.affiliation: University of California Davis, Sacramento, CA, USA.
authors.forename: Manasa S
authors.initials: MS
authors.lastname: Murthy
authors.affiliation: University of California Davis, Sacramento, CA, USA.
authors.forename: Jeremiah J
authors.initials: JJ
authors.lastname: Duby
authors.affiliation: University of California Davis, Sacramento, CA, USA.
authors.forename: Patricia L
authors.initials: PL
authors.lastname: Parker
authors.affiliation: University of California Davis, Sacramento, CA, USA.
authors.forename: Blythe P
authors.initials: BP
authors.lastname: Durbin-Johnson
authors.affiliation: University of California Davis, Sacramento, CA, USA.
authors.forename: Denise M
authors.initials: DM
authors.lastname: Roach
authors.affiliation: University of California Davis, Sacramento, CA, USA elnagle@ucdavis.edu.
authors.forename: Erin L
authors.initials: EL
authors.lastname: Louie
mesh_terms: D001786:Blood Glucose / Q000032:analysis; D016638:Critical Illness; D003920:Diabetes Mellitus / Q000188:drug therapy; D005260:Female; D005947:Glucose / Q000009:adverse effects / Q000627:therapeutic use*; D006801:Humans; D006943:Hyperglycemia / Q000139:chemically induced / Q000188:drug therapy; D007003:Hypoglycemia / Q000139:chemically induced / Q000188:drug therapy*; D007004:Hypoglycemic Agents / Q000009:adverse effects*; D007328:Insulin / Q000009:adverse effects*; D008297:Male; D012189:Retrospective Studies
chemical_list: D001786:Blood Glucose; D007004:Hypoglycemic Agents; D007328:Insulin; D005947:Glucose
keywords: antidote; critically ill; hypoglycemia; pharmacokinetics; rescue dextrose