amp of D50

[happyRN21]

Hi everyone,

I have the following questions: If a person is hypoglycemic and unconscious, do you give an amp of D50 or 1mg of glucagon I'm in the ED? I also want to know what an amp actually means. How many mg/cc is an amp of D50 and how do you administer it in an emergency situation? Is it IV push or IV drip? If it is an IVP, over how many mins do you push? If it's an IV drip, for how long should it infuse into the pt?

Thank you in advance for your responses.

[xtxrn, ASN, RN]

IV D50 feels horrible when it "hits"....and always needs to be followed up (for an otherwise po walkie talkie) with a good source of protein if the next meal is more than 30 minutes out.

Had an idiot nurse send me out to wait for a taxi, knowing it would take 45 minutes for them to get there....I had my meter, and sure enough, started to crash again (I was new to insulin at the time, and had been at 37mg/dl at home, with nothing working)....I told the triage person (can't believe she was licensed in anything) that I had been seen for low blood sugar, and it was in the 50s again (from 128 s/p D50). She told me that I'd already been seen, and she'd see if someone had time (this is after I'd chugged down Coke, and eaten some candy- checking along the way). I was safer in the cab. Even a plain unit serving of peanut butter would have helped stabilize things when I was around 125.

The follow up is as important as the initial treatment .... :)

[Aeterna, BSN, RN]

At the hospital I work in, an amp of D50W is standard if the patient cannot take any high-sugar juice/food PO. If they are awake, then we usually give orange juice or something.

We do have a patient on our floor who we end up giving D50W every few weeks or so because her sugars are so whacky. We can't even give her orange juice because she's also a nephrology patient and it'll throw her potassium out of whack. So it was D50W automatically for the longest time, even if she was awake. However, after they had to pull her PICC, they couldn't put a new one in so they changed her to glucagon IM. Unfortunately, it really doesn't work as fast so when she starts going comatose, we do our best to get IV access and get the D50W in.

[akulahawkRN, ADN, RN, EMT-P]

MunoRN said:

D50 should be used very conservatively. It often has a pH of 3.5, which makes it a strong vesicant (anything less than a pH of 5 is considered a vesicant). Even if it doesn't extravasate it will still damage the vein to some degree due to it's acidity. There is no reason to give it just for a BG of

Even if D50 had a pH level that's closer to 7.0, it exerts such a powerful osmotic pull that it'll dessicate any cells in the area, and it'll keep doing so until it's no longer able to dessicate cells because it's been diluted enough. Think of it as a colloid, like Hespan that's easier to metabolize, in this regard.

ChristineN said:

Just curious as to why IM Glucogon is the preferred medical intervention? I would think most pt's would prefer to have something IV vs IM.

IM Glucagon is relatively fast and can be given quickly. Unfortunately, this route has it's own issues. If the patient has been hypoglycemic for a long time, there's a good chance that the stores of glycogen have been depleted. When that happens, not much glucose will make it to the bloodstream.

IV D50 is very, very thick. You're going to want to administer it via a large (18 ga or larger) bore cannula in a big vein. Push it in slowly and let it mix with your IV fluid. You won't be able to slam it in because of it's thick viscosity anyway, so take a little time. The fluid exiting the catheter won't be as thick and will circulate a little better and won't exert as much osmotic pull. Also, if you try to slam it in, there's a chance you could cause it to extravasate, which is a very bad thing...

As others have said, once the D50 has been given, follow up with something longer lasting and more complex than glucose... The body will use that 25g of glucose in a very short time. It's only 100 calories...

[That Guy, BSN, RN, EMT-B]

xtxrn said:

IV D50 feels horrible when it "hits"....and always needs to be followed up (for an otherwise po walkie talkie) with a good source of protein if the next meal is more than 30 minutes out.

The follow up is as important as the initial treatment .... ?

This is what I was waiting for someone to mention! Yes getting the sugar up fast is important but please please please hit them with some protein as well to help maintain!

[Penelope_Pitstop, BSN, RN]

donsterRN said:

Our protocol is the D50 amp. I remember the first time I had to push it, it was like liquid cement going through a swizzle stick. And I'm a strong, big guy! But it works like a charm...

Funny story - an older nurse on my floor (she'd actually recovered from a massive CVA to work on the floor and pull charge!) had to administer D50 IVP. A resident was standing there next to her, and thinking she was pushing it so slowly because of her elder status, nicely offered to finish the dose. Well, that young fit man had just as much (if not more!) trouble pushing that amp into the IV.

Personally, I prefer to use D50 as a last resort. I've worked with nurses who want to use it right away, even if the patient is awake and able to drink juice.

[ZippyGBR, BSN, RN]

ayla2004 said:

nurses cant push d50 in my hospital

we give glucose tabs if can eat drink

hypostop gel if pt perfers

if not eating IM glucogon

if not effective bleep medic for iv d50 i work ina teaching hosptial and IM glucagon is very effective

bonkers that you can't push D50 ....

as usual teaching hospitals marginalising Nurses in favour of the fact they think they have on tap Juniors still

how long out of clinical practice was the clippy cloppy shoed clipboard wielding alleged Nurse who came up with that idea...?

D50 has it;s uses but it;s not a magic cure -all as the rebound hypo can strike if you don't get some longer carbs on board,,,,

[Unknown member]

I'm a nursing student so I can't speak from experience... but I can share with you all what I was taught in school last year.

1) Each facility has it's own protocol for hypoglycemia....LEARN IT AND FOLLOW IT!

2) If a person is awake and conscious, then most likely you will not use D50 (I've read other posts that say they do, just saying what I was taught..); if PO is possible, then PO is the way to go.

3) D50 is a vesicant drug and cannot be pushed "as fast as possible" as most of you have said... we were taught to push it over 17 MINUTES!! This freaks me out because if my patient is unconscious from low BS, my reaction would be to push it quickly... but my instructors insist the correct way to do it is over 17 minutes.

Please don't yell at me for this, haha, this is what I was taught in school.

[RN-LOGIC]

Samantha13 said:

I'm a nursing student so I can't speak from experience... but I can share with you all what I was taught in school last year.

1) Each facility has it's own protocol for hypoglycemia....LEARN IT AND FOLLOW IT!

2) If a person is awake and conscious, then most likely you will not use D50 (I've read other posts that say they do, just saying what I was taught..); if PO is possible, then PO is the way to go.

3) D50 is a vesicant drug and cannot be pushed "as fast as possible" as most of you have said... we were taught to push it over 17 MINUTES!! This freaks me out because if my patient is unconscious from low BS, my reaction would be to push it quickly... but my instructors insist the correct way to do it is over 17 minutes.

Please don't yell at me for this, haha, this is what I was taught in school.

Thank you so much for your input. Just remember that with an unconscious pt and a good iv, you are not really worry about waiting 17 minutes to push it. A good example is when a pt is coding you really dont worry about pushing epi or any drugs slow. In the real world sometimes what's in the book and what is practical don't go together, with time you'll find your mojo. Welcome to the nursing world and thank you for sharing your knowledge.

[tokmom, BSN, RN]

D50 push here to. Of course it's nasty to veins, but be sure you have a good IV site. It's pretty thick, so pushing it quickly isn't optional. Also, remember it will wear off soon, so be prepared for another crash, until you have IV or foods given.

[Penelope_Pitstop, BSN, RN]

Samantha13 said:

we were taught to push it over 17 MINUTES!! This freaks me out because if my patient is unconscious from low BS, my reaction would be to push it quickly... but my instructors insist the correct way to do it is over 17 minutes.

I'm sorry, what? D50 is a RESCUE drug. Wow. And where did 17 minutes come from...that is a very random amount of time!

I'm not yelling at you, Samantha; I am questioning your instructors!

[Unknown member]

DeLanaHarvickWannabe said:

I'm sorry, what? D50 is a RESCUE drug. Wow. And where did 17 minutes come from...that is a very random amount of time!

I'm not yelling at you, Samantha; I am questioning your instructors!

Haha, that is okay. I know, it sounds quite ridiculous but LOOK:

2011 Intravenous Medications by Gahart

"50% solution, 3 mL over 1 minute"

3 mL/1 minute = 50 mL/x minutes = 16.66 = 17 minutes

[Penelope_Pitstop, BSN, RN]

Samantha13 said:

Haha, that is okay. I know, it sounds quite ridiculous but LOOK:

2011 Intravenous Medications by Gahart

"50% solution, 3 mL over 1 minute"

3 mL/1 minute = 50 mL/x minutes = 16.66 = 17 minutes

I checked out my health care system's formulary, and it agrees with this except in emergent use. Apparently in a continuous infusion, the 3mL/min maximum is appropriate. So no more than 180 mL/hour. (But dear heavens, I have never seen anything more than D10 given as a drip!)

My formulary also recommends central access, and doesn't have a maximum per minute push rate for emergent use. Ugh, that is annoying! I think formularies and drug guides are sometimes written by Martians...