amp of D50

Comatose and intubated? I don't remember that being part of the original discussion. But, since you bring it up, of course I am not giving OJ if a patient is comatose from low BG - but I've had patients with feeding / NG tubes with blood sugars well below 70 that were not symptomatic - they got juice through the tube. If they are sitting up, talking to me, and A&Ox3 they may not need D50. Just as asymptomatic folks that are not NPO/do not have feeding tubes would get juice.

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...

The first time I pushed it, I called out for another nurse because I thought I must be doing something wrong...

We give D50 quite frequently for low BGs, even on walky/talky/eating patients. Don't ask me why. I don't write the orders. All of our patients have central access in some form.

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

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.

We have standing orders for hypoglycemic patients depending on the symptoms (unconscious or conscious with or without IV access and so forth). There is a formula for the amount of d50 to give also and I've not had to give an amp before.

I only pushed it once on a young brittle diabetic (she is no longer living) that started talking "kooky" to me and I knew she had dropped..blood sugar was 35. 3 or so hours later it was 500.

Hello do-over. No, being comatose and intubated were not part of the original discussion...the same way oj and ngts weren't part of the original discussion...but you responded both times (you must like me). However, since I work in ICU...a lot of patients happen to be comatose and intubated. BUT I'm glad to have your attention.

Something interesting to remember about IM glucagon is that it depletes stored glycogen in the liver, putting the patient at risk for further hypoglycemia later.

The same thing with d50, you have 30min then you should have a more permanent fix.

Like the phrase says there are more than one way to skin a cat. Everything depends on your patient. You can push 1 amp of D50 straight in, fast acting but it wears off as fast as well. So in my icu unit, I push 25 ml D50 ivp and the rest 25ml/D50 I mix it with 25 ml of water and flush it down the ngt. This helps to stabilize the sugar in your body once the D50 ivp has wore off. Another option is to mix D50 to a 500 bag of crystalloid and give it as a bolus then again it all comes down to the situation of the patient. I have given glucagon several times for different reasons. We give 1mg im or subq when iv not available. When giving glucagon the pt will experience nausea and vomiting. It is imperative to turn the patient on their side during treatment to avoid aspiration. we also use glucagon for beta blocker toxicity. Hope this helps.

Why are you not looking this up for yourself?

I take it that if you've got the time to log on here, you're not at work in the middle of a diabetic emergency :)

You remember more if you take the initiative to find the info....

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 .... :)