'Runaway' IV of 50% dextrose?

[2bNurseTimTin]

One patient had a ‘runaway’ IV of 50% dextrose. To prevent temporary excess of insulin or transient hyperinsulin reaction what solution you prepare in anticipation of the doctor’s order?

A. Any IV solution available to KVO

B. Isotonic solution

C. Hypertonic solution

D. Hypotonic solution

[Woodenpug, BSN]

It's a fun question. You don't have the obvious answer slow down the current IV, or the better answer: Why drip D50, or how. (You would not need a MD order to return the IV to its proper rate while waiting for MD orders to prevent a sentinel event.) My guess would be 'C' hypertonic since D50 is hypertonic and a sudden drop in available glucose would play havoc with insulin levels. For that matter D10 is hypertonic.

Where did you see the question?

[GilaRRT]

Not going to give free answers;however, I would question the 50% dextrose. An IV of D50 would be a bit unusual. Assuming we gave a massive dose of D50, why would "excess of insulin" be a consideration?

[Daytonite, BSN, RN]

You wouldn't want the patient to have any more dextrose, that's for sure. There are a number of isotonic solutions that have dextrose in them. There is only one hypotonic solution and that is 0.45% sodium chloride. These solutions will lower osmotic pressure causing fluids to be drawn into the blood and the blood cells and away from the intracellular compartment.

[iluvivt, BSN, RN]

I think the answer is isotonic...this is my thinking D50 is very hypertonic...the large glucose molecules will pull fluids from the tissues and you could have cellular dehydration. So now you have a high blood sugar and your pancreas will start producing more insulin...so I would choos the isotonic...which will stay in the vascular space and dilute it and promote diuresis and excretion of glucose at the max rate that the human kidney will allow. Let us know the answer b/c I did not look this up in a book or anything...that just seems to make sense.

[2bNurseTimTin]

You see, my professor told us the answer was "C" - giving another hypertonic solution, explaining that the main focus of the question is on how to prevent temporary excess of insulin or transient hyperinsulin reaction caused by the ‘runaway’ IV of 50% dextrose. Whereby giving dextrose will compensate for the excess insulin.

But my colleagues pondered wouldn't simple logic explain that you should compensate excessive hypertonic infusion with a hypotonic solution? I doubt that though.

[yahnie jee]

it's hypertonic..

[classicdame, MSN, EdD]

Crazy question. What is "runaway"? Accidental bolus? I would not do any till I checked the blood glucose level. But I do know it is dangerous to leave someone on hypertonic fluids too long due to electrolyte shifts. The question is not a good one.