The Effect of 50% Dextrose on Serum Glucose Levels in Adult Hypoglycemic Patients: A Prospective Observational Study.

Abstract

Objective: This study aimed to observe changes in serum glucose levels following the administration of 50 mL of 50% dextrose solution (D50) in hypoglycemic patients. Specifically, we seek to determine the prevalence of rebound hyperglycemia episodes, the peak effect, and the duration of action of a single dose of 50 mL D50.

Method: This prospective observational study was conducted at four emergency departments (two tertiary care hospitals and two secondary care hospitals) in Oman over a three-year period, from May 1, 2019, to April 30, 2022. Adult patients (>12 years old) presenting with documented hypoglycemia (serum glucose level ≤3.9 mmol/L) were included. All patients underwent bedside serum glucose measurements at predetermined time intervals following the administration of D50. Data were analyzed using the Epidata program (Buenos Aires, Argentina). The mean serum glucose level at each time interval was calculated, along with the prevalence of rebound hyperglycemia. The independent sample t-test, one-way ANOVA, and Pearson's chi-squared test were used for statistical analysis.

Results: A total of 102 patients (53 females and 48 males) were included in this study. The majority of patients were diabetic (N = 87), while 15 (14.7%) were non-diabetic. Rebound hyperglycemia was predominantly observed within five minutes of administering 50 mL of D50, with a mean serum glucose level of 12.2 mmol/L and a maximum reading of 22.6 mmol/L. Rebound hyperglycemia occurred more frequently in the non-diabetic group (73.3%) compared to the diabetic group (56.3%). Six patients (5.7%) required a second dose of 50 mL D50, all of whom were diabetic.

Conclusion: A single dose of 50 mL D50 effectively restores and maintains the desired serum glucose level in non-diabetic hypoglycemic adult patients for up to 60 minutes. However, diabetic patients may require additional doses or continuous dextrose-containing fluids if they do not begin oral feeding. Using a lower concentration of dextrose-containing fluids may help mitigate the phenomenon of rebound hyperglycemia.