Dose:  100 to 400 mg/kg/dose IV bolus (see comments)

Comments: Dextrose is used to treat hypoglycemia and, when combined with insulin, hyperkalemia. Hypoglycemia though very common in premature infants has been aggressively treated because of the belief that the newborn brain only uses glucose as a metabolic substrate. Hypoglycemia if present with severe symptoms or for a long enough period of time may have an impact on neurological outcome. No specific values can be derived from the literature as to what constitutes hypoglycemia though. Previous recommendations based on data from the 1960's may no longer be relevant (Cornblath, Pediatrics, 85:834, 1990). Stay tuned for further developments in redefining hypoglycemia, if it exists, in the newborn. Baird (Neonatal Network 1996; 15:63) reviewed the controversies about definitions of hyper and hypoglycemia as well as the limitations of screening in the NICU.

The use of chemstrips either alone or with a reflectance colorimeter is neither precise nor accurate. This is especially true for values below 50 mg/dl. In addition, the methods are hematocrit dependent. For these reasons, borderline or abnormal values should be checked using standard laboratory methods. Because of the rapid in vitro glycolysis of the newborn red blood cell, blood should be stored on ice or separated immediately. If whole blood samples stand at room temperature, the glucose levels can drop 15 to 20 mg/dl/hr (Yeh, Neonatal Therapeutics, page 214, 1991).

Toxicity: Hyperglycemia. Pildes has presented data on the poor developmental outcome in infants < 1250 grams who had blood glucose values in excess of 125 mg/dl (Cornblath, Pediatrics, 85:834, 1990). Using more concentrated glucose solutions can produce a hyperosmolar state. Hyperosmolality has been associated with disruption of the blood-brain barrier in animals and the development of kernicterus (Bratlid, Pediatrics, 71:909, 1983; and Levine, Pediatrics, 69:255, 1982), and may predispose infants to IVH due to fluid shifts following changes in serum osmolality (Volpe, NEJM, 291:43, 1974).
 

Dextrose Code Sheet

Preparation: Dextrose 10% (100 mg/ml) is available in 100, 500, and 1000 ml IV bags.  Stable for 24 hours without refrigeration after opening. To prepare a higher concentration on an emergent basis, use the high concentration dextrose table.  Use until fluid ordered from the pharmacy arrives.