TOPLINE

Dextrose 10% (D10) and dextrose 50% (D50) demonstrated similar effectiveness in reversing hypoglycemia in the emergency department (ED), with no significant difference in the time to achieve euglycemia. However, rebound hypoglycemia occurred in more than 40% of patients treated with D50, compared with approximately 27% of those treated with D10.

METHODOLOGY

• Researchers conducted a retrospective cohort study at a 51-bed ED to compare D10 and D50 for the treatment of hypoglycemia, defined as a blood glucose (BG) level < 70 mg/dL.
• A total of 375 patients were included, of whom 246 received D10 (median age, 59.5 years; 47.6% men) and 129 received D50 (median age, 60.8 years; 57.4% men).
• The primary outcome was the time to achieve euglycemia (BG levels, 70-180 mg/dL) within 6 hours of the first dextrose dose.
• Safety outcomes included the incidence of hyperglycemia (BG levels > 180 mg/dL), rebound hypoglycemia (BG levels < 70 mg/dL), and extravasation within 6 hours of the first dose.

TAKEAWAY

• The time to achieve euglycemia was not significantly different between the D50 and D10 groups (38.0 vs 51.0 minutes; P = .053), although D50 was associated with a clinically faster response.
• Rebound hypoglycemia within 6 hours was more common with D50 than with D10 (43.4% vs 27.2%; P = .002).
• In patients with severe hypoglycemia (BG levels < 40 mg/dL), the time to euglycemia was similar with D50 and D10 (34.5 minutes for both; P = .655), with no significant difference in achieving euglycemia within 6 hours (96% vs 92%; P = .678).
• More patients receiving D50 than those receiving D10 required a continuous infusion of dextrose within 6 hours (20.2% vs 11.4%; P = .022) and were admitted to the ICU (27.1% vs 14.6%; P = .032).

IN PRACTICE

"There was no difference between D10 and D50 in the primary efficacy outcome of time to achieve euglycemia. However, more patients in the D50 group required initiation of a dextrose continuous infusion and experienced rebound hypoglycemia," the authors wrote. 

"Larger controlled studies are warranted to validate these efficacy and safety outcomes and to determine the preferred agent for hypoglycemia in the ED setting," they added.

SOURCE

The study was led by Daniel Fischer, Medical University of South Carolina, Charleston. It was published online on August 20, 2026, in The Journal of Emergency Medicine.

LIMITATIONS

The study was limited by its retrospective design, the inability to evaluate all potential confounders such as the cause of hypoglycemia and medication adherence, the lack of a standardized hypoglycemia protocol resulting in variation in treatment dosing and monitoring intervals, and differences in baseline BG levels and prehospital dextrose treatment between the two groups, which may have influenced the findings.

DISCLOSURES

The study did not receive any funding. The authors reported having no competing interests.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.