1 Alameda County Medical Center, Highland Hospital, Department of Emergency Medicine, Oakland, California USA.
2 Contra Costa County Emergency Medical Services, Martinez, California USA.
Prehosp Disaster Med. 2014 Apr;29(2):190-4. doi: 10.1017/S1049023X14000284. Epub 2014 Apr 15.
Prehospital first responders historically have treated hypoglycemia in the field with an IV bolus of 50 mL of 50% dextrose solution (D50). The California Contra Costa County Emergency Medical Services (EMS) system recently adopted a protocol of IV 10% dextrose solution (D10), due to frequent shortages and relatively high cost of D50. The feasibility, safety, and efficacy of this approach are reported using the experience of this EMS system.
Over the course of 18 weeks, paramedics treated 239 hypoglycemic patients with D10 and recorded patient demographics and clinical outcomes. Of these, 203 patients were treated with 100 mL of D10 initially upon EMS arrival, and full data on response to treatment was available on 164 of the 203 patients. The 164 patients' capillary glucose response to initial infusion of 100 mL of D10 was calculated and a linear regression line fit between elapsed time and difference between initial and repeat glucose values. Feasibility, safety, and the need for repeat glucose infusions were examined.
The study cohort included 102 men and 62 women with a median age of 68 years. The median initial field blood glucose was 38 mg/dL, with a subsequent blood glucose median of 98 mg/dL. The median time to second glucose testing was eight minutes after beginning the 100 mL D10 infusion. Of 164 patients, 29 (18%) required an additional dose of IV D10 solution due to persistent or recurrent hypoglycemia, and one patient required a third dose. There were no reported adverse events or deaths related to D10 administration. Linear regression analysis of elapsed time and difference between initial and repeat glucose values showed near-zero correlation.
In addition to practical reasons of cost and availability, theoretical risks of using 50 mL of D50 in the out-of-hospital setting include extravasation injury, direct toxic effects of hypertonic dextrose, and potential neurotoxic effects of hyperglycemia. The results of one local EMS system over an 18-week period demonstrate the feasibility, safety, and efficacy of using 100 mL of D10 as an alternative. Additionally, the linear regression line of repeat glucose measurements suggests that there may be little or no short-term decay in blood glucose values after D10 administration.
传统上，院前急救人员会通过静脉推注 50 毫升 50%葡萄糖溶液（D50）来治疗野外的低血糖症。由于 D50 经常短缺且相对成本较高，加利福尼亚州康特拉科斯塔县的紧急医疗服务（EMS）系统最近采用了静脉注射 10%葡萄糖溶液（D10）的方案。本文报道了使用该 EMS 系统的经验，以评估这种方法的可行性、安全性和疗效。
在 18 周的时间里，护理人员使用 D10 治疗了 239 例低血糖症患者，并记录了患者的人口统计学和临床结果。其中，203 例患者在 EMS 到达时最初接受了 100 毫升 D10 的治疗，在这 203 例患者中，有 164 例患者的治疗反应数据完整。计算了 164 例患者初始输注 100 毫升 D10 后的毛细血管血糖反应，并拟合了时间与初始和重复血糖值之间差值的线性回归线。检查了可行性、安全性和重复输注葡萄糖的需求。
研究队列包括 102 名男性和 62 名女性，中位年龄为 68 岁。中位初始现场血糖为 38mg/dL，随后的中位血糖为 98mg/dL。开始输注 100 毫升 D10 后，第二次血糖检测的中位时间为 8 分钟。在 164 例患者中，29 例（18%）因持续或反复低血糖需要额外剂量的 IV D10 溶液，1 例患者需要第三次剂量。没有报告与 D10 给药相关的不良事件或死亡。初始和重复血糖值之间的时间和差值的线性回归分析显示几乎没有相关性。
除了成本和可用性的实际原因外，在院外环境中使用 50 毫升 D50 的理论风险包括外渗损伤、高渗葡萄糖的直接毒性作用以及高血糖的潜在神经毒性作用。一个地方 EMS 系统在 18 周内的结果证明了使用 100 毫升 D10 作为替代方案的可行性、安全性和疗效。此外，重复血糖测量的线性回归线表明，D10 给药后血糖值可能几乎没有或没有短期衰减。
