D50: All or Some?

[djmedic]

Greeting and Salutations,

Here is the question of the day.

With a hypoglycemic Pt that is unable to swallow safely, do you give the entire amp of D50 (25g) or only part of the amp or in increments like Narcan?

The 2nd part to this question is, do you give Thiamine with every D50 or only when positive that the Pt is an alcoholic?

Thanx,

DJ

[reaper]

Greeting and Salutations,

Here is the question of the day.

With a hypoglycemic Pt that is unable to swallow safely, do you give the entire amp of D50 (25g) or only part of the amp or in increments like Narcan?

This should be covered in your protocals. Ours are 60-80 mg/dl, get 12.5. Below 60 mg/dl get 25. I still use dicrestion on all my pt's.

The 2nd part to this question is, do you give Thiamine with every D50 or only when positive that the Pt is an alcoholic?

Also protocal. Ours gives us discretion on when we use it.

Thanx,

DJ

[letmesleep]

I typically will give the entire 25g IVP in a known diabetic who is found unresponsive if family is present to tell me or they are a frequent flier. I also think that you have to use some common sense as well tho, knowing how the drug metabolizes and how your diabetic Pts are going to respond short and long term needs to be considered, again it all comes down to a good Pt Hx. Pt to Pt, call to call, there is no REAL standard in my opinion. As far as thiamine, I'll have to investigate a little, but is there some thought process that it improves the response to D-50? I know that "back in the day" we had the "coma cocktail", but I think we have gotten away from that type of "cook book" medicine

[spenac]

The important thing to remember is while they respond quickly they will also drop quickly again. So work with your protocol but remember they need something to help them maintain proper levels. We do generally administer complete dose.

As to thiamine primarily given to those with known or suspected alcohol abuse. We have other times thiamine may be used as well.

[letmesleep]

SPENAC, I know that Thiamine is used on alcoholics yada yada, but other than a known diabetic with alcohol use and/or abuse is there anything you can tell me about why it would be given as a follow up to the D-50? I have never heard of this one before, just wondering?

[AZCEP]

Any time you suspect a nutrition imbalance Thiamine is a good idea. Urban outdoorsman with alcohol is probably the most common situation, but those in the wilderness/extreme rural setting also can benefit.

[JakeEMTP]

Thiamine helps convert carbohydrates into energy. Since D50 is a carbohydrate we give Thiamine to help in this process.

We give 25g D50 followed by 100mg Thiamine for BGL less than 60. If the patient's BGL doesn't increase to greater than 60, or they remain in an altered mental state, we can administer and additional dose of 25g D50.

[letmesleep]

Thanks JAKE, I'm going to pull out the old "protocol" book and look in to this thiamine thing, I wonder now why WE have never gotten orders for this on a diabetic call.....maybe a phone call to the MED director is in order as well to shed some light on it....hmmmm!

[firedoc5]

Depending on how low the BGL is dictates on how much D50 is given initially. I've heard the arguments before on how much to give right off the bat. Give 25 and see how they respond over a certain amount of time, or save time and just give the whole thing. Nine times out of ten of only giving 25 you wind up giving them the rest anyway.

For some reason we didn't carry Thiamine in the field. But have given it in the ER when doing clinicals. Usually to alcohol induced hypoglycemia. But if the doc felt like any pt. that was hypoglycemic and is malnourished he would order it. Some docs give it no matter what, sort of like "hand-in-hand" with the D50.

[mobey]

I gotta ask... How can you not know this basic stuff? No offence but I am what you would compare to an EMT-I and it is clear as anything to me.

Your credentials say NREMT-P, so your nationally registered as the highest level of education available in EMS and you don't know how to properly administer D50??

Sorry if I offend but maybe it is time for a refresher course.

On second thought, maybe you are asking because you are curious how other areas do it?

I administer 1/2 an amp then reassess.

I find this is especially important if they are insulin dependant, a full amp of D50 can really screw these peoples day up, and it is not appreciated.