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10% dextrose use in hypoglycemia

Matthew H Bilhimer, Cierra N Treu, Nicole M Acquisto
PURPOSE: To characterize hypoglycemia management and identify characteristics associated with refractory (need for additional treatment following initial management) and recurrent (adequate initial treatment followed by blood glucose [BG] ≤50 mg/dL) hypoglycemia. METHODS: Retrospective review of adult emergency department (ED) patients who presented to a large academic medical center with hypoglycemia (BG ≤ 50 mg/dL) between January 2011 and July 2015. Data collection focused on BG measurements and treatment practices...
January 2017: American Journal of Emergency Medicine
Amanda M Thompson, Carlos R Franco Palacios, Maria N Henriksen
PURPOSE: The concurrent use of intravenous lipid emulsion (ILE) and high-dose insulin (HDI) for the management and treatment of propranolol toxicity in a pediatric patient is described. SUMMARY: A seven-month-old infant (weight, 6.1 kg) was admitted to a hospital emergency department with lethargy and bradycardia after an unintentional overdose of propranolol suspension, which had been prescribed several days previously for treatment of a scalp hemangioma. Notable physical examination and laboratory findings were as follows: blood pressure, 121/84 mm Hg (normal range, 90 ± 30/60 ± 10 mm Hg); heart rate, 62 beats/min (normal range, 100-150 beats/min); respiratory rate, 24 breaths/min (normal range, 25-35 breaths/min); oxygen saturation, 100% on room air; and rectal temperature, 35...
June 15, 2016: American Journal of Health-system Pharmacy: AJHP
Renee D Schmid, Lynn R Hovda
Xylitol is a five-carbon sugar alcohol produced from natural resources frequently used as a sugar substitute for humans. We report the development and successful treatment of acute hepatic failure and coagulopathy in a dog after xylitol ingestion. A 9-year-old 4.95 kg (10.9 lb) neutered male Chihuahua was evaluated at a veterinary clinic for vomiting after ingesting 224 g (45 g/kg, 20.5 g/lb) of granulated xylitol. Hypoglycemia developed within 1-2 h, elevated liver values, suggesting the development of acute hepatic failure, within 12 h and coagulopathy less than 24 h after ingestion...
June 2016: Journal of Medical Toxicology: Official Journal of the American College of Medical Toxicology
G K Dimitriadis, K Gopalakrishnan, R Rao, D K Grammatopoulos, H S Randeva, M O Weickert, N Murthy
UNLABELLED: We report the case of a 70-year-old previously healthy female who presented acutely to the Accident and Emergency department with left-sided vasomotor symptoms including reduced muscle tone, weakness upon walking and slurred speech. Physical examination confirmed hemiparesis with VIIth nerve palsy and profound hepatomegaly. A random glucose was low at 1.7 mmol/l, which upon correction resolved her symptoms. In hindsight, the patient recalled having had similar episodes periodically over the past 3 months to which she did not give much attention...
2015: Endocrinology, Diabetes & Metabolism Case Reports
Dwayne A Pierce, Greg Russell, James L Pirkle
BACKGROUND: Hyperkalemia is a potentially life-threatening condition that is common in kidney disease patients. Insulin is used to treat hyperkalemia, but may cause hypoglycemia, especially in kidney disease when insulin may be metabolized more slowly. OBJECTIVE: We compared the rates of hypoglycemia in patients with low estimated glomerular filtration rate (eGFR) using high versus low doses of insulin for hyperkalemia to determine if lower doses of insulin would decrease the incidence of hypoglycemia...
December 2015: Annals of Pharmacotherapy
Hirofumi Ino, Taishi Masamune, Hiroaki Sato, Katsumi Okuyama, Keiichi Wada, Hironobu Iwashita, Tadahiko Ishiyama, Takeshi Oguchi, Daniel I Sessler, Takashi Matsukawa
BACKGROUND: Hyperglycemia is common in critically ill and surgical patients, as are core temperature disturbances. The effect of hyperglycemia on thermoregulatory defenses remains unknown. We determined the effect of blood glucose concentration on the shivering threshold in rabbits. METHODS: Twenty-seven rabbits lightly anesthetized with isoflurane were randomly assigned to infusions of (1) saline, (2) insulin titrated to produce blood glucose concentrations 60 to 100 mg/dL, or (3) 50% dextrose titrated to produce blood glucose concentrations 200 to 300 mg/dL...
August 2015: Anesthesia and Analgesia
Teng J Peng, Lars W Andersen, Brian Z Saindon, Tyler A Giberson, Won Young Kim, Katherine Berg, Victor Novack, Michael W Donnino
INTRODUCTION: Dextrose may be used during cardiac arrest resuscitation to prevent or reverse hypoglycemia. However, the incidence of dextrose administration during cardiac arrest and the association of dextrose administration with survival and other outcomes are unknown. METHODS: We used the Get With The Guidelines®-Resuscitation national registry to identify adult patients with an in-hospital cardiac arrest between the years 2000 and 2010. To assess the adjusted effects of dextrose administration on survival, we used multivariable regression models with adjustment for multiple patient, event, and hospital characteristics...
April 10, 2015: Critical Care: the Official Journal of the Critical Care Forum
Jill Apel, Sirimon Reutrakul, David Baldwin
BACKGROUND: Hypoglycemia is common in patients with end-stage renal disease (ESRD). We identified the incidence and timing of hypoglycemia and its risk factors in hospitalized patients with ESRD after the treatment of hyperkalemia with insulin. METHODS: We conducted a retrospective study of all hospitalized adult patients treated with hemodialysis who received intravenous insulin to treat hyperkalemia between 1 January 2011 and 31 December 2011. We identified patients who became hypoglycemic [blood glucose <3...
June 2014: Clinical Kidney Journal
Katarina R Bennett, M Casey Gaunt, Dennilyn L Parker
CASE DESCRIPTION: A 3-year-old female domestic ferret (Mustela putorius furo) with an insulinoma was treated because of a hypoglycemic crisis prior to scheduled pancreatectomy with concurrent nodulectomy. CLINICAL FINDINGS: Previously, the ferret had clinical signs of lethargy and hind limb weakness; at that time, blood glucose concentration was low, and a tentative diagnosis (subsequently confirmed) of insulinoma was made. Prednisolone treatment (0.3 mg/kg [0.14 mg/lb], PO, q 12 h) did not improve clinical signs; the dosage was gradually increased over a 1-month course (1...
February 15, 2015: Journal of the American Veterinary Medical Association
Augusto Boido, Valerio Ceriani, Antonio E Pontiroli
AIMS: Glucagon is used as an emergency drug in hypoglycemia, mainly when the patient is unconscious. A few studies report on ineffectiveness of glucagon in relieving hypoglycemia. The present systematic review and meta-analysis evaluate the effectiveness of glucagon alone and in comparison with dextrose and the effectiveness of intranasal glucagon in comparison with injected glucagon. METHODS: Studies were grouped into three groups: (1) reports on glucagon ineffectiveness; (2) comparison of glucagon and dextrose; (3) comparison of intranasal glucagon and injected glucagon...
April 2015: Acta Diabetologica
Kathleen Ennis, Hannah Dotterman, Ariel Stein, Raghavendra Rao
BACKGROUND: Prolonged hypoglycemia leads to brain injury, despite treatment with 10% dextrose. Whether induction of hyperglycemia or ketonemia achieves better neuroprotection is unknown. Hyperglycemia is neuroprotective in other brain injuries during development; however, it worsens hypoglycemia-induced injury in the adult brain via poly(ADP-ribose)polymerase-1 (PARP-1) overactivation. METHODS: Three-week-old rats were subjected to insulin-induced hypoglycemia and treated with 10% dextrose or 50% dextrose...
January 2015: Pediatric Research
K K Mukherjee, Pinaki Dutta, Apinderpreet Singh, Prakamya Gupta, Anand Srinivasan, Hemant Bhagat, S N Mathuriya, Viral N Shah, Anil Bhansali
BACKGROUND: Electrolyte imbalance and acute diabetes insipidus (DI) are the most common complications in patients undergoing craniopharyngioma surgery. Improper management of water and electrolyte imbalance is common cause of morbidity and mortality. Data is sparse and controversial regarding the choice of fluid therapy in this population during perioperative period. METHODS: In this retrospective-prospective study involving 73 patients (58 retrospective), the type of fluid therapy was correlated with occurrence of hypernatremia, hyponatremia, DI, morbidity, and mortality...
2014: Surgical Neurology International
Lalantha Leelarathna, Shane W English, Hood Thabit, Karen Caldwell, Janet M Allen, Kavita Kumareswaran, Malgorzata E Wilinska, Marianna Nodale, Jasdip Mangat, Mark L Evans, Rowan Burnstein, Roman Hovorka
INTRODUCTION: Closed-loop (CL) systems modulate insulin delivery according to glucose levels without nurse input. In a prospective randomized controlled trial, we evaluated the feasibility of an automated closed-loop approach based on subcutaneous glucose measurements in comparison with a local sliding-scale insulin-therapy protocol. METHODS: Twenty-four critically ill adults (predominantly trauma and neuroscience patients) with hyperglycemia (glucose, ≥10 mM) or already receiving insulin therapy, were randomized to receive either fully automated closed-loop therapy (model predictive control algorithm directing insulin and 20% dextrose infusion based on FreeStyle Navigator continuous subcutaneous glucose values, n = 12) or a local protocol (n = 12) with intravenous sliding-scale insulin, over a 48-hour period...
July 24, 2013: Critical Care: the Official Journal of the Critical Care Forum
Balazs Benyo, Attila Illyés, Noémi Szabó Némedi, Aaron J Le Compte, Attila Havas, Levente Kovacs, Liam Fisk, Geoffrey M Shaw, J Geoffrey Chase
INTRODUCTION: Stress-induced hyperglycemia increases morbidity and mortality. Tight control can reduce mortality but has proven difficult to achieve. The SPRINT (Specialized Relative Insulin and Nutrition Tables) protocol is the only protocol that reduced both mortality and hypoglycemia by modulating both insulin and nutrition, but it has not been tested in independent hospitals. METHODS: SPRINT was used for 12 adult intensive care unit patients (949 h) at Kálmán Pándy Hospital (Gyula, Hungary) as a clinical practice assessment...
November 1, 2012: Journal of Diabetes Science and Technology
Miguel Glatstein, Dennis Scolnik, Yedidia Bentur
BACKGROUND: Sulfonylureas are used extensively for treating type-2 diabetes mellitus. Sulfonylurea poisoning can produce sustained and profound hypoglycemia refractory to IV dextrose, particularly in children and the elderly. OBJECTIVE: To review the use of octreotide, a long-acting somatostatin analog, in the treatment of sulfonylurea-induced hypoglycemia. METHODS: A computerized search of U.S. National Academy of Medicine, Embase, PubMed and Toxline databases was undertaken using the keywords "octreotide", "sulfonylurea", "poisoning", "intoxication", "overdose" and "children"...
November 2012: Clinical Toxicology
Yumiko Umino, Nicolas Cuenca, Drew Everhart, Laura Fernandez-Sanchez, Robert B Barlow, Eduardo Solessio
PURPOSE: Mice rendered hypoglycemic by a null mutation in the glucagon receptor gene Gcgr display late-onset retinal degeneration and loss of retinal sensitivity. Acute hyperglycemia induced by dextrose ingestion does not restore their retinal function, which is consistent with irreversible loss of vision. The goal of this study was to establish whether long-term administration of high dietary glucose rescues retinal function and circuit connectivity in aged Gcgr-/- mice. METHODS: Gcgr-/- mice were administered a carbohydrate-rich diet starting at 12 months of age...
February 2012: Investigative Ophthalmology & Visual Science
Richard Michael Bracken, Rhydian Page, Benjamin Gray, Liam P Kilduff, Daniel J West, Jeffrey W Stephens, Stephen C Bain
PURPOSE: Individuals with type 1 diabetes mellitus (T1DM) are encouraged to reduce rapid-acting insulin and consume CHO to prevent hypoglycemia during or after exercise. However, research comparing the metabolic and performance effects of different CHO is limited. This study compared the alterations in metabolism and fuel oxidation in response to performance running after preexercise ingestion of isomaltulose or dextrose in T1DM. METHODS: After preliminary testing, on two occasions, seven T1DM individuals consumed 0...
May 2012: Medicine and Science in Sports and Exercise
Jean-Louis Wayenberg, Catia Cavedon, Chiraz Ghaddhab, Nicolas Lefèvre, Serge P Bottari
BACKGROUND: The clinical significance of early transient hypoglycemia (ETH), a frequent event in preterm newborns, is a highly controversial issue. In experimental models, hypoglycemia has been reported to cause oxidative stress. Among the reactive species, early generated peroxynitrite is responsible for protein nitration and lipid peroxidation, a process referred to as nitrative stress. OBJECTIVES: The aim of the present study is to investigate whether ETH is associated with protein nitration in the preterm newborn...
2011: Neonatology
G Nunnari, B M Celesia, F Bellissimo, S Tosto, M La Rocca, F Giarratana, F Benanti, E Caltabiano, R Russo, B Cacopardo
AIM: To report hypoglycaemia, a life-threatening adverse event, associated with trimethoprim-sulfamethoxazole. A sulfonylurea-like effect, leading to insulin raise, was investigated. METHODS: Two cases of trimethoprim-sulfamethoxazole-associated hypoglycaemia in 2 patients with a diagnosis of new HIV-1-infection presenting with Pneumocystis jiroveci pneumonia are reported. The patients had no predisposing factors, such as renal or liver impairment, interfering with trimethoprim-sulfamethoxazole elimination, thus leading to hypoglycaemia...
December 2010: European Review for Medical and Pharmacological Sciences
Sujani Poonuru, Sumedha R Pathak, Hemender S Vats, Ram D Pathak
The conventional methods of treatment of severe hypertriglyceridemia are dietary restriction and lipid lowering medications, mainly fibric acid derivatives. In the medical literature, use of insulin infusion to treat hypertriglyceridemia has not been highlighted sufficiently. We report a 53-year-old male who presented with a four-day history of epigastric pain. The patient's clinical history was significant for hypertriglyceridemia, type-2 diabetes mellitus with medication noncompliance, obesity, status post-gastric bypass surgery, and alcohol abuse with prior admissions for detoxification...
March 2011: Clinical Medicine & Research
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