Drinking D50

[AZCEP]

If the patient is alert enough to take something by mouth, why do people feel a need to jab them with a needle?

There is little reason to do this.

[ptemt]

AZCEP,

Thanks for staying on topic.

Lots of other more or less interesting, informative and entertaining replies as to be expected.

The patient was at BGL of 27. On scene drank an amp, ate part of a swiss and roast beef sandwich, some OJ and a pepsi with no significant improvement up to BGL 35. On the way one tube oral plus one amp IVP and another amp in the ER. Full recovery with mention of some "bad insulin."

I am really just wondering if drinking D50 is quicker than the paste inside the cheek or swallowed.

[katbemeEMT-B]

If the patient is alert enough to take something by mouth, why do people feel a need to jab them with a needle?

There is little reason to do this.

I agree with you AZCEP and I have seen this with a couple of medics that I worked with. Regardless of situation, get out a needle and admin. drugs or IV them. I'm not saying ALL medics are like that, just a couple that I know. They don't work for us any longer.

As for this patient, he is alert and has a patent airway. Give him a soda and some peanut butter and jelly on something like bread or crackers. We've even put the peanut butter and jelly on a granola bar because there was nothing else to use in the house. That also worked. Patient said it wasn't bad either. EWWW :puke:

[Dustdevil]

Unfortunately, there is a problem in that approach. Time and resources.

How long do you sit with this guy on the scene, watching him eat lunch and rechecking his BGL? At what point do you decide it's okay to no-ride him and leave? At what point do you realise that you aren't going to get it over 35 and then either push IV D50 or take him to the hospital? Yes, it varies case by case, but in ANY case, you are taking your unit out of service for too long for a non-emergent patient.

I don't want to sit in his smelly arse house for half an hour. And I don't have a food service certificate from the health department. I ain't feeding this guy anything but D50 or a pen to refuse with. It's time to take control of the situation and make a decision. No ride him or get on the road already.

[zippyRN]

Never heard about the pizza, nice idea! I feel that if someone is awake enough to drink, I'm not going to have them drink D50! From what I gather it doesn't taste very well....

standard advice to drunks or diabetics treated at events

- go and sget something proper to eat - remind the daibetics about complex carbs and bafle the drunks ...

[sledogg1]

Drug Name

Dextrose 50% (D-Glucose) -- Monosaccharide absorbed from intestine and distributed, stored, and used by tissues. Parenterally injected dextrose used in patients unable to obtain adequate oral intake. Direct oral absorption results in rapid increase of blood glucose concentrations. Effective in small doses; no evidence of toxicity. Concentrated dextrose infusions provide higher amounts of glucose and increased caloric intake, with minimal fluid volume. Use 1 ampule of 50 mL of a 50% glucose solution (25 g).

Adult Dose 0.5-1 mg/kg IV bolus

Pediatric Dose <12 years: Not established

>12 years: Administer as in adults

Contraindications Do not administer to a patient in diabetic coma if blood sugar levels are extremely high, and avoid in severely dehydrated patients

Do not administer concentrated solution if intraspinal or intracranial hemorrhage is present; avoid in dehydrated patients with DT, hepatic coma, or glucose-galactose malabsorption syndrome

Interactions Caution when administering parenteral fluids to patients receiving corticosteroids or corticotropin, especially if solution contains sodium ions

Pregnancy A - Safe in pregnancy

Precautions Extravasation may cause significant tissue necrosis when used IV; Isolated reports of nausea, which may also occur with hypoglycemia, have been recorded; Dextrose solutions administered IV can result in dilution of serum electrolyte concentrations and overhydration when there is fluid overload; caution in congested states or pulmonary edema.

Ok.......................if u can find it where u can drink D50 let me know,I can't.

[AZCEP]

Dextrose 50% (D-Glucose) -- Monosaccharide absorbed from intestine and distributed, stored, and used by tissues...Direct oral absorption results in rapid increase of blood glucose concentrations.

Did you not read your own post?

The gastrointestinal tract is well suited to manage the makeup of a little sugar. After dealing with hydrochloric acid all day, this is nothing.

[scottymedic]

I'm catching up with some of the A/P's tomorrow so I will run this by them, its a good question as we dont carry the glucose gels in our trucks, just glucose tabs and Dextrose (D.50) and glucagon. With the time a gel is taken to break down and absorb, surely a fluid would be absorbed faster? Direct difusion into the blood stream. I do agree, there are some needle happy medics out there, on all continents as it seems, if you can save the patient unecessary pricking and pain and if they can manage oral replacement therapy as opposed to an IV route, why not take that way?

Excellent topic AZCEP and will report back when I chat tomorrow.

Scotty

[Dustdevil]

Did you not read your own post?

[spenac]

, if you can save the patient unecessary pricking and pain and if they can manage oral replacement therapy as opposed to an IV route, why not take that way?

Wheres the fun in that? All the education was so I could have fun, not for my patients comfort, wasn't it? :laughing5: :laughing5: :laughing3: