When IV access is available, what is the typical EMS dose of dextrose?

• A. 5 g (D10)
• B. 10 g (D20)
• C. 25 g (50 mL of 50% D50)
• D. 50 g (D100)

Answer: (C)

When a patient is hypoglycemic and IV access is available, the goal is to raise blood glucose quickly with a single, reliable bolus. The typical EMS dose is 25 grams of dextrose given as 50 milliliters of a 50% solution (D50). This provides rapid, predictable glucose delivery in a small volume, which is convenient for the field.

Why this dose works best: a smaller amount like 5 grams (D10) or 10 grams (D20) often isn’t enough to correct severe hypoglycemia promptly. A much larger amount, such as 50 grams (D100), can cause hyperglycemia and additional osmolar load, and is unnecessary for a single rescue bolus. Using 50% dextrose in 50 mL achieves rapid glucose elevation with a manageable volume, minimizing delays while reducing the risk of overcorrection. Remember to monitor for IV patency and potential infiltration, as extravasation of a hyperosmolar solution can injure tissue. If IV access isn’t available, other therapies like IM glucagon or oral glucose (if the patient can safely protect their airway) are considered.