As empiric therapy for coma, give 50–100 mL of 50% dextrose (equivalent to 25–50 g of glucose) slowly (eg, about 3 mL/min) via a secure intravenous line (children: 2–4 mL/kg of 25% dextrose, or 5–10 mL/kg of 10% dextrose; do not use 50% dextrose in children). Dextrose 10% can also be given by intraosseous route.
Persistent hypoglycemia (eg, resulting from poisoning by sulfonylurea agent) may require repeated boluses of 25% (for children) or 50% dextrose and infusion of 5–10% dextrose, titrated as needed. Consider the use of octreotide (See Octreotide) in such situations. Note: Glucose can stimulate endogenous insulin secretion, which may exacerbate a hyperinsulinemia (resulting in wide fluctuations of blood glucose levels during treatment of sulfonylurea poisonings).
Hyperinsulinemia-euglycemia therapy usually requires an initial dextrose bolus (unless the patient's initial blood glucose is >250 mg/dL), followed by a dextrose infusion at a rate of 0.5 g/kg/h with a 5–50% dextrose solution (if >25% dextrose solution, administer via a central line) as needed to maintain euglycemia while insulin is infused (See Insulin).