Glucose (antidote)

#completed #carded

Related FACEM curriculum (2022) learning objectives:

• ME 3.8.1.6(e) Principles of management of toxicological presentations including: Indications for antidotes
• ME 3.8.2.4 Identify the appropriate antidote or antivenom.

Presentations

• Various forms, including infusion packs, ampoules, vials, and single-use syringes with concentrations ranging from 5% to 70%.

Toxicological Indications

• Correction of hypoglycaemia:
  • Ethanol ingestion in children.
  • Insulin poisoning.
  • Propranolol poisoning.
  • Quinine poisoning.
  • Salicylate poisoning.
  • Sulfonylurea poisoning.
  • Valproate poisoning.
• Combined with high-dose insulin therapy:
  • Beta-blocker poisoning.
  • Calcium channel blocker poisoning.

Contraindications

• No absolute contraindications.

Mechanism of Action

• Rapidly corrects hypoglycaemia via parenteral administration.
• Effect short-lived in hyperinsulinaemic states.
• Used to maintain euglycaemia when insulin therapy is applied for hyperkalaemia or toxin management.

Pharmacokinetics

• Normal blood glucose maintained through homeostatic mechanisms.
• Toxic hypoglycaemia usually caused by hyperinsulinaemic states.

Administration

Initial Symptomatic Hypoglycaemia Correction

• Adults: 50 mL of 50% glucose IV bolus; repeat if needed.
• Children: 2 mL/kg of 10% glucose IV bolus; repeat if needed.

Deliberate Self-Poisoning with Insulin

• Requires massive ongoing glucose infusion to maintain euglycaemia or mild hyperglycaemia.
• Use concentrated solutions (50%) via central line to reduce fluid overload and prevent phlebitis.

Deliberate Self-Poisoning with Sulfonylureas

• Large volumes of concentrated glucose until hyperinsulinaemic state controlled with octreotide.

Other Causes of Hypoglycaemia

• Lower glucose requirement, often managed with oral supplementation.
• Hospital admission for monitoring recommended.

Therapeutic Endpoints

• Maintain euglycaemia or mild hyperglycaemia.

Adverse Drug Reactions

• Hyperglycaemia.
• Hyperosmolality.
• Hypokalaemia with large doses in hyperinsulinaemic states.
• Local thrombophlebitis due to extravasation.
• Rebound hypoglycaemia, especially with sulfonylurea overdose.

Management of Rebound Hypoglycaemia

• Administer further IV concentrated glucose boluses as needed.

Specific Considerations

• Pregnancy: No restrictions.
• Paediatric: No restrictions.

Handy Tips

• Anticipate large dextrose requirements in deliberate insulin overdose; use central lines for 50% glucose.
• Initiate octreotide after correcting hypoglycaemia in sulfonylurea overdose.
• Replace potassium with glucose infusions.

Pitfalls

• Failure to anticipate ongoing glucose needs in insulin self-poisoning cases.
• Failure to start octreotide post-glucose treatment in sulfonylurea poisoning.