D - 25 Mixing and Administration Review
It never hurts to review some basics, and the mixing of medications and their proper use is one area that we could all use. Here is a review of mixing D25 for the pediatric patient.
We know that by protocol we cannot give pediatric patients full strength dextrose. The 50% strength can cause a rapid fluid displacement at the cellular level which can be fatal to these patient. Therefore infusing the milder 25% is the proper treatment.
After asking several folks, we've decided that the generally the best way for us to produce 25% dextrose is a simple as 1-2-3 and it goes like this:
- Start with a new 25 gram 50% Dextrose syringe, expel half of it - 25 ml - leaving 25 ml.
- Draw back in 25 ml of sterile water (or normal saline will do). Do this slowly or you'll pull out the screw in plunger! Agitate syringe to mix the dilutant.
- This gives you 12.5 grams dextrose in 50 ml which is1 gram dextrose in 4 cc.
Remember that by protocol pediatric patients under 8 years of age receive 1 gram per kilogram of 25% dextrose-
Here's an Example
This child has become acutely unresponsive and has a blood glucose of 22. Mom says that at his 4 month check-up 1 week ago her little boy weighted 14 pounds. You have established an IV and need to give 25% dextrose - how much will you give if mixed like we just discussed?
Your math:
Convert: 14 pounds which equals 6.3 kilograms we'll call it -6-
Multiply: 6 times 4 for the 4ml per gram ratio which gives you 24 ml
This is the amount you'll give: 24 ml-