D10 Protocol

1. D50VS D10

2. OR
TRADITION

3. D50
Causes hyperglycemia
Can cause tissue necrosis
Can cause a headache and/or nausea
Rebound hypoglycemia
Can cause local skin irritation
Thrombophlebitis
Frequently national shortages
Rapid rise in level of consciousness

4. D10
Easier to titrate to effect
Slower more controlled rise in level of
consciousness
Less viscous
Better for the veins and surrounding tissues
Easier to return the patient to euglycemia
Just as effective and safer than D50

5. NEW PROTOCOL

6. 2.8.2 Diabetic Emergencies
(Hypoglycemia/Hyperglycemia)
• Protocol for patients with blood
sugar below 80mg/dl. Keep in
mind that low blood sugar can be
affected by medications,
infections, stress or alcohol.

7. BASIC LEVEL: EMT AND PARAMEDIC
• Initial Patient Assessment Protocol 2.1.1
• Airway Assessment/Management Protocol
2.1.1
• Oxygen via nasal cannula@ 2-4 LPM to
maintain pulse ox > 94% (non rebreather @ 15
LPM if SpO2 < 90%)
• Attach cardiac monitor and pulse oximeter

8. ALS LEVEL 1: PARAMEDIC ONLY
• Inititiate IV and Draw Blood
• If patient tachycardic and/or hypotensive bolus 1-
2 L in increments of 250cc, recheck vital signs and
lung sounds with each increment. Discontinue
bolus if HR slow <110, BP >90 or signs/symptoms
of pulmonary edema. If no signs/symptoms
resume rate at 125ml/hr. If no IV access, consider
IO ONLY if patient is seriously ill (hypotensive and
tachycardic). Do not place IO simply for high or
low blood sugar when patient is otherwise stable.

9. Continue Paramedic Only
• Determine blood glucose level.
 If glucose is <80 mg/dl and patient is
Asymptomatic (no headache, nausea, and/or
AMS)
60 mg/dl-80mg/dl; No emergency treatment ok
for patient to drink cola, juice or other oral form
of glucose they may have with them.
If sugar <60mg/dl; Oral glusose (juice, piece of
candy, or sublingual glucose).

10. Continue Paramedic Only
Symptomatic (headache, nausea, AMS)
If sugar 60mg/dl; Sublingual glucose paste, or hang
250ml D10W and run 100ml wide open (titrate to
effect). Give second dose of 100ml D10W if glucose still
<80mg/dl when glucose rechecked in 5 min. If unable
to establish IV consider Glucagon 1mg IM.
If blood sugar <60mg/dl; hang 250ml D10W and run
bolus 200-250ml wide open (titrate to effect). If no IV
give Glucagon 1mg IM.

11. Continue Paramedic Only
If glucose >80mg/dl and <250 mg/dl, no
specific treatment, supportive care.
If glucose >250mg/dl, Symptomatic patients
exhibiting AMS, Kussmaul respirations, dry
skin with poor skin turgor, and/or ketotic
breath:
Bolus with 1 – 2 liters of IV fluid in 250cc
increments with vital signs rechecked and lung
exam between each increment. Discontinue bolus
if signs of pulmonary edema.

12. Continue Paramedic Only
Asymptomatic patients with glucose
>250mg/dl, just give IV fluids at 125ml/hr.
Contact Medical Control or Medical Director if
any concerns or any questions.