Pharmacology
Dextrose 10%
GENERIC NAME
Dextrose
TRADE NAME
Dextrose 10
DESCRIPTION
Dextrose is a simple sugar that is rapidly metabolized by the body, providing quick restoration of blood glucose levels.
HOW SUPPLIED
Prefilled bag: 25 grams/250 ml (10% solution)
INDICATIONS
- Hypoglycemia
CONTRAINDICATIONS
- No major contraindications for IV administration of Dextrose.
- Known or suspected CVA (stroke) in the absence of hypoglycemia.
MECHANISM OF ACTION
Rapidly restores blood glucose levels in cases of hypoglycemia.
SIDE EFFECTS
- Local venous irritation and potential tissue necrosis if IV infiltration occurs.
AUTHORIZATION
AEMT: Standing order
Paramedic: Standing order
DOSAGE
- Adult: 250 ml IV/IO wide open, may repeat once if blood glucose remains < 60 mg/dL.
- Pediatric: 5 ml/kg (0.5 g/kg) IV/IO, may repeat once if blood glucose remains < 60 mg/dL.
ADMINISTRATION NOTES
- If desired dose is ≤ 100 ml, draw the required amount of D10 into a syringe and administer via slow IV/IO push using the port closest to the patient.
- If the desired dose is > 100 ml, administer by running wide open as a piggy-back to Normal Saline.
Glucagon
GENERIC NAME
Glucagon Hydrochloride
TRADE NAME
None
DESCRIPTION
Glucagon is used to increase blood glucose levels, particularly in cases where an IV line cannot be immediately established. Intramuscular (IM) administration results in a quicker onset than subcutaneous (SQ) and is therefore the preferred route.
HOW SUPPLIED
Vial: 1 mg powder (activated by injection of 1 cc sterile water)
INDICATIONS
- Hypoglycemia
CONTRAINDICATIONS
- Allergy or hypersensitivity to Glucagon
MECHANISM OF ACTION
Glucagon increases circulating blood glucose levels by promoting the breakdown of stored glycogen to glucose. Return to consciousness typically occurs within 5–20 minutes after administration. However, Glucagon may lose its effectiveness if given within the previous 48 hours.
SIDE EFFECTS
- Hypotension
- Dizziness
- Headache
- Nausea and vomiting
ADDITIONAL INFORMATION
After administration of Glucagon, the patient should eat a carbohydrate-rich meal as soon as possible to prevent recurrent hypoglycemia.
AUTHORIZATION
Paramedic: Standing order
DOSAGE
- Adult: 1 mg IM/SQ
- Pediatric < 20 kg: Refer to specific dosages listed in the 402 – Drug Dosage Chart – Pediatric
- Pediatric > 20 kg: 1 mg IM/SQ
Glucose
GENERIC NAME
Glucose
TRADE NAME
Glutose, Insta-Glucose
DESCRIPTION
Oral glucose is used to provide supplemental glucose in cases of hypoglycemia. It is administered when the patient is conscious and able to swallow.
HOW SUPPLIED
Tube: 15 gm
INDICATIONS
- Hypoglycemia
CONTRAINDICATIONS
- Allergy or hypersensitivity to glucose
- Patient is not awake or unable to swallow
MECHANISM OF ACTION
Oral glucose restores blood sugar levels in patients experiencing hypoglycemia.
SIDE EFFECTS
- None
AUTHORIZATION
EMT: Standing order
AEMT: Standing order
Paramedic: Standing order
DOSAGE
- Adult: 15 gm (1 tube) orally
- Pediatric: 15 gm (1 tube) orally
Fentanyl Citrate
GENERIC NAME
Fentanyl Citrate
TRADE NAME
Fentanyl
DESCRIPTION
Fentanyl is a potent narcotic analgesic used for pain management. It acts quickly and has a short duration of action, making it suitable for trauma patients experiencing pain.
HOW SUPPLIED
Prefilled Syringe: 100 mcg/2 ml
INDICATIONS
- All trauma patients with pain
CONTRAINDICATIONS
- Allergy or hypersensitivity to Fentanyl
- Acute respiratory compromise or bradycardia
MECHANISM OF ACTION
Fentanyl Citrate binds with opiate receptors in the central nervous system, altering the perception of and emotional response to pain.
SIDE EFFECTS
- Nausea
- Vomiting
- Abdominal cramps
- Headache
- Anxiety
- Respiratory depression
AUTHORIZATION
Paramedic: Standing order
DOSAGE
- Adult:
- IV/IO/IM: 100 mcg, may repeat once after 10 minutes (max 200 mcg total)
- IN: 200 mcg (administer half in each nostril), may repeat once after 10 minutes (max 400 mcg total)
- For patients ≥ 65 years: 25 mcg per dose, titrate to effect
- Pediatric:
- IV/IO/IM: 1 mcg/kg, may repeat once after 10 minutes (max 72 mcg total)
- IN: 2 mcg/kg (administer half in each nostril), may repeat once after 10 minutes (max 144 mcg total)