The nurse is preparing a 50 mL dose of 50% Dextrose IV for a client with insulin shock. How should the nurse administer the medication?
A.
Ask the pharmacist to add the Dextrose to a TPN solution.
B.
Mix the Dextrose in a 50 mL piggyback for a total volume of 100 mL.
C.
Push the undiluted Dextrose slowly through the currently infusing IV.
D.
Dilute the Dextrose in one liter of 0.9% Normal Saline solution.
The correct answer and Explanation is :
The correct answer is:
C. Push the undiluted Dextrose slowly through the currently infusing IV.
Explanation:
In the case of insulin shock, which is also referred to as hypoglycemia or a severe drop in blood glucose levels, the immediate goal is to rapidly elevate the blood glucose level. The most appropriate treatment for insulin shock is the administration of a hypertonic dextrose solution, typically 50% dextrose in water (D50).
Option A: Ask the pharmacist to add the Dextrose to a TPN solution.
This option is not suitable because Total Parenteral Nutrition (TPN) is a complete nutritional solution intended for long-term nutritional support, not for the rapid correction of acute hypoglycemia. Additionally, it would delay the intervention needed for an acute condition.
Option B: Mix the Dextrose in a 50 mL piggyback for a total volume of 100 mL.
This approach would delay the onset of action as it involves diluting the dextrose solution. For acute management of hypoglycemia, a rapid effect is required, and diluting the dextrose would slow down the absorption and impact of the treatment.
Option D: Dilute the Dextrose in one liter of 0.9% Normal Saline solution.
Diluting the dextrose in such a large volume is also inappropriate for acute hypoglycemia. It would not provide the immediate rise in blood glucose levels needed and could lead to complications or prolonged treatment time.
Option C: Push the undiluted Dextrose slowly through the currently infusing IV.
This is the best option because administering undiluted 50% dextrose allows for rapid delivery of glucose directly into the bloodstream. The “push” technique involves administering the dextrose in a controlled manner, ensuring that it is delivered quickly but safely. Since 50% dextrose is a hypertonic solution, it should be administered carefully to avoid potential complications such as phlebitis or vein irritation. Monitoring the patient closely during administration is crucial.
In summary, administering the undiluted dextrose solution directly into the IV line is the most effective and timely method for addressing the acute hypoglycemic episode and rapidly elevating the blood glucose level.