Dextrose 25% Shortage and Instructions for Using 50% for Peds
Hospira Company provides the only D25% syringes for hospitals and EMS bag.   Hospira is on back order until June of this
year and there are hospitals who have no stock to replace the D25% syringes in the drug bags.  

To work around this shortage  in the interim pharmacists who cannot replace the D25% will place an instruction sheet in the
Intermediate side of the bag.  If you will have a need for D25% peds patients or D12.5% for infants, the instructions will explain
how to do that with  the D50%  syringe in the bag.  This will allow you to administer the right concentration to the pediatric or
infant.  

You may want to print these instructions and leave in the medic as a reference also until the shortage is over which is
anticipated  to be over by mid June of this year.   
Once the shortage is over the pharmacists will remove the instruction sheet and replace with the D25% syringes.

Dextrose 25%/10ml shortage instructions:

For Children under 25kg:
GMVEMSC protocol requires you to administer 2ml/kg of the 25% concentration.
To achieve this with the D50% syringe - remove 25ml of the D50% solution.  Add 25ml of Normal Saline IV solution to the
remaining 25ml of D50% which will dilute the contents of the syringe to a final concentration of 25%.  Administer 2ml/kg of the
25% concentration.

Infants less than one year:
GMVEMSC protocol requires you to administer 2ml/kg of the 12.5% concentration
To achieve this with the D50% syringe Remove 37.5ml of the D50% solution.  Add 37.5ml of Normal Saline IV solution to the
remaining 12.5ml of D50% which will dilute the contents of the syringe to a final concentration of 12.5%.  Administer 2ml/kg of
the 12.5% concentration.  
See the instructions listed below, or click here to download a printable document for
your bulletin boards!
7/23/2010   Critical D50% shortage       (Click here to download a flyer for posting)

As many of you are aware Hospira is the only manufacturer of pre-filled syringes and 50ml ampoules.  The company is behind
with production of D50% and other ALS meds as well which has resulted in a huge backlog.  D50% is now at a critical level and
hospitals are on a day to day basis for supplying D50% to their own hospital  as well as the EMS bags.  It was initially anticipated
that the shortage would be over by mid July but that has not occurred.  It is now anticipated that it will be mid August before
stock back to par level.

The Regional Physician’s Advisory Board has been made aware of this critical shortage and has established the following
guidelines during this critical shortage in order to minimize the use of the D50%.

Per Region 2 Regional Physician’s Advisory Board, EMS is being asked to do the following:

Use D50% IVP only with documented hypoglycemia with unconsciousness or cardiac arrest .

If you encounter a patient with mild altered mental status and Accu-Check reading is a low normal or slightly low normal then
administer oral glucose as long as it will not present an aspiration risk.

If a glucose measurement if not possible, i.e. equipment failure, etc., then dextrose in some form, D50 only if unconscious,
instant glucose if confused, etc. ( and no aspiration risk) should be administered if clinically indicated.