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WINNER OF THE EMERGENCY MEDICINE JOURNAL (EMJ) AWARDED FOR MOST ORIGINAL RESEARCH

001 10% OR 50% DEXTROSE IN THE TREATMENT OF HYPOGLYCAEMIA OUT-OF-HOSPITAL? A RANDOMISED CONTROLLED TRIAL

C. Moore, M. Woollard.Pre-hospital Emergency Research Unit, Welsh Ambulance Services NHS Trust, Lansdowne Hospital, Cardiff, UK

Objective: This randomised controlled trial aimed to determine whether 10% dextrose is as safe and effective as 50% dextrose when treating hypoglycaemia out-of-hospital.

Methods: Hypoglycaemic patients in the out-of-hospital setting with a blood glucose level of 4 mmols/l or less were randomised to receive either intravenous 10% or 50% dextrose. Paramedics in a large UK ambulance service administered either concentration of dextrose in 5-gram increments. 10% dextrose was administered in 50 ml aliquots via a three-way tap and giving set and 50% in 10 ml aliquots from pre-filled (25 g in 50 ml) syringes. The maximum cumulative dose for subjects in both groups was limited to 25 g. Paramedics recorded standard pre and post-treatment clinical data and rated the convenience of administration of each dextrose formulation using a Lickert scale.

Results: Fifty one patients were recruited (10% n = 25, 50% n = 26). There were no significant differences between groups in age or sex profile, median pretreatment Glasgow Coma Score (GCS) and blood glucose level, or the proportion of insulin dependent diabetics. Following treatment there were no significant differences in median time to recovery (8 minutes), median post-treatment GCS (15), subjects experiencing a further hypoglycaemic episode within 24 hours (4 per group), time on scene, or ease of administration. There were, however, significant differences in the median total dose of dextrose administered (10% = 10 grams, 50% = 25 grams, p<0.001) and median post-treatment blood sugar levels (10% = 6.2 mmols/l and 50% = 9.4 mmols/l, p = 0.003). There were no reports of extravasation injury from either group.

Conclusions: 10% dextrose proved as effective as 50% in the out-of-hospital treatment of hypoglycaemia. It is administered in lower doses than a 50% presentation, which results in more acceptable post-treatment blood glucose levels.

002 AMBULANCE INITIATIVES TO REDUCE EMERGENCY DEPARTMENT ATTENDANCE

M. W. Cooke, J. …