Emergency medical services facing critical dextrose shortage

Amid shortages going back months to over a year of dextrose syringes and intravenous fluid bags to treat a wide variety of emergency conditions, US emergency medical services (EMS) are scrambling to adapt treatment protocols and conduct trainings on how to use them.Dextrose is a critical drug used to treat conditions such as low blood sugar (hypoglycemia), dehydration, acute alcohol poisoning, and high potassium levels, or as a carbohydrate in parenteral nutrition, according to David Margraf, PharmD, PhD, pharmaceutical research scientist at the Resilient Drug Supply Project (RDSP), part of the University of Minnesota's Center for Infectious Disease Research and Policy (CIDRAP), publisher of CIDRAP NewsWhile oral glucose could be substituted for dextrose injections, Margraf said, "There will be many patients who can't take anything by mouth, so they need intravenous or intraosseous dextrose.

The other option is intramuscular or intranasal glucagon, but this drug is expensive, in shortage, and may not be the appropriate treatment for some patients."Glucagon also has the disadvantages of having a slower onset of action and being more difficult to administer than dextrose. "Prefilled dextrose syringes are preferred, but many times EMS use dextrose from large bags," Margraf said. "This adds time and complexity."And because supplies of glucagon, a hormone that stimulates the production and release of glucose, haven't shipped for more than 6 months and are on backorder, many EMS agencies no longer even include it in their treatment protocols, according to EMS1.Some products backordered until 2023Per the US Food and Drug Administration (FDA), dextrose formulations in shortage include dextrose 25% injection (manufacturer