Can D10 be administered via the ETT route?

In neonatal patients, obtaining IV access can be challenging, often requiring the use of an IO for D10W administration, which typically requires a base hospital patch. If IV or IO access is unavailable, would it be appropriate to administer D10W via the endotracheal tube (ETT)? If not, what are the physiological and pharmacological reasons for this (e.g., fluid viscosity, drug absorption)?

No, D10W (10% dextrose in water) should not be administered via the endotracheal tube (ETT). Unlike lipid-soluble drugs such as epinephrine, naloxone, atropine, and lidocaine (which can be absorbed through the pulmonary epithelium), dextrose is poorly absorbed via the respiratory tract. The viscosity of D10W further limits its ability to be effectively delivered through the ETT, and it does not reliably raise serum glucose levels when administered this way. 

If IV or IO access is unavailable in a neonatal patient requiring glucose, glucagon would be the more appropriate alternative. Glucagon can be administered intramuscularly (IM) and acts by stimulating glycogenolysis in the liver to increase blood glucose levels. While glucagon is less effective in neonates with limited glycogen stores, it remains the best available option when IV or IO dextrose administration is not possible. If a patient is persistently hypoglycemic and access cannot be obtained, a base hospital physician patch should be considered for further direction.