Hypoglycemia - James Format

Applies to: Blood glucose less than 70 mg/dL or greater than 300 mg/dL

• Patient-reported low or high blood glucose
• Diabetic patients with other medical symptoms (e.g., vomiting)
• Altered mental status
• Alcohol intoxication, suspected
• Seizure
• Stroke symptoms
• Unresponsive patients
• Cardiac arrest

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BLS

• Check blood glucose level
• If blood glucose is less than 70 mg/dL, administer 10-15 grams of oral glucose between the patient’s gum and cheek.
• Administer additional dose of 10-15 grams of oral glucose if not improved after 10 minutes.

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ALS

• HYPOglycemia: If blood glucose is less than 70 mg/dL, administer 10% dextrose in 50 mL (5 gram) boluses, 1 minute apart, to a maximum of 250 mL OR 25 grams of 50% dextrose IVP, until:
  • the patient has a return to normal mental status, and
  • the patient’s blood glucose is at least 90 mg/dL
• If patient has persistently altered mental status and blood glucose less than 90 mg/dL despite treatment, repeat dosing regimen above.
• If unable to initiate an IV and blood glucose is less than 70 mg/dL, administer glucagon 1 mg IM/IN.
  • If the patient has persistently altered mental status and blood glucose less than 90
    mg/dL at 15 minutes, transport to the hospital should not be delayed.
• HYPERglycemia: If blood glucose is greater than 300 mg/dL, administer 10 mL/kg Lactated Ringer’s bolus unless rales, wheezing, pedal edema, or history of renal failure or CHF is present. 

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MC

• Not Applicable