Skip to main content

Hypoglycemia

This policy applies to: Patients with blood sugar < 60 mg/dl

Exclusion Criteria: None

Recognize
  • Altered mental status
  • Anxiety
  • Slurred speech
  • Sweating
  • Pale skin
  • Tremors
  • Seizures
  • Medic alert bracelet / jewelry

Evaluate

  • Primary survey with airway management
  • Obtain blood glucose measurement

Administer Treatment

  • RemoveIf allergypatient triggerhas ifaltered knownmental andstatus present
    • with
  • Prioritize interventions based on clinical presentation and severityconcerns of reactioninability to protect airway, obtain IV access,
    reference Vascular Access (P33)
  • Supplemental oxygen PRN for goal SpO2
  • AttentiveAdult: treat patients with a blood glucose reading of < 70 mg/dl
      • If patient is conscious, cooperative and promptcan airwayprotect assessmenttheir andairway, managementadminister Oral Glucose 1-2
         Airway Management if indicated per Airway Management PCGtubes (P1)15-30g) PO
      • If patient has suspected or known exposure and exhibits signs of any: respiratory distress, airway
        restriction, altered mental status or shock,there treatis accordinglyconcern of inability to protect airway,
        administer D10W, 125 mL (12.5 gm) IV/IO over 10 minutes, may repeat PRN
          • If D10W is not available, administer EpinephrineDextrose Auto-Injector50%, 0.3 mg IM if available
          • Vascular access per Vascular Access PCG25-50mL (P33)
            • 12.5-25
          • Consider crystalloid fluid bolus 500 mLgm) IV/IO over
            5 to support10 hemodynamics,minutes, may repeat PRN
          • Diphenhydramine (Benadryl) 50 mg IM/IV/IO
          • Epinephrine (1mg/1mL) 0.3 mg IM or Epinephrine (1mg/10mL) 0.1 mg IV/IO q 3 min PRN for
            MORE SEVERE REACTION
              • Consider Epinephrine infusion 0.01 mcg/kg/min IV/IO, titrate to max 0.1 mcg/kg/min
                as an alternative to repeat IM or IV/IO doses
              • Monitor ECG rhythm closely, Epinephrine may potentiate arrhythmias, especially in
                patients over the age of 40
          • Consider Glucagon 1mg IM (>20 Kg patients) if venous access unobtainable
      • Repeat blood glucose measurement every 30 minutes and treat accordingly
      • For persistent hypoglycemia despite treatment, consider a maintenance infusion with escalating
        dextrose concentration
          • D12.5% is the highest dextrose concentration that may be infused peripherally
          • Dextrose concentrations higher than D12.5% require a central line or IO
      • For refractory low blood glucose with coinciding hypotension, consider adrenal crisis and treat with
        Hydrocortisone (Solu-Cortef) 1mg/Kg IV/IO, max 100mg/dose, repeat PRN
          • If Solu-Cortef is unavailable, treat with Methylprednisolone (Solu-Medrol) 125 mg2mg/Kg IV/IO
            • ,
            max
          • Albuterol125mg/dose, (2.5repeat mg/3 mL) nebulizedPRN for wheezing or shortness of breath

      Consider Differentials

      • UrticariaEnvironmental (rash only)exposure
      • AnaphylaxisToxic (severe systemic effect)ingestion
      • Shock (severe vascular effect)Alcoholism
      • Angioedema (drug induced or infection)
      • Aspiration / airway obstruction
      • Vasovagal event
      • Asthma or COPD
      • Infection (ex: retropharyngeal abscess, bacterial tracheitis, croup, epiglottitis, strep)
      • Pulmonary edema or CHFSepsis
      • Metabolic disordersetiology
      • Adrenal crisis

      Transport Considerations

      • DuringBlood transport,glucose maintainmeasurement astuteis airway,required breathing,on circulationall patients less than 1 year of age, if not obtained at
        sending facility within the last 4 hours
      • Hypoglycemia and mentalhypothermia statusoften assessmentcoexist. with
        promptIf interventionone as needed. Stability can quickly change to instability inof these patients.
        • conditions
      • Considerexists, earlydetermine airwayif management,the
        other referenceis Airwayalso Management PCG (P1)present

      Information

      • Typically,Hypoglycemia should be considered in any person with an altered LOC. However, glucose should not
        be administered unless the shorterpatient is actually hypoglycemic. Administration of glucose or dextrose to
        a patient who does not have hypoglycemia but instead has experienced a stroke resulting in an
        altered LOC could be detrimental
      • Remember that sick children have high metabolic requirements with high glucose utilization. Check
        blood glucose early and often
      • D10W is the intervalpreferred fromIV exposurebolus solution to symptoms,treat the more severe the reactionhypoglycemia
      • HemodynamicAbnormal instabilityglucose may recur uplevels to 24be hoursconsidered afterhypoglycemia initialand stabilizationtreated during transport:
          • Adult < 70 mg/dl
          • Pediatric < 60 mg/dl
          • Neonatal < 50 mg/dl

      Other Populations

      • Neonate Neonatal/and Pediatric drugDosing: dosing:
          • PediatricOral Glucose 0.2g/Kg PO (infant), Epinephrine15g Auto-Injector JR dose is 0.15 mgPO for patients 15-30 KgPediatric
          • DiphenhydramineD10W, (Benadryl) 1 mg/2mL/Kg IM/slow IV/UVC/IO over 510 minminutes, maxmay doserepeat 50PRN mg
          • Epinephrine (1mg/1mL) 0.01 mg/Kg IM/IV/IO q3 min until stable or infusion started
              • MaxGlucagon 0.5 mg per doseIM (Intentionally<20 largerKg) thanor adult1mg dosing)
                • IM
              • Epinephrine(>20 infusionKg) 0.01if mcg/Kg/minvenous IV/IO,access titrate to max 1 mcg/kg/minunobtainable
          • MethylprednisoloneNeonate: (Solu-Medrol) 2 mg/Kg IV/IO max
              dose
            • 125mg
              • Hypoglycemia has the potential for causing severe neurological damage
              • AlbuterolSymptoms formanifest 15mostly Kgfrom orCNS more,(jittery, usehigh adultpitch dosecry, seizures)
              • AlbuterolHigh forglucose lessutilization thanmay 15quickly Kgdeplete glycogen stores resulting in persistent hypoglycemia
              • Consider Inborn Error of Metabolism, specifically medium chain fatty acid deficiency (1.25mg/MCAD), 3ml)in nebulizedneonates with O2persistent at 6 lpmhypoglycemia

          Navigate

          References

          Campbell,De Ronna.Leon-Crutchlow, “Anaphylaxis:Diva EmergencyD., Treatment.”et al. "Approach to Hypoglycemia in Infants and Children." UpToDate, JanuaryJul 2022.
          Sicherer, Scott. “Prescribing Epinephrine for Anaphylaxis Self-Treatment.” UpToDate, January 2022.2021.
          “U.S. Army Medevac Critical Care Flight Paramedic Standard Medical Operating Guidelines.” Jan.Jan 2020.
          Vella, A., et al. "Hypoglycemia in Adults without Diabetes Mellitus: Clinical Manifestations, Diagnosis, and
           Causes." UpToDate, Feb 2021.

Back to top