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Medical

HYPOGLYCEMIA

Signs and Symptoms: Differential Diagnosis:
• Diaphoresis and pallor • Environmental Exposure
• Neuroglycopenic • Postprandial syndrome
manifestations/AMS • CNS Dysfunction
• Tremor • Toxic Ingestion
• Palpitations • Metabolic disorders
• Anxiety
Universal Patient Care Guideline
Airway Guideline
Continued from: BLOOD GLUCOSE ANALYSIS
Tactical Evacuation Guideline IV/IO Guideline
Cardiac Monitor If administering Dextrose, obtain
blood glucose sample from
Verify Blood Glucose contralateral arm!
Analyzer is accurate then NO Glucose <60mg/dL
repeat BLOOD GLUCOSE • Ensure IV patency
ANALYSIS YES • Administer dextrose 10% IV via
premixed infusion bag (preferred)
YES Assessment: AMS or prefilled syringe until mental

Glucose <60mg/dL • Mental Status status returns to baseline and
glucose level is >60mg/dL

No AMS
NO Oral glucose
• Administer commercially prepared If unable to establish IV access
Continue Assessment and Treat glucose gel or equivalent until
per Appropriate Guideline glucose level >70mg/dL • Administer glucagon 1mg IM
-Recheck glucose 15 minutes after
(Hypoglycemic patients must be alert administration of glucagon.
For patients with an insulin pump who enough to swallow and protect -May repeat glucagon 1mg IM if
are hypoglycemic with associated Airway!) glucose level is <70mg/dLL with
altered mental status: continued altered mental status.
• Stop the pump or disconnect When appropriate, return to:
catheter at insertion site if patient Tactical Evacuation Guideline
cannot ingest oral glucose or ALS is ****IO Dextrose****
not available Intraosseous (IO) administration of
dextrose should only be reserved for
• Leave the pump connected and hypoglycemic patients with severe
running if able to ingest oral glucose altered mental status or active
or receive ALS interventions. seizures and IV access cannot be
obtained.
Pearls:
• There are no statistically significant differences in the median recovery time to a GCS score of 15 following
administration of D10% versus D50%. D10% may benefit patients by decreasing the likelihood of post-
treatment hyperglycemia and reducing the likelihood of extravasation injury.
• Sulfonylureas (e.g., glyburide, glipizide) have long half-lives ranging from 12–60 hours. Patients with corrected
hypoglycemia who are taking these agents are at particular risk for recurrent symptoms and frequently require
hospital admission.
• Hypoglycemia may be detrimental to patients at risk for cerebral ischemia, such as victims of stroke, cardiac
arrest, and head trauma.
• Oral glucose equivalents include 3–4 glucose tablets, 4oz. fruit juice (e.g. orange juice), non-diet soda, 1T
of pure maple syrup, sugar, or honey. Oral glucose okay if patient alert, protecting airway, and solution
available. Proteins + complex carbs (e.g., sandwich, granola) are better, longer lasting glucose source than
simple sugars.
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