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2.10P                        Hypoglycemia - Pediatric                                        

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E

EMT STANDING ORDERS

  • Routine Patient Care.

  • Obtain glucose reading

  • Oral glucose: administer commercially prepared glucose gel or equivalent.

    • Hypoglycemic patients must be alert enough to swallow and protect airway.

  • For patients with an insulin pump who are hypoglycemic with associated altered mental status (GCS<15):

    • Stop the pump or disconnect catheter at insertion site if patient cannot ingest oral glucose or ALS is not available.

    • Leave the pump connected and running if able to ingest oral glucose or receive ALS interventions

A/P

ADVANCED EMT/PARAMEDIC STANDING ORDERS

  • Administer dextrose 10% IV via premixed infusion bag (preferred) or prefilled syringe until mental status returns to baseline and glucose level is greater than 60mg/dL or per Pediatric Color Coded Appendix 3. IV pump not required.

  • If unable to obtain IV access:

    • Patients < 20 kg, give glucagon 0.5 mg IM or Glucapen Jr 0.5 mg IM.

    • Patients > 20 kg, give glucagon 1 mg IM or Glucapen 1.0 mg IM.

Click here for a video demonstrating use of the Glucapen.

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Intraosseous (IO) administration of dextrose should be reserved for hypoglycemic patients with severe altered mental status or active seizures and IV access cannot be obtained.

PEARLS

  • Hypoglycemic emergency in pediatrics is defined as glucose <60mg/dl with associated altered mental status, GCS <15.

  • 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. See Bibliography below.

  • Causes of hypoglycemia include medication misuse or overdose, missed meal, infection, cardiovascular insults (e.g., myocardial infarction, arrhythmia), or changes in activity (e.g., exercise).

  • 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.

  • Oral glucose equivalents include 3-4 glucose tablets, 4 oz. fruit juice (e.g. orange juice), non- diet soda, 1 tablespoon of pure NH maple syrup, sugar, or honey.

  • Encourage patients who refuse transport after improvement in GCS and are back to baseline to consume complex carbohydrates (15 grams) and protein (12 – 15 grams) such as peanut butter toast, mixed nuts, milk or cheese to stabilize blood sugar.

  • Hypoglycemia may be detrimental to patients at risk for cerebral ischemia, such as victims of stroke, cardiac arrest, and head trauma.

Protocol Performance Standards

Performance / Documentation Standards

  • Was the patient's weight determined via weight-based resuscitation tape (unless weight definitively known)

  • Documentation of pre- and post-treatment blood glucometry

  • Assessment of patient's mental status.

Protocol Bibliography

Protocol Bibliography

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