Hypoglycaemia (Paediatric)
 
Status
Evidence of probable Hypoglycaemia
- e.g. Hx diabetes, unconscious, pale, diaphoretic
   
Assess
BGL
               
BGL >4
BLS
Consider other causes of altered conscious state
- e.g. stroke, seizure, hypovolaemia
 
 
BGL <4 Responds to commands
Glucose 15g Oral
         
Adequate response   Poor response
Consider transport   Consider Glucagon IM
  Consider Dextrose IV
     
 
BGL <4 Does not respond to commands
(QAP)
<25kg - Glucagon 0.5IU IM (0.5ml)
>25kg - Glucagon 1IU IM (1ml)
IV cannula in a large vein
Confirm IV patency
Dextrose 10% 3ml/kg (300mg/kg) IV
- Normal Saline 10ml IV flush
If unable to obtain IV access, Glucagon as above
         
Adequate response   Inadequate response
GCS 15   GCS <15 after 3 minutes
If still being given, cease Dextrose IV and flush with Normal Saline 10ml   Repeat Dextrose 10% IV 2ml/kg (200mg/kg) titrating to Pt conscious state
- Normal Saline 10ml flush
 
 
Special Notes
Pt may be aggressive during management.
Ensure IV patent before administering Dextrose. Extravasation of Dextrose can cause tissue necrosis.
Ensure sufficient advice on further management and follow-up if Pt refuses transport.
 
General Care
If Pt’s next meal more than 20min. away, encourage the Pt to eat a long acting carbohydrate (e.g. sandwich, piece of fruit, glass of milk) to sustain BGL to next meal.
If adequate response, maintain initial Mx and transport.
If the Pt refuses transport, repeat the advice for transport using friend/relative assistance. If Pt still refuses transport, document the refusal, and leave Pt with a responsible third person and advise the third person of actions to take if symptoms re-occur and of the need to make early contact with LMO for follow up.
If inadequate response transport without undue delay.
Maintain general care of unconscious Pt and ensure adequate airway and ventilation.
Further dose of Dextrose 10% may be required in some Hypoglycaemic episodes. Consider consultation if BGL remains less than 4 mmol/L and unable to administer oral carbohydrates
Continue initial Mx and transport.