Metabolic

2-6-a. Hypoglycemia / Insulin Reaction

Check blood glucose. If blood glucose reading < 70 mg/dl perform the following steps:

1) If patient is alert and able to swallow and maintain their airway, administer oral glucose preparation approximately 12 - 30 grams PO *. Go to step 4 below.

2) If patient is not alert or is not able to swallow and protect their airway, start IV NS at TKO rate and give glucose 12.5 gm IV (25 ml of 50% dextrose solution **)

3) If unable to start IV, give glucagon 1 mg IM.

4) Recheck blood glucose. Treat as needed *Oral glucose preparations are commonly available ranging from 4 gm tablets to 15 gm of gel, as a single unit dose or as multiple doses.

**If D50W is unavailable, other solutions (D25W, D10W or D5W may be used, with the amounts given titrated to clinical improvement while minimizing fluid overload. Fluid choices in order to give 12.5 gm of glucose (Dextrose):

D50 = 25 cc

D10 = 125 cc

D25 = 50 cc

D5 = 250 cc

2-6-b. Hyperglycemia

Notify receiving hospital of high glucose level.