Metabolic

Metabolic: Hypoglycemia / Insulin Reaction

Check blood glucose. If blood glucose reading <70 mg/dl (or <40 mg/dl in newborn) perform the following steps:

1) If child is alert and able to swallow and maintain their airway, give oral glucose preparation 12 - 30 grams then go to step 4

2) If child is not alert or is not able to swallow and maintain their airway, start IV with Normal Saline at TKO rate and give Glucose according to age as follows:

a) For newborns give 0.2 g/kg = 2ml/kg of 10% Dextrose Solution.

i. If D10W is unavailable, prepare D10NS by diluting D50W by 4:1 with saline by taking a 250 ml bag of NS, withdraw and discard 50 cc of NS, add a 50 ml D50W pre-fill syringe to the bag and mix

ii. Label it D10 NS

iii. Draw up dose

b) For infants and all children older than 1 month, give glucose 0.5 g/kg or 5 ml/kg using D10W, (max dose = 12.5 g)

3) If unable to obtain IV access, give Glucagon 1 mg IM (0.5 mg IM if less than one year of age)

4) Recheck blood glucose and treat as needed