Severe hypoglycemia can be scary, especially when the patient isn't responding to front-line therapies (e.g. IV dextrose). However, some unconventional tools and an organized approach can make this extremely manageable.
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Josh is the creator of PulmCrit.org. He is an associate professor of Pulmonary and Critical Care Medicine at the University of Vermont.
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Hypoglycemia is an often encountered problem in EMS, although with increasing use of insulin pumps the incidence seems to me to be decreasing. EMS is frequently called when the patient becomes unresponsive. These patients often have veins that are very difficult to access, and I often end up accessing a very small vein with a small catheter that will not pass D50. We do not carry D25 or D10 so we have to mix our own. That, however, is not difficult and the easiest concentrations to shoot for are D25 and if necessary D12.5. D12.5 will go thru a 22… Read more »
Grant, I think there is a fundamental difference between the hypoglycemic / opiod OD presentation in that for the opiod overdose patient, the reduction of LOC happens first, followed by respiratory depression. Therefore, as long as you reverse enough receptors to get the patient spontaneously breathing on their own, you can leave them napping peacefully in safety while transporting to hospital. You can take your time while reversing because you can ventilate the patient with BVM while titrating naloxone. In the hypoglycemic patient, the reduced LOC happens relatively late in the process, when serum glucose is dangerously low. If you… Read more »
Patrick…Thank you for your reply. I wish it had been different, but as Shakespeare once said, “Dem’s da breaks”.
If you waste 300 from a 500 bag and add the amp in, you get 10%. Makes math easier to dose, especially for kids.
Also, regarding dosing to lethargy; I don’t know if that’s possible. Dextrose isn’t like narcan that the stopping point can accurately predicted. A dangerously low blood sugar usually means unresponsive, it’s not too much higher before confused and feisty happens. I think we’re better off replenishing the glucose and trying to keep everyone safe until they have their faculties again. As you said, it sucks bringing the fuzz in to help restrain, but I cant think of there’s a better way to do it.
First of all I have to thank you for this wonderful website and the Podcast.
There is am minor error in the moderate hypoglycemia definition: mg/d instead of mg/dl