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  • Writer's pictureLouie Romanos

Mom runs into ER and yells HELP! My child isn’t responding to me

Blood sugar IS the 6th vital sign

Part of our pediatric assessment as initial responders includes blood glucose. This falls under the disability portion of the primary assessment and can be easily obtained via bedside instrumentation. Failure to recognize and treat hypoglycemia in the infant/child may lead to irreversible neurological damage (Felter, R., 2010).

How do you know when it's present?

Hypoglycemia is recognized when an infant or child has a serum glucose <50mg/dl with neuroglycopenic symptoms, or <40mg/dl without neuroglycopenic symptoms (Hoe. F.M., 2008). To convert this to the metric that we use in Canada, you must divide by 18. So, for the 2 year old that comes in with decreased LOC and tachypnea, he/she would be diagnosed as hypoglycemic if the serum glucose was less than 2.2mmol/L.

Managing it quickly is key to achieving successful patient outcomes

If the patient does not have an IV in place or they can’t tolerate oral ingestion of glucose, then IV access must be accomplished. Remember, both PALS (Pediatric Advanced Life Saving) and ATLS (Advanced Trauma Life Support) recommend IO access if IV access cannot be attained after 3 attempts or 90s, whichever is sooner (Mackway-Jones, 2001). Site selection will depend on what’s the most readily accessible and includes the antecubital, external jugular and saphenous veins. Ideally, you want to have two working PIV’s (Peripheral Intravenous) access.

Treatment involves a system for creating and delivering glucose concentratons

Fluid delivery systems for pediatric resuscitation and glucose delivery include: 18-22G IV catheter, 3-way stop-cock, IV tubing, 1L bag of N/S, 10cc syringe for bolus administration. Choosing the type of concentration of glucose given will be dependent on the size of your patient and catheter size. Generally, hypoglycemia is corrected by administering .5-1g/kg glucose. This equals 2-4ml/kg D25W or 5-10ml/kg D10W (Felter, R., 2010). In the child with a small gauge needle size, you can use D10W and its subsequent higher infusion volumes. High concentration dextrose solutions should be used with caution since infiltration can lead to significant tissue damage (Felter, R., 2010). We do not use D50W to treat hypoglycemia in the infant or pediatric patient.

Identifying hypoglycemia and managing it quickly is an easy way to prevent morbidity and mortality in the pediatric patient

Failure to identify and treat hypoglycemia in the infant and child patient is associated with potentially fatal neurological sequelae and increased morbidity/mortality. Identifying the hypoglycemic state is easily accomplished via bedside measurements and should be routinely taken when obtaining initial vital signs. Achieving quick IV access and reversing hypoglycemia is essential for improving survival. The two main concentrations used for treating this condition include D10 and D25. The former is preferred to the later as it is less likely to cause venous sclerosis and tissue destruction when misplaced interstitially. These concentrations can be easily formulated and delivered to the acutely ill infant and pediatric patient.


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