Hypoglycemia Medical Directive

Question 1

Hypoglycemia

What are the indications of the hypoglycemia MD?

Answer 1

Suspected hypoglycemia.

Question 2

Hypoglycemia

What are the conditions for dextrose administration?

Answer 2

Age ≥2 years
LOA: Altered
Other: Hypoglycemia

Question 3

Hypoglycemia

What are the conditions for glucagon administration?

Answer 3

Age: N/A
LOA: Altered
Other: Hypoglycemia

Question 4

Hypoglycemia

What are the contraindications to dextrose administration?

Answer 4

Allergy or sensitivity to dextrose

Question 5

Hypoglycemia

What are the contraindications to glucagon administration?

Answer 5

• Allergy or sensitivity to glucagon
• Pheochromocytoma

Question 6

What is the order of treatment for the hypoglycemia MD?

Answer 6

1. Consider glucometry
2. Consider dextrose (if available and authorized)
3. Consider glucagon (if not using dextrose)

Question 7

Hypoglycemia

What is the dosing info for D10?

Answer 7

Age ≥2 years
Route: IV
Dose: 0.2 g/kg (2 ml/kg)
Max. single dose: 25 g (250 ml)
Dosing interval: 10 min
Max. # of doses: 2

Question 8

Hypoglycemia

What is the dosing info for D50?

Answer 8

Age ≥2 years
Route: IV
Dose: 0.5 g/kg (1 ml/kg)
Max. single dose: 25 g (250 ml)
Dosing interval: 10 min
Max. # of doses: 2

Question 9

Hypoglycemia

What should dextrose administration be titrated to achieve?

Answer 9

Titrate dextrose to a level of awareness where the patient can safely consume complex carbohydrates.

Question 10

Hypoglycemia

What is the dose of glucagon for a patient who is <25 kg?

Answer 10

Route: IM
Dose: 0.5 mg
Max dose: 0.5 mg
Dosing interval: 20 min
Max. # of doses: 2

Question 11

Hypoglycemia

What is the dose of glucagon for patients ≥25 kg?

Answer 11

Route: IM
Dose: 1 mg
Max dose: 1 mg
Dosing interval: 20 min
Max. # of doses: 2

Question 12

Hypoglycemia

What are the clinical considerations for the hypoglycemia MD?

Answer 12

• If the patient responds to dextrose or glucagon, he/she may receive oral glucose or other simple carbohydrates.
• If only mild signs or symptoms are exhibited, the patient may receive oral glucose or other simple carbohydrates instead of dextrose or glucagon.
• If a patient initiates an informed refusal of transport, a final set of vital signs including blood glucometry must be attempted and documented.
• IV administration of dextrose applies only to PCPs authorized for PCP Autonomous IV.