- Past medical history
- Recent blood glucose check
- Last meal
- History of trauma
- Change in condition
- Changes in feeding/sleeping habits
- Altered mental status
- Hypoglycemia (cool, diaphoretic skin)
- Hyperglycemia (warm, dry skin, fruity breath, Kussmaul respirations: rapid, deep breathing, signs of dehydration)
- Abdominal pain
- Alcohol/drug use
- Toxic ingestion
- Head trauma
- CNS (stroke/tumor/seizure/ infection)
- Altered baseline mental status
- Thyroid (hyper/hypo)
- Diabetes (hyper/hypoglycemia)
- Environmental exposure
- Pulmonary (hypoxia)
- Electrolyte abnormality
- Psychiatric disorder
Glucose <60 with signs of hypoglycemia ?
- Consider Oral Glucose 1-2 tubes if awake and no risk for aspiration
Glucose >60 with altered mental status ?
- See appropriate protocol: Cardiac, Hyper/Hypothermia, Seizure, Hypotension
Glucose >250 with signs of poor perfusion and/or dehydration ?
- Notify receiving facility or contract Medical Control
- Pediatric = 1 day to less than age 12, or less than 55 kg in ages 12-18.
- Use Handtevy for drug dosages.
- Be judicious and cautious when providing fluid to children in DKA.
- Low glucose (less than 60), normal glucose (60-120), high glucose (greater than 250).
- Pay careful attention to the head exam for signs of bruising or other injury.
- While infusing 10% Dextrose (D10), monitor the patient for changes in level of consciousness. Can be administered by AEMT but a Paramedic must be the primary attendant.
- It is safer to assume hypoglycemia than hyperglycemia if doubt exists. Re-check blood glucose after administration of Dextrose or Glucagon (GlucaGen).
- Be aware of altered mental status as a presenting sign of an environmental toxin or Haz-Mat exposure and protect personal safety.
- Consider restraints if necessary for patient's and/or personnel's protection per the Behavioral Emergency Chemical Restraint Protocol.