History:

 

• Past medical history
• Medications
• Recent blood glucose check
• Last meal
• History of trauma
• Change in condition
• Changes in feeding/sleeping habits

 

Significant Findings:

 

• Altered mental status
• Lethargy
• Combative/irritable
• Hypoglycemia (cool, diaphoretic skin)
• Hyperglycemia (warm, dry skin, fruity breath, Kussmaul respirations: rapid, deep breathing, signs of dehydration)
• Seizure
• Abdominal pain
• Nausea/vomiting
• Weakness

 

Differential:

 

• Alcohol/drug use
• Toxic ingestion
• Head trauma
• CNS (stroke/tumor/seizure/ infection)
• Altered baseline mental status
• Hypothermia/hyperthermia
• Thyroid (hyper/hypo)
• Shock
• Diabetes (hyper/hypoglycemia)
• Acidosis/alkalosis
• Environmental exposure
• Pulmonary (hypoxia)
• Electrolyte abnormality
• Psychiatric disorder

 

 Treatment:

 

• Oxygen

 

• Obtain BGL

 

• Initiate IV

 

Glucose <60 with signs of hypoglycemia ?

 

 

• • Consider Oral Glucose 1-2 tubes if awake and no risk for aspiration

 

 

• • 10% Dextrose (D10) 5 mL/kg IV; may repeat once if still unresponsive and low BGL

 

 

• • if no IV access, administer Glucagon (GlucaGen) 0.1 mg/kg IM/SQ; max 1 mg

 

Glucose >60 with altered mental status ?

 

• • See appropriate protocol: Cardiac, Hyper/Hypothermia, Seizure, Hypotension

 

Glucose >250 with signs of poor perfusion and/or dehydration ?

 

• • Contact Medical Control

 

• • Notify receiving facility or contract Medical Control

 

PEARLS:

 

• 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.