Altered Mental Status
- Known diabetic; medical alert tag
- Report of illicit drug use or toxic ingestion
- Past medical history
- History of trauma
- Change in condition
- Changes in feeding or sleeping habits
- Decreased mental status or lethargy
- Change in baseline mental status
- Bizarre behavior
- Hypoglycemia (cool, diaphoretic skin)
- Hyperglycemia (warm, dry skin, fruity breath, Kussmaul respirations; rapid, deep breathing, signs of dehydration)
- Head trauma
- CNS (stroke/tumor/seizure/ infection)
- Cardiac (MI/CHF)
- nfection (CNS and other)
- Thyroid (hyper/hypo)
- Diabetes (hyper/hypoglycemia)
- Toxic ingestion
- 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.
- 10% Dextrose (D10) 250 mL IV
Glucose > 60 with altered mental status ?
See appropriate protocol :
Glucose > 250 with signs of poor perfusion and/or dehydration ?
- Normal Saline up to 1,000 mL IV
- Notify receiving facility or contact Medical Control
- 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) solution, monitor the patient for changes in level of consciousness and signs/symptoms of CHF/pulmonary edema.
- 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.
- Do not let alcohol confuse the clinical picture. Alcoholics frequently develop hypoglycemia and may have unrecognized injuries.
- Consider restraints if necessary for patient's and/or personnel's protection per the Behavioral Emergencies/Chemical Restraint Protocol.
- 50% Dextrose (D50) can be given on a case-by-case basis per Paramedic discretion.
These are the glucometers carried on every unit:
ForaCare GD20 Blood Glucose Monitoring System
- Lo = < 20 mg/dL (1.1 mmol/L)
- Hi = > 600 mg/dL (33.3 mmol/L)
- Keytone? = >240 mg/dL (13.3 mmol/L)
- System operating range 50 F to 104 F.
- Error Code = E -t