Protocol Status: PUBLISHED
Protocol:
Version: 2026.01
Effective Date:
Last Reviewed:
Medical Director Approval:
Clinical Note: This content reflects current GCEMS clinical guidelines as of the dates listed above. If content appears inconsistent with current policy, use the most recent approved guideline and notify leadership for correction.

Pediatric: AMS/Diabetic

 

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

 

 

 

 

 

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.