› ! Hypoglycemia → › ! Sepsis → › Adrenal crisis → First 5 minutes critical workflow
› Immediate stabilization
› Airway protection if unable to protect airway
› Cardiac monitor
› IV access
› Point of care glucose within minutes of arrival
› Immediate treatment targets
› Treat if glucose below 3.9 mmol/L with symptoms
› Treat if glucose below 3.0 mmol/L regardless of symptoms
› Repeat glucose in 10 to 15 minutes after therapy
› Immediate escalation
› If seizure or coma then IV dextrose immediately
› If refractory after two boluses then start dextrose infusion and ICU consideration
Glucose replacement therapy
› If awake and able to swallow
› Oral fast carbohydrate 15 g
› Recheck glucose at 15 minutes
› Repeat oral carbohydrate 15 g if still below 4.0 mmol/L
› Follow with complex carbohydrate and protein when stable
› If altered or unable to swallow with IV access
› Dextrose 10 percent IV 150 mL over 10 to 15 minutes
› Recheck glucose at 10 to 15 minutes
› Repeat dextrose 10 percent IV 150 mL if still low
› If recurrent then dextrose infusion 10 percent at 100 to 200 mL per hour titrate to glucose 6 to 10 mmol/L
› If no IV access
› Glucagon IM 1 mg
› Glucagon SC 1 mg
› Establish IV access as soon as possible
› Oral carbohydrate once awake and safe
Etiology directed therapy
› Sulfonylurea suspected or confirmed
› Octreotide 50 mcg SC
› Repeat octreotide 50 mcg SC every 6 hours as needed
› Dextrose bolus for immediate correction with octreotide for recurrence prevention
› Activated charcoal within 1 to 2 hours if protected airway and large ingestion
› Insulin overdose
› Prolonged dextrose infusion expectation
› Frequent glucose monitoring every 30 to 60 minutes once stable
› Potassium monitoring and repletion as needed
› Sepsis or critical illness
› Sepsis bundle local protocol dependent
› Early antibiotics when indicated
› Adrenal insufficiency suspected
› Hydrocortisone IV 100 mg if adrenal crisis concern
› Isotonic fluids for hypotension
Monitoring and reassessment loop
› Reassessment cadence
› Glucose every 15 minutes until above 4.0 mmol/L and stable
› Glucose every 30 to 60 minutes during observation
› Neuro status reassessment after normalization
› Treatment complications monitoring
› Extravasation risk with dextrose
› Fluid overload risk with infusion in heart failure
› Hypokalemia risk during insulin driven shifts
› Consultation triggers
› Toxicology for sulfonylurea or insulin overdose
› Endocrinology for recurrent unexplained hypoglycemia
› Obstetrics for pregnancy
› ICU for infusion requirement or refractory course
Show 33 more ▾