A 3 year old M presents to the ED with lethargy. Fingerstick is 38.
How do you give this kid sugar??
IV dextrose is the primary treatment, at a dose of 0.5-1 mg/kg
Practically speaking this translates into 5ml/kg of D10 for newborns, and 2ml/kg of D25 for infants and children. Of note, it is sometimes recommended to give 0.2ml/kg of D10 as a bolus prior to infusion for neonates. In these patients it has been shown to reduce rebound hypoglycemia due to endogenous insulin release in response to hyperglycemia from a larger bolus of glucose.
In adolescents and adults the dose is 1ml/kg of D50 (we usually give 2 amps)
Recommendations are nicely summarized in the table below:
| Patient Age | Dextrose Bolus Dose | Dextrose Maintenance Dosage | Other Treatments to Consider |
|---|---|---|---|
| Neonate | D10 5 mL/kg PO/NG/IV/IO | 6 mL/kg/h D10 | Glucagon, 0.3 milligram/kg IM |
| Hydrocortisone, 25 grams PO/IM/IV/IO | |||
| Infant | D10 5 mL/kg PO/NG/IV/IO | 6 mL/kg/h D10 | Glucagon, 0.3 milligram/kg IM |
| or | Hydrocortisone, 25 grams PO/IM/IV/IO | ||
| D25 2 mL/kg | |||
| Child | D25 2 mL/kg PO/NG/IV/IO | 6 mL/kg/h D10 for the first 10 kg + 3 mL/kg/h for 11–20 kg + 1.5 mL/kg/h for each additional kg >20 kg | Glucagon, 0.3 milligram/kg/IM |
| Hydrocortisone, 50 grams PO/IM/IV/IO | |||
| Adolescent | — | 6 mL/kg/h D10 for the first 10 kg + 3 mL/kg/h for 11–20 kg + 1.5 mL/kg/h for each additional kg >20 kg | Glucagon, 0.3 milligram/kg IM |
| Hydrocortisone, 100 grams PO/IM/IV/IO |
References:
Qureshi N, Al-Mogbil M, Kentab OY. Hypoglycemia and Metabolic Emergencies in Infants and Children. In: Tintinalli JE, Stapczynski J, Ma O, Cline DM, Cydulka RK, Meckler GD, T. eds. Tintinalli’s Emergency Medicine: A Comprehensive Study Guide. New York, NY: McGraw-Hill; 2011.http://accessemergencymedicine.mhmedical.com/content.aspx?bookid=693&Sectionid=45915475. Accessed October 16, 2014.
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