DIABETIC EMERGENCIES
ALL LEVELS
DESIGNATION OF CONDITION
Signs and symptoms may include any or all of the following: Hypoglycemia altered men- tal state, seizures, unconscious, drooling, skin is pale and moist, confused, agitated, sud- den onset, headache. Hyperglycemia – hot skin, acetone/fruity breath, Kussmaul respi- rations, polyuria, polydipsia, and polyphagia. There may be a history of recent injury, illness or unusual exertion. Though usually occurring in IDDM, this may also occur in NIDDM. Consider other causes of symptoms.
EMPHASIS ON PATIENT CARE
Maintain adequate perfusion, glucose replacement if hypoglycemic
1. Primary Management - Assess ABC’s and manage as indicated.
2. Secondary Management - History, physical exam, vital signs
Perform glucometry, if available.
3. If Blood Glucose Level (BGL) < 60 mg/dL: or registers “LOW”
a. If the patient is conscious and able to self-protect the airway, administer 15gm oral glucose. Reassess BGL after administration.
b. If the patient is unconscious, initiate transport and consider AEMT/ALS intercept for intravenous glucose administration.
If BGL is > 200 mg/dL or registers “HIGH”:
a. Protect the patient’s airway, administer oxygen, assist ventilations if indicated and consider AEMT/ALS intercept for IV fluids.
b. If no change in mental status, transport as soon as possible to an appropriate medical facility.
AEMT / PARAMEDIC
1. If the patient has an altered mental state and glucose level is <60 mg/dl:
a. Initiate an IV / IO of an isotonic solution and bolus at 20 mL./kg. if associated dehydration or signs of poor perfusion are present
b. Administer D-10 250 ml IV solution titrating to recovered mental status. Repeat dose in 10 minutes if patient mentation does not improve. If still no improvement, re-check BGL and if BGL < 60 mg./dl., administer 3rrd dose.
• Pediatric & neonates dose D-10 5ml./kg. rapid IV infusion.
c. Only administer the volume of D-10 needed to restore level of consciousness. It is hypotonic and can create other problems (low Na+) especially in pediatric patients.
d. In severe chronic alcoholism and malnutrition consider THIAMINE 100 mg. slow IV/IO/ or IM. (EMT-P only).
2. For services still utilizing GLUCAGON the follow guidance is provided.
a. Indications:
• Hypoglycemia
• Severe beta blocker overdose (paramedic only)
• Severe calcium channel blocker overdose (paramedic only)
• Anaphylaxis refractory to epinephrine or those patients who can’t receive epinephrine.
b. Contraindications
• Patients who cannot rapidly be supplied with glucose by mouth, IV, or rectally after receiving GLUCAGON.
• Allergy to pork or beef.
c. Administration
• Comes as a powder to be reconstituted adding 1 ml of sterile water or NS for every mg of powder. Shake well.
• Hypoglycemia: Adult 0.5-1.0 mg IM. May repeat as needed in 10-20 minutes Pediatric: 0.1 mg/kg IM. May repeat as needed in 10-20 minutes
• Beta blocker overdose: Adult 3-10 mg IV/IO over one minute. This can be followed by a 2-5 mg/minute. Pediatric: 0.1 mg/kg over 1 minute. May repeat in 5 minutes as needed.
• Anaphylaxis (rarely indicated): Adult 1-2 mg slow IV/IO. Repeat 5-10 minutes as needed. Pediatric 0.1 up to 1.0 mg IV/IO. May repeat in 5-10 minutes as needed.
d. Note: Glucose must be administered quickly following GLUCAGON administration
ALL LEVELS
DESIGNATION OF CONDITION
Signs and symptoms may include any or all of the following: Hypoglycemia altered men- tal state, seizures, unconscious, drooling, skin is pale and moist, confused, agitated, sud- den onset, headache. Hyperglycemia – hot skin, acetone/fruity breath, Kussmaul respi- rations, polyuria, polydipsia, and polyphagia. There may be a history of recent injury, illness or unusual exertion. Though usually occurring in IDDM, this may also occur in NIDDM. Consider other causes of symptoms.
EMPHASIS ON PATIENT CARE
Maintain adequate perfusion, glucose replacement if hypoglycemic
1. Primary Management - Assess ABC’s and manage as indicated.
2. Secondary Management - History, physical exam, vital signs
Perform glucometry, if available.
3. If Blood Glucose Level (BGL) < 60 mg/dL: or registers “LOW”
a. If the patient is conscious and able to self-protect the airway, administer 15gm oral glucose. Reassess BGL after administration.
b. If the patient is unconscious, initiate transport and consider AEMT/ALS intercept for intravenous glucose administration.
If BGL is > 200 mg/dL or registers “HIGH”:
a. Protect the patient’s airway, administer oxygen, assist ventilations if indicated and consider AEMT/ALS intercept for IV fluids.
b. If no change in mental status, transport as soon as possible to an appropriate medical facility.
AEMT / PARAMEDIC
1. If the patient has an altered mental state and glucose level is <60 mg/dl:
a. Initiate an IV / IO of an isotonic solution and bolus at 20 mL./kg. if associated dehydration or signs of poor perfusion are present
b. Administer D-10 250 ml IV solution titrating to recovered mental status. Repeat dose in 10 minutes if patient mentation does not improve. If still no improvement, re-check BGL and if BGL < 60 mg./dl., administer 3rrd dose.
• Pediatric & neonates dose D-10 5ml./kg. rapid IV infusion.
c. Only administer the volume of D-10 needed to restore level of consciousness. It is hypotonic and can create other problems (low Na+) especially in pediatric patients.
d. In severe chronic alcoholism and malnutrition consider THIAMINE 100 mg. slow IV/IO/ or IM. (EMT-P only).
2. For services still utilizing GLUCAGON the follow guidance is provided.
a. Indications:
• Hypoglycemia
• Severe beta blocker overdose (paramedic only)
• Severe calcium channel blocker overdose (paramedic only)
• Anaphylaxis refractory to epinephrine or those patients who can’t receive epinephrine.
b. Contraindications
• Patients who cannot rapidly be supplied with glucose by mouth, IV, or rectally after receiving GLUCAGON.
• Allergy to pork or beef.
c. Administration
• Comes as a powder to be reconstituted adding 1 ml of sterile water or NS for every mg of powder. Shake well.
• Hypoglycemia: Adult 0.5-1.0 mg IM. May repeat as needed in 10-20 minutes Pediatric: 0.1 mg/kg IM. May repeat as needed in 10-20 minutes
• Beta blocker overdose: Adult 3-10 mg IV/IO over one minute. This can be followed by a 2-5 mg/minute. Pediatric: 0.1 mg/kg over 1 minute. May repeat in 5 minutes as needed.
• Anaphylaxis (rarely indicated): Adult 1-2 mg slow IV/IO. Repeat 5-10 minutes as needed. Pediatric 0.1 up to 1.0 mg IV/IO. May repeat in 5-10 minutes as needed.
d. Note: Glucose must be administered quickly following GLUCAGON administration