Management in an adult
- finger prick test to establish the diagnosis
- if the patient is drowsy or fitting then:
- give 50 ml of 50% glucose i.v., or alternatively glucagon 1 mg i.v./i.m./s.c.
- recheck the glucose by stick test after 5 mins and repeat again at 30 min
- if recurrent hypoglycaemia or condition that predisposes recurrent hypoglycaemia, for example sepsis, sulphonylurea excess, liver disease
- start 10% dextrose at 1000 ml over 12 hr, via a large antecubital vein or central line
- titrate the rate to keep the blood glucose level at 5-10 mM
- if sulphonylurea excess then maintain the glucose infusion for 24 hr and before tailing off, the blood glucose is tested routinely for 3 days
- higher concentrations of dextrose may be necessary (via a central vein) if the 10% dextrose is not sufficient.
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