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Question: Metabolic

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A 14-month old boy presents with altered mental status. He has had 2 days of vomiting and diarrhea, but no fever. He weighs 10 kg. Bedside blood glucose measurement is 38 mg/dL. A 22 gauge peripheral IV is obtained in his right hand.

Which of the following is the best treatment?

pemsou5_wp • July 5, 2022

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  1. Kelly July 6, 2022 - 1:37 pm Reply

    B) 50mL of IV D10W
    The rule of 50 can be used to calculate the appropriate dose of 0.5 gm/kg of dextrose to treat hypoglycemia. The number of mL/kg multiplied by the concentration of the dextrose should equal 50; i.e. 5 mL/kg of D10W, 2 mL/kg of D25W, or 1 mL/kg of D50W. However, D25W and D50W are too concentrated for the small peripheral veins of a toddler. Oral glucose should not be given in an unconscious or altered patient, particularly as there is a functioning IV. Similarly, glucagon is not indicated given that there is a functioning IV. Also, glucagon is only effective for insulin-mediated hypoglycemia (e.g. hyperinsulinism (iatrogenic or natural) or sulfonylurea ingestion). For neonates, 0.2 gm/kg, or 2 mL/kg of D10W is recommended, and some would use this dosing for older infants as well.

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