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You are caring for a 4-year-old girl brought in by EMS with an active generalized tonic-clonic seizure. EMS has obtained IV access. Her parent tells you that she has a seizure disorder and is currently taking Oxcarbazepine. While following your protocol for the treatment of status epilepticus, including assessment and maintenance of the airway and oxygenation and administration of intravenous benzodiazepines as an initial treatment, you obtain a blood glucose level and find that it is 25. A repeat test confirms the result. Her estimated weight by Broselow tape is 20 kg.
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August 4, 2025 at 9:46 pm
D) 100 mL of D10W intravenously
Although the patient has a history of prior seizures, the etiology of her current seizure is likely hypoglycemia. (In fact, she had always been found to have hypoglycemia with her previous seizures but the parent had been told that her seizures caused the hypoglycemia instead of vice versa). She is actively seizing so it is inappropriate to give her anything orally due to aspiration risk. The PALS recommended dose of dextrose is 0.5 gm/kg. This dose can be rapidly calculated as X mL/kg where X = the number multiplied by the concentration of dextrose in water to = 50. For example, for D50W, X = 1 (50 x 1 = 50); for D25W, X = 2 (25 x 2 = 50); for D10W, X = 5 (10 x 5 = 50). An ampule of D50W contains 25gm of dextrose, which is too much for this patient. D50W also carries the risk of vein irritation leading to extravasation and thrombophlebitis in a child with small veins. Although PALS recommends 0.5 gm/kg, many texts recommend starting lower at 0.2-0.25 gm/kg, and NALS recommends 0.2 gm/kg for neonates. To give 0.2 gm/kg, administer 2 mL/kg of D10W.