# Oral Glucose Contraindications



## theoriginalmslt (Jan 1, 2009)

hey,
im an emt in chicago and had an nh pt w/a blood sugar of 38, however we were called for vomitting x3 days. the pt also had a g-tube. we were less than 5 to the nearest hosp so als wasnt required. we administered 1 tube of oral glucsose by applying it between the cheek and gum. the pt tolerated it well and the blood sugar went up a little. the pts airway remained patent the entire time w/ good resps. uoa at the ed the pt vomited but the rn said it usually happens when oral glucose is given. while writing the report i realised that a contraindication for oral glucose is a pt who cannot swallow. were we wrong in giving the glucose and should we have just waited till we got to the ed?


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## rhan101277 (Jan 1, 2009)

The only contraindication I know of is unresponsive, or no airway.  Oral glucose doesn't do as well as D50.  On unresponsive pt's with suspected hypoglycemia, we are supposed to contact ALS for backup.

I think you did right in this situation.


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## jochi1543 (Jan 1, 2009)

Would have been an auto fail on our provincial exams. As an EMT-I, I would've given D50W, or, if unable to start IV, glucagon. As an EMR/EMT-B, I wouldn't have done anything in this situation as far as BGL management is concerned. Unconscious, unable to follow commands, and unable to swallow are all pretty clear contraindications. And even though minimal amounts CAN be absorbed SL or buccally, our provincial governing body states on the medication information distributed to the schools that they cannot - I suspect it's because they figure that the minimal effect on blood sugar is not worth the risk of airway obstruction in the case of someone who cannot swallow.


On a sidenote, a while ago a student at my school tried to BVM oral glucose into someone through the patient's OPA....(not real patient, just during an exam) LOL.:wacko:


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## KEVD18 (Jan 1, 2009)

inability to swallow is an absolute contra for oral glucose.


jochi, your provincial governing body needs to be reeducated.


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## rhan101277 (Jan 1, 2009)

I guess I should have been more specific in my post.  All patients that are unconscious shouldn't be able to swallow and therefore you shouldn't give it to them.  If you have a conscious person with an airway obstruction then you don't give it to them.  Its hard to back-seat drive these cases, sometimes you have to be there.


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## jochi1543 (Jan 1, 2009)

KEVD18 said:


> inability to swallow is an absolute contra for oral glucose.
> 
> 
> jochi, your provincial governing body needs to be reeducated.



Regarding what?


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## KEVD18 (Jan 1, 2009)

jochi1543 said:


> And even though minimal amounts CAN be absorbed SL or buccally, our provincial governing body states on the medication information distributed to the schools that they cannot


 

'nuff said


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## theoriginalmslt (Jan 1, 2009)

thanks, thats what i figured, im sittin there doin paperwork and im like sh*t, she couldnt swallow, probably shouldnt have given her somethin orally....she seemed to like it tho cuz she smiled that confused smile old people have....then she puked, oh well live and learn


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## mycrofft (Jan 1, 2009)

*I learned about another contra you might not know about*

gastric bypass or similar condition.
Give 'em a nice oral jolt and within a minute you will likely have a sweating, anxious, miserable and possibly synchopal patient. I don't thnink they would do a voluntary bypass on a diabetic, but stuff happens and there are folks who are forced to undergo similar procedures due to CA, or something could happen to the pancreas after the bypass was done.
I'm not sure of the mechanism.

ADDENDUM:  http://emedicine.medscape.com/article/173594-overview

DUMPING SYNDROME


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## crayzeeemt (Jan 3, 2009)

*Lesson Learned.*

If a pt cannot swallow, then you should not give anything by mouth.  The G- Tube was a big clue, but just a little oral glucose to the cheeks would make anyone say, " why not?"  So, like I said, just a lesson learned.


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## Ridryder911 (Jan 3, 2009)

Actually, the oral glucose is not supposed to be swallowed as much as it is to be absorbed per bucossa membrane. So one should be cautious in those that cannot swallow, and patient can be suctioned and placed in position. If one is to administer in any hypoglycemic conditions, close airway monitoring needs to be performed.

If possible a order to administer glucose per peg tube could had been obtained, albeit it would take longer but still administered.


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## theaussie (Jan 5, 2009)

Yes an inability to swallow would be correct, but sould we not also consider anyone with an altered LOC?

Should we not also consider the adverse effects - especially in alcoholics? Yes i am referring to Wernicke's encephalopathy. 

The adverse effect and the fact that we should avoid giving oral meds to any altered LOC patient seems to have been a point missed here


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## mikeylikesit (Jan 12, 2009)

yes but if they are upright and you can monitor the airway and listen for gargling[?] then you will be fine. If your a BLS crew and ALS is really far out some care with Oral Glucose is better then none. Even if the patient is Hyperglycemic you can still give the glucose if you do not know the BS. LOC is irrelevant for me since there is usually only a handful on concerns for me and monitoring an airway with suction ready is fairly simplistic. Like Rid said you don't swallow oral glucose you absorb it, the mucous membranse are one of the quicker ways to elevate BS since you don't have to wait for digestion to take place in order to absorb.


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## crotchitymedic1986 (Jan 12, 2009)

The better option would have been to just pour some "soda" in their G-Tube. A 12 oz can of Coke has 39gms of sugar, D50 only has 25gms.  There is nothing to it, just draw the soda up into a 60cc syringe, and shoot it in the G-tube.  I would flush it well with water after you are through.  If you do not feel confident, one of the family members who feeds the patient daily, could do it.


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## BossyCow (Jan 12, 2009)

crotchitymedic1986 said:


> The better option would have been to just pour some "soda" in their G-Tube. A 12 oz can of Coke has 39gms of sugar, D50 only has 25gms.  There is nothing to it, just draw the soda up into a 60cc syringe, and shoot it in the G-tube.  I would flush it well with water after you are through.  If you do not feel confident, one of the family members who feeds the patient daily, could do it.




so how does the carbonation react to that?


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## mikie (Jan 12, 2009)

*Maryland [BLS] Protocol*



> *ORAL GLUCOSE *
> a) Indications
> (1) Altered mental status with known diabetic history
> (2) Unconscious for an unknown reason
> ...



Source: p. 221 The Maryland 
Medical Protocols 
for Emergency Medical Services Providers  http://www.miemss.org/home/EMSProviders/EMSproviderProtocols/tabid/106/Default.aspx


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## Jon (Jan 12, 2009)

crotchitymedic1986 said:


> The better option would have been to just pour some "soda" in their G-Tube. A 12 oz can of Coke has 39gms of sugar, D50 only has 25gms.  There is nothing to it, just draw the soda up into a 60cc syringe, and shoot it in the G-tube.  I would flush it well with water after you are through.  If you do not feel confident, one of the family members who feeds the patient daily, could do it.


Funny. My protocols don't let me do that.

I'll stick to the oral glucose, and let it be absorbed though the mouth... thanks.


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## KEVD18 (Jan 12, 2009)

crotchitymedic1986 said:


> The better option would have been to just pour some "soda" in their G-Tube. A 12 oz can of Coke has 39gms of sugar, D50 only has 25gms. There is nothing to it, just draw the soda up into a 60cc syringe, and shoot it in the G-tube. I would flush it well with water after you are through. If you do not feel confident, one of the family members who feeds the patient daily, could do it.


 

wow. please proceed direclty to your state office of ems and turn your ticket in.


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## Shishkabob (Jan 12, 2009)

Contraindication is LOC for the inability to control their airway;

But most people will put some on a bite stick and administer it between cheek/gums.


But it depends on your state and your protocols, as mikie's protocols don't fly here in Texas.


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## mikie (Jan 12, 2009)

No contraindications per our protocol (which I posted about).......can administer; just monitor airway & prepare to suction

This doesn't make much sense to me...I worry to much about aspiration.  Why would my protocols allow it?  Am I alone?


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## WiFi_Cowgirl (Jan 20, 2009)

What about the new liquid glucose spray that's available? Could we dip a cotton swab in it and rub it around in their mouth? Would it be any different than putting in an NPA w/ lubricant? We don't worry about them aspirating surgi-lube.


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## EeyoreEMT (Jan 29, 2009)

*ABCs*

Ok- When we insert an airway, it is to obtain patent airway, to which you don't have if you are inserting one. You shouldn't be using very much lube on the tube, plus it is water soluable, will be absorbed in the lungs if I'm not mistaken, unless the lungs are already full of fluid. If you have an patent airway, keep it that way, always fall back on your ABCs. ANYTHING by mouth to a pt who cannot swallow or an obstructed airway is a big no-no. If it becomes more critical or the trip to the ER is a ways away, D50 IM or IV, at least by our protocols, call for ALS backup, vs. the pt aspirating and you documenting giving the pt something po.


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## FireCPT11 (Jan 29, 2009)

EeyoreEMT said:


> If it becomes more critical or the trip to the ER is a ways away, *D50 IM *or IV, at least by our protocols, call for ALS backup, vs. the pt aspirating and you documenting giving the pt something po.



D50 IM? I hope that it was meant that D50 would be given IV and Glucagon IM...Because I also wouldn't want to document my justification for thinking it was okay to cause severe tissue necrosis...:unsure:


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## Sasha (Jan 29, 2009)

FireCPT11 said:


> D50 IM? That is a protocol that I would like to see...:unsure:



I think he meant glucagon? At least I hope!


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## FireCPT11 (Jan 29, 2009)

Sasha said:


> I think he meant glucagon? At least I hope!



I think so...edited my post to clarify just in case...


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## EeyoreEMT (Jan 30, 2009)

Sorry, my bad, was muti-tasking. Yes, D50 is by IV, never IM, My mistake sorry for the confusion. It just blows my mind, that we have had even a physician at a statcare give a semi-conscious pt an oral glucose tablet and left the room. The pt's level was low 40's, I looked at my partner, and had to grow balls and dig it out of her mouth in front of the doctor. She was not conscious enough to have anything po, well in our opinion, she was moaning and drooling, no comprehensive words.


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