# Protocol for pediatric hypoglycemia



## tydek07 (Feb 23, 2010)

Hi all,

  Wondering if any of you have a protocol for pediatric hypoglycemia? We currently do not. Under our Pediatric Considerations is just states "Pediatric medication administration is per physician order only". I have been looking around online and have found several services that have a set protocol for this. One I found states:

12yrs and older --- 50mL (25g) of D50W
2-11yrs --- 1mL/kg (0.5g/kg) of D50W, max 25g
28 days to 2yrs --- 2mL/kg (0.5g/kg) of D25W
28 days and younger --- 2mL/kg (0.2g/kg) of D10W


  Do you think it is a good idea to have a set protocol for this, or do you think that one should 'seek medical direction'? I have talked to several physicians and some says "Yes, it's a good idea" and some say "No, it's not a good idea". Your thoughts?

-tydek


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## RescueYou (Feb 24, 2010)

We have a protocol, but we are advised that if the situation allows, to contact medical direction. But, if not, then to go ahead and administer and then notify MEDCOM.


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## medicgene (Feb 24, 2010)

*Pediatric Hypoglycemia*

Our Protocol is as follows:

with IV access:

under 2 yrs old: D25W 2ml/kg may repeat once in 5 minutes PRN
2 yrs and older: D50W 1ml/kg  ""                                       ""

IV site unavailable:

Glucagon 1 mg IM  x1

IO access:  D25W 2ml/kg x1  can repeat once with D25W 1ml/kg

hope that helps.


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## MS Medic (Feb 24, 2010)

We use standard wt based pedi doses but if you can't get an IV, we go to IO rather than IM.

I personally feel that anything that eleminates the need to call med control is a good thing.


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## medicgene (Feb 24, 2010)

yes.. the IM was for the glucagon   the rest get the drill if no IV


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## Outbac1 (Feb 24, 2010)

Basicly ours is-

 If a candidate for oral, give oral.
If no IV available give glucagon 0.5mg SC if pt <20kg, 1mg if over 20kg
IV available D50 at 1cc/kg. may repeat x 1 to max of 50cc

 Protocol is here but a bit fuzzy and hard to read. 
http://emergency.medicine.dal.ca/eh...owcharts/Protocol_Images/Ped_Hypoglycemia.gif

PCP, ICP,ACP,CCP  = Primary Care Paramedic, Intermediate CP, Advanced CP, Critical CP


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## Melclin (Feb 25, 2010)

Everyone still using D50? I thought there would be more of a move towards D10W on account of some very intuitive evidence in its favour.

Anyway, the way we do things:

If we feel they can swallow + bgl < 4 mmol/L = oral glucose, then consider glucagon depending on the response.

Not obeying commands/we feel that they won't/can't benefit from oral glucose + bgl <4mmol/L = 
-  >25 kg, 1IU IM glucagon, 
-  <25kg, 0.5IU IM glucagon. 
-  Intensive Care paramedics: cannulation + 3mls/kg 10% dextrose, followed by another 2ml/kg if required (titrated to response).


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## MrBrown (Feb 25, 2010)

We use 10% dextrose only

2mg/kg IV or 0.5mg glucagon IM


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## tydek07 (Feb 25, 2010)

Talked to our Clinical Supervisor and she is going to add the protocol. Up until now we have been taught what to do, and are just expected to know what to do after we call a physician. But now it will also be in words under the pediatric considerations. It will say:

1. Do not give to patients < 12 years without contacting medical control

2. Initial dose is 0.5-1.0g/kg IV. A maximum concentration of 25% dextrose in water (D25W) should be infused. D50W must, therefor, be diluted 1:1 with NS to achieve D25W. For example, to administer 10g to a 20kg child, mix 20cc D50W with 20ml NS and infuse slowly via IV.

3. A maximum concentration of 10% dextrose in water (D10W) should be used in neonates. D50@ muse, therefor, be diluted 1:4 with NS to achieve D10W. Neonatal dosage is 5-10ml/kg of D10W administered over 20 minutes.

I think it was just a "boo-boo" that they did not have that placed under the pediatric considerations up until now. We are still told to call a physician before administering it to a pediatric.

tydek


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## fma08 (Feb 25, 2010)

:blink: Ty's Alive!?


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## redcrossemt (Feb 26, 2010)

Would highly suggest making this protocol pre-radio if it's not already. Why would you need to call and ask permission to treat hypoglycemia just because it's a child? Especially when your dosages are listed in your protocol.

We do the following (without medical control):

12+ y/o = 12.5-25g of D50W
1-11 y/o = 0.5g/kg of D25W (2ml/kg)
<1 y/o = 0.25g/kg of D12.5W (2ml/kg)


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