Oral Glucose Contraindications

[theoriginalmslt]

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?

 

[rhan101277]

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.

 

[jochi1543]

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:

 

[KEVD18]

inability to swallow is an absolute contra for oral glucose.


jochi, your provincial governing body needs to be reeducated.

 

[rhan101277]

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.

 

[jochi1543]

inability to swallow is an absolute contra for oral glucose.


jochi, your provincial governing body needs to be reeducated.

Regarding what?

 

[KEVD18]

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

 

[theoriginalmslt]

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

 

[mycrofft]

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

 

[crayzeeemt]

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.

 

[Ridryder911]

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.

 

[theaussie]

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

 

[mikeylikesit]

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.

 

[crotchitymedic1986]

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.

 

[BossyCow]

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?

 

[mikie]

Maryland [BLS] Protocol

ORAL GLUCOSE
a) Indications
(1) Altered mental status with known diabetic history
(2) Unconscious for an unknown reason
b) Adverse Effects
Not clinically significant
c) Precautions
Patient without gag reflex may aspirate.
d) Contraindications
Not clinically significant
e) Preparations
10-15 grams of glucose (contained in 24, 30, or 37.5 gram tube)
f) Dosage
(1) Adult:Administer 10-15 grams of glucose paste between the gum
and cheek.
(2) Pediatric:Administer 10-15 grams of glucose paste between the gum
and cheek;this may be accomplished through several small
administrations.

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

 

[Jon]

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.

 

[KEVD18]

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.

 

[Shishkabob]

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.

 

[mikie]

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?