Protocol 2-572 - Hypoglycemia

CMH EMS & MIH Protocols

AEMT:

Ensure completion of applicable items above.

Consider IV NS/LR.

Adult:	Pediatric:
Blood sugar less than 60 mg/dl AND symptomatic: Dextrose 25 g IV. If unable to obtain IV: Consider Glucagon 1 mg IM/SQ/IN.	Blood sugar less than 30 mg/dl AND symptomatic: Dextrose 0.5-1 g/kg IV. Repeat as needed. Click "calculate" to get dose. If unable to obtain IV: Greater than 20 kg or 5 yr old: Consider Glucagon 1 mg IM/SQ. Less than 20 kg or 5 yr old: Consider Glucagon 0.5 mg IM/SQ.

RN:

Ensure completion of all applicable items above.

Consider IO NS/LR. Refer to AEMT section above for Dextrose administration via IO.

Contact MEDICAL CONTROL prior to PRC if any of the following:

IV or IO access has been performed.
Oral hypoglycemic in patient medication list.
Long-acting insulin in patient medication list.
Treated with Glucagon.
Unknown cause of hypoglycemia.

CP:

NEMSIS Protocol: 9914125 - Medical-Hypoglycemia/Diabetic Emergency

Citations:

Protocol 9-010 - References
NASEMSO Medical Directors Council, 2017
Sibley, Jacobsen, & Salomone, 2012

Change Log:

Date	Link to previous version	Description of change
10/04/13	pdf	Removed (entire tube) from oral Glucose.
11/17/15	pdf	Added comment that medical control must be contacted if any ALS intervention has been performed prior to PRC.
07/22/16	pdf	Moved Dextrose and Glucagon to AEMT section.
08/24/17	pdf	Removed D50W and D25W.
09/22/17		Reduced treatment threshold from 70 to 60. Removed ALS requirement if level below 40. Added requirement for medical control if no cause of hypoglycemia has been identified. Added more specific pediatric age/weight based dosages for Glucagon.
07/23/19	pdf	Added options to mix Thiamine with LRD10W for infusion.
04/17/20	pdf	Added content (without substantive modification) from old Protocol 4-120 - Hypoglycemia.
10/28/20	pdf	Fixed typo allowing intranasal Glucagon.
06/06/21	pdf	Moved to emsprotocols.online
02/25/22	pdf	After discussion at protocol committee meeting and research, it was decided to leave the probable typo that indicated Glucagon could be given intranasal. https://pubmed.ncbi.nlm.nih.gov/22971130/
02/28/22		Changed link for Thiamine.
03/15/23	pdf	Clarified RN and medic roles. Added CP.
03/17/23		Changed links to NS.
03/19/23		Changed links for LR.
03/20/23		Changed link for Glucose
03/20/23		Changed link for Glucagon.
03/20/23		Changed link for Dextrose.
05/26/23	pdf	Added link to 4-042.

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Protocol 2-572 - Hypoglycemia

EMD:

EMR:

EMT:

AEMT:

RN:

Medic:

CP:

Citations:

Change Log: