D50VS D10

ORTRADITION

D50Causes hyperglycemiaCan cause tissue necrosisCan cause a headache and/or nauseaRebound hypoglycemiaCan cause local skin irritationThrombophlebitisFrequently national shortages Rapid rise in level of consciousness

D10Easier to titrate to effectSlower more controlled rise in level of

consciousnessLess viscousBetter for the veins and surrounding tissuesEasier to return the patient to euglycemiaJust as effective and safer than D50

NEW PROTOCOL

2.8.2 Diabetic Emergencies (Hypoglycemia/Hyperglycemia)

•Protocol for patients with blood sugar below 80mg/dl. Keep in mind that low blood sugar can be affected by medications, infections, stress or alcohol.

BASIC LEVEL: EMT AND PARAMEDIC

• Initial Patient Assessment Protocol 2.1.1• Airway Assessment/Management Protocol

2.1.1 • Oxygen via nasal cannula@ 2-4 LPM to

maintain pulse ox > 94% (non rebreather @ 15 LPM if SpO2 < 90%)

• Attach cardiac monitor and pulse oximeter

ALS LEVEL 1: PARAMEDIC ONLY

• Inititiate IV and Draw Blood• If patient tachycardic and/or hypotensive bolus 1-2 L

in increments of 250cc, recheck vital signs and lung sounds with each increment. Discontinue bolus if HR slow <110, BP >90 or signs/symptoms of pulmonary edema. If no signs/symptoms resume rate at 125ml/hr. If no IV access, consider IO ONLY if patient is seriously ill (hypotensive and tachycardic). Do not place IO simply for high or low blood sugar when patient is otherwise stable.

Continue Paramedic Only

• Determine blood glucose level. If glucose is <80 mg/dl and patient is

Asymptomatic (no headache, nausea, and/or AMS)

60 mg/dl-80mg/dl; No emergency treatment ok for patient to drink cola, juice or other oral form of glucose they may have with them.

If sugar <60mg/dl; Oral glusose (juice, piece of candy, or sublingual glucose).

Continue Paramedic OnlySymptomatic (headache, nausea, AMS)

If sugar 60mg/dl; Sublingual glucose paste, or hang 250ml D10W and run 100ml wide open (titrate to effect). Give second dose of 100ml D10W if glucose still <80mg/dl when glucose rechecked in 5 min. If unable to establish IV consider Glucagon 1mg IM.

If blood sugar <60mg/dl; hang 250ml D10W and run bolus 200-250ml wide open (titrate to effect). If no IV give Glucagon 1mg IM.

Continue Paramedic Only

If glucose >80mg/dl and <250 mg/dl, no specific treatment, supportive care.

If glucose >250mg/dl, Symptomatic patients exhibiting AMS, Kussmaul respirations, dry skin with poor skin turgor, and/or ketotic breath:Bolus with 1 – 2 liters of IV fluid in 250cc

increments with vital signs rechecked and lung exam between each increment. Discontinue bolus if signs of pulmonary edema.

Continue Paramedic Only

Asymptomatic patients with glucose >250mg/dl, just give IV fluids at 125ml/hr.

Contact Medical Control or Medical Director if any concerns or any questions.