NREMT Paramedic Cognitive ExamMedicalEasy
A 55-year-old female with a history of type 2 diabetes is found unresponsive. Her blood glucose level is 30 mg/dL. She is cool, pale, and diaphoretic. Her vital signs are BP 100/60 mmHg, HR 110 bpm, RR 20 bpm, SpO2 96% on room air. She has an established IV line. What is the most appropriate initial treatment?
- AAdminister 25 mL of D10 intravenously
- BAdminister 50 mL of D50 intravenously
- CAdminister 1 liter of normal saline intravenously
- DAdminister 1 mg glucagon intramuscularly
Show answer & explanationAnswer & explanation
Correct answer: B. Administer 50 mL of D50 intravenously
The patient is experiencing severe hypoglycemia (blood glucose 30 mg/dL) and is unresponsive. For an adult with an established IV, D50 (50% Dextrose) is the preferred treatment to rapidly raise blood glucose levels. Glucagon is used if IV access is not available, and D10 is typically for pediatric patients or less severe cases.
Why the other options are wrong
- A. D10 (10% Dextrose) is typically used for pediatric patients or as a continuous infusion after initial bolus, not as the primary bolus for severe adult hypoglycemia.
- C. Normal saline would provide volume but would not address the severe hypoglycemia directly.
- D. Glucagon is an option if IV access is not available, but D50 is preferred with an established IV.
Hypoglycemia Management (Adult)
Treatment for low blood glucose in adults, primarily involving rapid administration of glucose, either orally for conscious patients or intravenously for unconscious patients.
- Blood glucose < 60-70 mg/dL is considered hypoglycemic.
- Unresponsive adults with IV access get 25g of Dextrose (e.g., 50 mL D50).
- If no IV access, 1 mg glucagon IM can be given.
Memory trick: D50 for the 'D-ead' sugar level, when they're down and out!