Clinical Scenario:
A 2-year-old boy is brought to the emergency department after an early morning generalized tonic-clonic seizure. He had poor oral intake due to viral gastroenteritis and had been fasting for nearly 16 hours. On arrival, he is drowsy with cold extremities. Capillary blood glucose is 34 mg/dL. Intravenous access has been secured.
What is the most appropriate immediate treatment?
A. 10% dextrose intravenously
B. 25% dextrose intravenously
C. Glucagon intramuscularly
D. Hydrocortisone intravenously
E. Normal saline bolus
Correct answer & Explanation:
Correct Answer: A. 10% dextrose intravenously
Explanation
This child has symptomatic severe hypoglycemia, presenting with seizures and altered consciousness. Once intravenous access is available, the priority is rapid correction of blood glucose using 10% dextrose intravenously, as recommended in current pediatric emergency guidelines and Nelson.
The usual dose is 5 mL/kg of 10% dextrose (0.5 g/kg glucose), followed by a continuous glucose infusion with frequent monitoring to maintain normoglycemia and identify the underlying cause.
Why the other options are incorrect
A. 10% dextrose intravenously
Correct. This is the recommended first-line treatment for symptomatic hypoglycemia when intravenous access is available.
B. 25% dextrose intravenously
Not routinely recommended in young children because of its high osmolality and risk of tissue injury if extravasation occurs.
C. Glucagon intramuscularly
Useful when intravenous access is not available, but IV dextrose is preferred once access has been established.
D. Hydrocortisone intravenously
May be indicated if adrenal insufficiency is suspected but should not delay glucose administration.
E. Normal saline bolus
Appropriate for hypovolemic shock but does not correct hypoglycemia.Learning Point
In any child with seizures or altered consciousness, hypoglycemia should be excluded immediately. If IV access is available, the recommended emergency treatment is 10% dextrose 5 mL/kg intravenously, followed by a glucose infusion and investigation of the underlying cause.
