Hypoglycaemia

Any child with a blood glucose of <3mmol/L needs emergency treatment immediately as follows:

STEP 1:

Initial bolus 2-5ml/kg of 10% dextrose

How to make 10% dextrose:

Take a 20ml syringe and add 4ml of 50% dextrose

Then add 16ml of normal saline

The syringe now contains 20ml of 10% dextrose

STEP 2:

Initial bolus MUST BE FOLLOWED with:

½ Darrows Dextrose at maintenance rate

(See below on how to calculate this)

Note: 
Just giving a one-off bolus of dextrose is not enough to maintain the blood sugar. This is because any child who has a low blood sugar has run out of glucose stores in their body. Therefore a steady supply needs to be provided through a ½ DD infusion until the child has recovered enough to eat and drink normally.

STEP 3:

Re-check the blood glucose 20-30 minutes after initial bolus

The blood glucose level might still be low and further boluses may be needed. Any further boluses should be given as 2ml/kg of 10% dextrose.

HOW TO CALCULATE MAINTENANCE FLUID REQUIREMENTS PER 24 HOURS:

For every kilogram of body weight use the following formula to calculate volume for 24 hours:

• 0-10 kg – 100ml/kg
• 10-20 kg – 50 ml/kg
• >20 kg – 20 ml/kg

First calculate the required volume of maintenance fluid for the 24 hour period. Then divide by 24 to give the hourly maintenance rate.

Example: A 14 kg child needs the following total volume in 24 hours:

Hourly maintenance rate = 1200 ÷ 24 = 50ml/hour

Note: 
NEVER give 50 ml of 50% dextrose to children