If a patient cannot ingest a simple oral carbohydrate, what is the next step in treatment?

• A. Maintain fluids
• B. Give oral sugar
• C. Dextrose IV or glucagon
• D. Observe

Answer: (C)

When blood glucose is low and the patient cannot take anything by mouth, you must provide glucose directly into the body rather than trying to give oral sugar. The fastest, most reliable approach is to administer parenteral glucose: give dextrose by IV (for example, 50% dextrose IV push) to rapidly raise the glucose, or, if IV access isn’t available, give glucagon by IM or SC injection. These routes bypass the GI tract and correct hypoglycemia quickly. Simply maintaining fluids or observing won’t fix the low blood sugar, and giving oral sugar isn’t feasible if ingestion isn’t possible or if the patient is at risk of aspiration. After treatment, recheck blood glucose and monitor the patient closely.