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Pediatric emergency medicine trisk 1877 1877

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plasma glucose should then be maintained by an infusion of dextrose at a rate of to mg/kg/min Generally, this goal can be accomplished by providing 10% dextrose at one and one-half times the maintenance rate While waiting for vascular access, mucosal and enteral routes should be considered if can be done safely Glucagon (0.03 mg/kg up to a maximum of mg intramuscularly) may be used to treat hypoglycemia that is known to be caused by hyperinsulinism but is not indicated as part of the routine therapy of hypoglycemia with an unknown etiology Glucocorticoids should not be used because they have minimal acute benefit and may delay identification of the cause of hypoglycemia The adequacy of therapy should be evaluated both chemically and clinically The plasma glucose should be monitored frequently and consistently until a stable level higher than 70 mg/dL is attained on more than one measurement Adrenergic symptoms should resolve quickly The resolution of CNS symptoms may be prolonged, particularly if the child was initially seizing or unconscious Seizures that not respond to correction of hypoglycemia should be managed with appropriate anticonvulsants (see Chapters 72 Seizures and 97 Neurologic Emergencies ) The mild acidosis (pH 7.25 to 7.35) usually seen in hypoglycemia will correct without specific intervention Marked acidosis (pH

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