Hypoglycaemia ICU Management — FRCA Final MCQ

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EasyIntensive Care MedicineHypoglycaemia ICU ManagementFRCA Final

A 70-year-old man (ASA III) is on day 3 in ICU following bowel surgery. He becomes acutely confused with a GCS of 12. His blood glucose is 2.1 mmol/L. He is on an insulin infusion for glucose control. What is the immediate management?

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Correct answer: C — Stop insulin and wait for glucose to rise naturally

For severe hypoglycaemia (glucose <3.0 mmol/L with symptoms) in a patient with IV access, the JBDS and NICE recommend: 75-100 mL of 20% dextrose IV (providing 15-20 g glucose). 50% dextrose is no longer recommended as first-line due to risk of phlebitis, tissue necrosis if extravasated, and vein damage. 10% dextrose can also be used (150-200 mL). The insulin infusion should be paused, glucose rechecked at 10-15 minutes, and the dextrose bolus repeated if glucose remains <4.0 mmol/L. Once glucose is >4.0, a carbohydrate snack should be given if the patient can eat, or the dextrose infusion adjusted.

Reference: JBDS – 2022 – Management of hypoglycaemia; NICE – 2022 – NG17 Diabetes