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Severe hypoglycaemia — SCE Acute Medicine MCQ

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HardAcute Renal and Metabolic EmergenciesSevere hypoglycaemiaSCE Acute Medicine

A 73-year-old man presents with vomiting, weakness, confusion or collapse. Relevant history includes diabetes, kidney disease, endocrine disease or a treatment trigger. On assessment, volume status and bedside physiology are abnormal. Investigations show reduced consciousness with capillary glucose 1.7 mmol/L. What is the most important immediate action?

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Correct answer: D — Give intravenous glucose or intramuscular glucagon if IV access is unavailable

The key discriminator is that reduced consciousness with capillary glucose 1.7 mmol/L, which makes Give intravenous glucose or intramuscular glucagon if IV access is unavailable the single best answer. Reverse anticoagulation where appropriate is less appropriate because it does not address the dominant acute risk in the vignette; Protect the airway and support ventilation would fit a different presentation or later stage of care. Start acetylcysteine without delay and Give intramuscular adrenaline immediately are suboptimal because they would either delay time-critical treatment or follow the wrong acute pathway. Teaching point: SCE-style acute medicine questions usually test prioritisation using physiology, timing and a guideline-defined threshold, rather than isolated factual recall.

Reference: JBDS hypoglycaemia guideline; BNF