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Acute severe hypoglycaemia on sulfonylurea — SCE Acute Medicine MCQ

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ModerateAcute Renal and Metabolic EmergenciesAcute severe hypoglycaemia on sulfonylureaSCE Acute Medicine

A 78-year-old man is assessed on the acute medical unit. He takes gliclazide and is found confused with capillary glucose 1.9 mmol/L. After dextrose he improves but glucose falls again. Initial assessment includes relevant observations, bedside tests and urgent blood results. What is the most appropriate next step in management?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: A — Give intravenous glucose and monitor for recurrent hypoglycaemia

Give intravenous glucose and monitor for recurrent hypoglycaemia is the best answer because sulfonylurea-induced hypoglycaemia can recur and requires prolonged monitoring after glucose replacement. Give intramuscular adrenaline 500 micrograms is plausible, but it is less appropriate for the physiology or timing described in this stem. The other distractors either fit a neighbouring presentation, delay definitive treatment, or miss the key immediate risk. Clinical pearl: Octreotide may be required after specialist advice.

Reference: JBDS hypoglycaemia guideline; BNF