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What Are The Present Recommendations For Hypoglycemic Treatment?
What are the current recommendations for hypoglycemic treatment for a patient that is alert/can swallow but NPO for surgery? My hospital s current guidelines only address patients responsive and able to swallow (4 oz. juice or 1 tube instant glucose for BG 41-69 and 8 0z juice or 2 tubes instant glucose for BG 40). The protocol does not address procedure if patient is NPO and 4-8 oz juice is much more than the normal sips of water w/ meds usually allowed prior to surgery and puts the patient at risk for aspiration. I would not hold treatment while waiting for the provider to call me to clarify and would probably give D50 IV in this situation. I discussed this with colleagues and nobody is clear as to the current recommendations for this situation.
Mon, 21 Jul 2014
Dear Sir/Madam
You raised a very beautiful query.
There are no Internationally accepted guidelines for preventing hypoglycemia in a NPO patient. In my practice i follow this technique- NPO patients are Generally given 3units of N.S depending on the waiting period. I change over to 1 unit 5%dextrose, 1 unit N.S and one unit RL. Insulin for such patients, i go by sliding scale. This has till now helped me manage surgical patients without hypoglycemia. Please try it out and tell me if it is practical in your set up. I am against giving D50 because it caused sudden spike in blood sugar which is also bad for a surgical patient plus the solution is thick causing pain to the patient. I always prefer to plan the fluid maintenance with 5%dextrose. Please let me know your opinion and experience after trying this method..
With regards
Dr.Riyaz Sheriff
You raised a very beautiful query.
There are no Internationally accepted guidelines for preventing hypoglycemia in a NPO patient. In my practice i follow this technique- NPO patients are Generally given 3units of N.S depending on the waiting period. I change over to 1 unit 5%dextrose, 1 unit N.S and one unit RL. Insulin for such patients, i go by sliding scale. This has till now helped me manage surgical patients without hypoglycemia. Please try it out and tell me if it is practical in your set up. I am against giving D50 because it caused sudden spike in blood sugar which is also bad for a surgical patient plus the solution is thick causing pain to the patient. I always prefer to plan the fluid maintenance with 5%dextrose. Please let me know your opinion and experience after trying this method..
With regards
Dr.Riyaz Sheriff
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