Low blood sugar, juice or D50? - page 2
by mappers 19,179 Views | 42 Comments
Last night I had a patient with a BS of 39. I had just finished giving report on her when she asked us to check her BS. Since the oncoming nurse still had to get report on a few more patients, I got the aid to check the BS then... Read More
- 0Apr 17, '10 by paranrs66I think you did fine! If you had decided to give D-50 that would have been fine too! There are pro's and con's to each decision. For ex. You know you had to be prepared to manage an airway if the pt. had gotten into trouble swallowing while her sugar was so low. Sometimes people with tolerate low sugars well, another time they will not. If you had given D-50 there are risks there as well, extravasation, rebound, etc. It's easy to second guess someone, but only the person making a decision saw, felt, smelled and heard the whole picture and you are the one who has to take responsibility for doing something as well as doing nothing! I know you know this! Good job following thru, too! Another nurse may have just given report and left, another may have given D-50 and reported then left, b/c they would have gotten off on time since D-50 is generally faster to bring up B.S. than watching someone eat and waiting for BS to begin to rise slowly with digestion. Good Job on doing the "right thing" for your patient! Just my two cents...
- 2Apr 17, '10 by DeLanaHarvickWannabeQuote from supernaturalI respectfully disagree.Plus most people end up dieing with sugar that low.
Perhaps most people die with a glucose of 39 without interventions. However, giving juice to a patient constitutes an intervention. This patient most likely had sugars this low at home before, and most likely didn't have an amp of D50 at hand. She clearly knew how to take care of her hypoglycemic episodes appropriately. If, in fifteen minutes, the juice didn't bring up the sugar, or, worse, the sugar dropped, (I've seen it happen and it's crazy!) that's when I would have considered D50 or glucagon.
Otherwise, I only give D50 if there is a specific order for it (this is rare), if the patient is NPO, or if the patient is unable to drink juice safely.
My guess is that this patient was more in danger of death due to poor control of diabetes than for one particular blood sugar in the 30's.
- 0Apr 17, '10 by DeLanaHarvickWannabeQuote from leslie :-DI agree 100%, Leslie. I forgot to mention these things in my post.first, you really need to check your facilitie's protocol, regardless of pt loc.
using nsg judgment, it makes a whole lot more sense to give sweetened juice/drink to those able to drink it.
but you need to stay with them and recheck it...that is also good nsg judgment.
- 1Apr 17, '10 by Meriwhen Senior ModeratorNot too long ago, I had a patient with a BG in the 30s...they were AO4, feeling "funny" but denying other symptoms, and capable of eating and drinking. So I gave them some sweetened OJ and some crackers and sat with them while they noshed. It did the trick...a little too well: it was 203 when we rechecked it.
So I would have done the same as you and offered food/drink if the patient was able to eat and then rechecked...I also would have let the doctor know about the 39 right away, and also what the BG was when it was rechecked.
I had a patient with a BG of 14 who was also AO4 and denying symptoms...I strongly suspect that it was a testing error since they were more alert and oriented than most of the staff that early in the morning But since they were on bedtime Lantus, we still notified the doctor and they got juice, crackers and a recheck just to be safe.
- 0Apr 17, '10 by rgdavisRNI would have given the juice and a snack too. First of all, the patient was conscious, could swallow and wasn't NPO. Secondly, D50 is pretty rough on a peripheral IV site, so why give it to a patient who could correct her blood sugar by eating snacks.
If I was too busy to stay with the patient after she started feeling better, I'd still keep checking her and her blood sugar periodically to make sure she did not become hypoglycemic again. If the blood sugar came up and stayed up, I don't see any reason to give IV D50.
- 0Apr 17, '10 by NickiLaughsI had a patient A/O, just seemed a little "off" and sweating. Checked sugar: 19, not kidding, lab called when i was about to dbl check blood sugar (to make sure it wasn't an error) stating that the sugar had come back at 28......I decided to forego second blood sugar grabbed 2 OJS and basically have him chug them.
But protocol at my hospital is: if they can take PO and are A/O: give them OJ
If they can't take PO or after a BS check 15 min after OJ is still low: then you give them D50
Recheck again in 15 min: if it's still low, Start Dextrose 10% and Call MD *this is an ICU by the way*
In my personal experience, the OJ somehow works quicker? I never understood that, but I seem to get better results quicker with that.
I would just check the protocol of you facility.
- 0Apr 17, '10 by RN1980better get on speed with the hospital protocol concerning this, you likely wont get in trouble for for giving juice or amp of d50 and overting the deterioration of a patient, however some bean counter in performance improvement might raise heck & you get canned for not following protocol. ironic....huh.
- 0Apr 17, '10 by alem-tsahaix2 what the above poster said. Your intervention was absolutely fine, but I wouldn't have given report on that pt until AFTER I had re-checked the FS. The oncoming nurse had nothing but subjective data to go by so she is probably just trying to cover herself by giving the D50.