Hyperglycemic Episode Treated w/OJ?

nightmare, RN · Jul 28, 2008

Someone in hypo would respond fairly quickly with glucose,if they are hyper however they would get worse and you would know to summon immediate help.

cardiacRN2006, ADN, RN · Jul 28, 2008

It takes a long time for elevated sugars to cause a diabetic coma (HHNK or DKA), but minutes or less for hypoglycemia to cause problems.

So, in the absence of a glucometer you give sugar-always. You can correct it if it turns out to be high.

ChristineN, BSN, RN · Jul 28, 2008

We actually had this question this week in my NCLEX review class. Being a tech and soon to be new GN who works on an endocrine floor, I had beef with the instructors question:

Pt 20F, unresponsive lying on sofa, fruity smelling breath, rapid respirations, 1 episode vomiting last night what are you going to do?

(a Give OJ?

(b Initiate CPR

(c Give coffee

(d Get to hospial STAT

The correct answer was Give OJ, and I have major issues with this. (1) Pt was unresponsive so the OJ will be a choking hazard. (2) I'm not going to assume this pt is hypoglycemic when the pt has the classic signs and symptoms of DKA. In fact, in DKA a pts K is elevated, so OJ would be the worst thing I could give this pt right now.

MQ Edna · Jul 28, 2008

We actually had this question this week in my NCLEX review class. Being a tech and soon to be new GN who works on an endocrine floor, I had beef with the instructors question:
Pt 20F, unresponsive lying on sofa, fruity smelling breath, rapid respirations, 1 episode vomiting last night what are you going to do?
(a Give OJ?
(b Initiate CPR
(c Give coffee
(d Get to hospial STAT
The correct answer was Give OJ, and I have major issues with this. (1) Pt was unresponsive so the OJ will be a choking hazard. (2) I'm not going to assume this pt is hypoglycemic when the pt has the classic signs and symptoms of DKA. In fact, in DKA a pts K is elevated, so OJ would be the worst thing I could give this pt right now.

I know, it goes against better judgment. I guess the theory behind it is what a previous poster said. When giving someone orange juice it may snap them right out of it, but if it doesn't then at least you have a more definite idea that it's hyperglycemic and by then you would take the appropriate actions. I assume, if it's correct, that if someone is hyperglycemic then the oj will take a few minutes to cause any more damage and by then you should know what to do by then already. I may be wrong, does that sound correct to anyone?

The question is stupid and I hope I never run into that one on the test. If the pt. is unresponsive then of course you would begin checking vitals. It's a stupid stupid question and I would get upset if they ever asked me something like that.

nightmare, RN · Jul 28, 2008

Another indicator,which is not always present,especially in type 2's is that hyper.patients are generally dry and hypo patients generally sweat.

lpnstudentin2010, LPN · Jul 28, 2008

NOT A NURSE HERE BUT:

When I took first aid/CPR we were told to give something sugery to anyone with diabeties who was having a problem if we did not know what the problem is (obvioulsy if they are able to say my sugar is low/high treat accordingly). When I questioned this was told more damage can be done if it is low then if it is high.

ernrs2b · Jul 28, 2008

i have not heard of giving OJ for hyperglycemia, but our doctors in the ER like to treat DKA with D5W IVF infusing with insulin at the same time

ChristineN, BSN, RN · Jul 28, 2008

i have not heard of giving OJ for hyperglycemia, but our doctors in the ER like to treat DKA with D5W IVF infusing with insulin at the same time

That makes sense, because you don't want to bring them down too quickly. Often these pts have critically high K's, which would make me question the orange juice even more, though.

cardiacRN2006, ADN, RN · Jul 28, 2008

DKA's elevated K is due to hemoconcentration and will drop quickly with rehydration.

But that's not the point, because the pt in your description has DKA-meaning, you know the status of his glucose level.

This original question is, how do you initially treat a diabetic emergency without knowing the initial BS? In all cases, without knowing the BS, you treat with sugar of some sort.

But, in the case of an unresponsive pt, you were very correct to not select the OJ. That was a poorly written question, IMO. In that case, you would give the D50 or even the glucose paste to their gums.

BEDPAN76 · Jul 28, 2008

Back in the old days we had no way to get a blood glucose level. Lab tech had to come, draw, take to lab, do whatever and call results. This was when we tested urines for S & A. (sugar and acetone), Soooo, the thinking was that it is easier to bring down the blood sugar (if, in fact, it was too high). Some places had us mix in a packet or 2 of sugar!! BOY DO I FEEL OLD!! Anyway, when we finally did get lab results, we could give Reg. Insulin SQ. By the way, the highest blood sugar I saw was 1127. on a bilat. AKA pt. :confused:

vampiregirl, BSN, RN · Jul 29, 2008

i have not heard of giving OJ for hyperglycemia, but our doctors in the ER like to treat DKA with D5W IVF infusing with insulin at the same time

I think we are looking a two different situations here. In the hospital, most of the time the tools to determine what the blood glucose is are readily available. In the community, a glucometer and very limited medical info may be available, so the best course of action would be to administer the OJ, as several other posters mentioned.

Not to take this thread too off course, but on my EMS service we have used milk when it is available instread of oj on conscious (mild) episodes of hypoglycemia with very good results. I did some research and found several some data that supported this. Has anyone else seen this?