Low glucose baby, NPO, no access to dextrose

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What do you do with a patient who was on TPN, has just lost their PICC, is a very hard stick with PIV, just tested 40's with glucose, and is strictly NPO?? This happened on my floor and it was a very serious situation as you can imagine.

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What was NPO status for?

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Specializes in Complex pedi to LTC/SA & now a manager.
Quote
What was NPO status for?

NPO = nil per oras or nothing by mouth

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Specializes in Complex pedi to LTC/SA & now a manager.

Is glucagon contraindicated in the interim?

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Not sure. Never seen glucagon given to babies-- but then we have not had this situation before in my experience.

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brithoover said:
What was NPO status for?

Severe aspiration- could not safely swallow without compromising airway. I also believe (and this was not my patient so hard for me to remember) that the patient had a non-working gut, like maybe short gut or something. In either case giving anything through the digestive system was not an option that was brought up by the MDs.

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It was solved, by the way, by the IV team placing a stat PIV and running D10 until new PICC could be placed. But if that PIV could not be placed and baby was not improving, then what?

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Specializes in Nursing Professional Development.

You seem kind'a vague on the details about the digestive system. Was it impossible to give anything rectally?

Also, sugar can be absorbed through the mucous membranes of the mouth, with no real swallowing required.

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You can place an IO in an infant in an emergency. And if you didn't have an IO and couldn't place a PIV then transfer to ICU for a central line/cut down as previous poster said

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Specializes in Trauma Surgical ICU.

Just wondering, what can you give rectally for hypoglycemia?? I have never heard of such a thing but I don't work NICU or PICU.. We would have went for the IM glucagon. Im not sure if a baby can have that either though.

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Specializes in Pedi.

Before you said the gut wasn't working, my first thought would be drop an NG and throw something down that.

If you couldn't get access by PIV, isn't there an intensivist or anesthesiologist available who could place a fem line or a broviac since it's kind of an emergency situation?

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umcRN said:
You can place an IO in an infant in an emergency. And if you didn't have an IO and couldn't place a PIV then transfer to ICU for a central line/cut down as previous poster said

That's kinda what I was thinking too, IO.

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