Low glucose baby, NPO, no access to dextrose

[anon456]

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.

[anon456, BSN, RN]

This is one of those situations that keeps me up at night.

[llg, PhD, RN]

Sun0408 said:

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 I'm glucagon. I'm not sure if a baby can have that either though.

I've never done this ... and am just speculating, mind you ... but ...

The large intestine absorbs fluid ... would glucose water also be absorbed? I don't know how much or how fast. But people do absorb things (like meds) through enemas and suppositories. I have heard about people being fed rectally in the olden days. (My aunt was born prematurely in 1918 and fed rectally at first.) If there were really NO other access to try, I would try it before just standing there and letting the kid die.

Now that's a good reason to study nursing history. (A class that many would consider just another one of the "fluff" BSN courses.)

I would also be swabbing the mouth with glucose as some is broken down by saliva and absorbed in the mouth.

But this assuming that there is really no other access ...

[Sun0408, ASN, RN]

Haha, thanks. I was thinking wow, do they have glucose in the form of a suppository for infants :)

[Esme12, ASN, BSN, RN]

llg said:

I've never done this ... and am just speculating, mind you ... but ...

The large intestine absorbs fluid ... would glucose water also be absorbed? I don't know how much or how fast. But people do absorb things (like meds) through enemas and suppositories. I have heard about people being fed rectally in the olden days. (My aunt was born prematurely in 1918 and fed rectally at first.) If there were really NO other access to try, I would try it before just standing there and letting the kid die.

Now that's a good reason to study nursing history. (A class that many would consider just another one of the "fluff" BSN courses.)

I would also be swabbing the mouth with glucose as some is broken down by saliva and absorbed in the mouth.

But this assuming that there is really no other access ...

LOL....I had nursing history in my ASN program at a university.

Glucagon may be given....... In an infant, give Glucagon infant 50ug/kg IV, I'm or SC (maximum dose is 1 MG) or 30 ug/kg in children. In response to glucagon, the blood sugar will increase more than 40 mg/dl in the case of hyperinsulinism. Glucagon will also increase the blood sugar in an infant or child but not to the degree that it is increased in hyperinsulinism. Hypoglycemia

[CrunchRN, ADN, RN]

I was wondering about IM dextrose also. Thanks Esme.

[Jolie, BSN]

Glucagon CAN be given to an infant in an emergency, but may or may not actually have any real effect.

In order for glucagon to be effective, the recipient must have glycogen stored in the liver. Babies (even healthy, term ones) have few glycogen stores, and a chronically ill, compromised infant is unlikely to have any. Any response from glucagon would likely be minimal and very short-lived.

Bucchal absorption would certainly be worth a try, but vascular access of some type is needed ASAP for this baby.

STAT intraosseous while we're working on venous access via ultrasound.

Ideally, IO is done with a drill or the like but a Jamshidi works well and, in a seconds-to-minutes emergency, a large-bore angiocath with gentle touch.

I also had the same thought as llg: buccal absorption or rectal.

Cut-down... just depends on where you are and whether you've got a doc who can pull it off. Not rocket-science but not something that many docs have done much/recently/at all.

[wooh, BSN, RN]

if your facility cannot do io, it shouldn't have babies as patients.

[NicuGal, MSN, RN]

I've never given glucagon in all my years. You can place an IO until the kid can get a line. We usually call IR and see if the can bounce up to throw in a fem line. If strict NPO you want nothing in that gut.

[Jory, MSN, APRN, CNM]

anon456 said:

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?

Never seen a situation where a line could not be placed...ever.

That is what we do...run D10 and check glucose every 30 minutes, then every hour until stabilized.

If a PICC is lost then a new PIV is accessed and if it's a kid that keeps blowing the lines then the NNP is called to put in a PICC...in our facility you cannot do a blood pressure in an extremity with a PICC.

I have seen TWICE where a Broviac had to be placed b/c a blown PICC could not be replaced, but never once saw a kid where some kind of IV access couldn't get placed in the meantime....we are talking access of less than an hour, not continuous. We try to head these off before it happens.

No nurse is permitted to stick saphenous or antecubital viens for IV sites...period. It's because if a PICC ever needs placed, we have a location.

[platon20]

Quote

Cut-down... just depends on where you are and whether you've got a doc who can pull it off. Not rocket-science but not something that many docs have done much/recently/at all.

Cut-downs are easy. I worked with an RN at Cooks in Ft Worth who was better than any doctor. They would consult her to do it when they had a difficult access issue.

[AnnieOaklyRN, BSN, RN, EMT-P]

Place an IO if there are no contraindications!