What is the treatment for hypoglycemia with altered mental status?

• A. 50% Dextrose 50 mL IV
• B. NPO And Observation
• C. Oral Glucose Tablets
• D. Insulin Infusion

Answer: (A)

In hypoglycemia with altered mental status, the priority is to rapidly raise the blood glucose because CNS function depends on it and the patient may not be able to protect the airway or swallow safely. The best answer is giving intravenous concentrated dextrose right away, typically 25 g of glucose as a 50% dextrose solution (50 mL). This provides the quickest, most reliable correction of hypoglycemia and reversal of neuroglycopenic symptoms.

If IV access isn’t available, glucagon given IM can be used to raise glucose, but it’s slower and depends on hepatic glucose stores. Oral glucose tablets aren’t appropriate when mental status is altered due to the risk of aspiration and inability to ingest safely. Simply keeping the patient NPO and observing would miss a life-threatening emergency, and an insulin infusion would make the hypoglycemia worse, not improve it.

After the bolus, recheck the glucose and treat any persistent hypoglycemia as needed, while monitoring the patient and addressing the underlying cause. Once stabilized and able to swallow, a longer-term approach with dietary carbohydrates can be considered to prevent recurrence.