You come on shift the next morning and notice that Bob is pale and sweaty, dizzy, shaky and appears confused with a GCS of 14/15.
Q. You come on shift the next morning and notice that Bob is pale and sweaty, dizzy, shaky and appears confused with a GCS of 14/15. What could be the cause of Bob’s symptoms?
Hyperglycaemia
Fluid overload
Hypoglycaemia ✓
These symptoms could indicate that Bob has hypoglycaemia.
Q. What would you do next? Select the options from the list below which you consider the most suitable.
Ask doctor to consider brain CT – No – The first priority is to establish whether Bob, who is not eating & vomiting, is hypoglycaemic. If hypoglycaemic on BM stix, this may well explain the drowsiness and so a brain CT may not then be required. Try again to select the best option.
Re-measure BM stix immediately – Yes – But immediate action would also be required to correct the glucose if hypoglycaemic. Try again to select the best option.
Before measuring anything give sugary drink and food – No – It would be important to rapidly establish if Bob is hypoglycaemic to guide appropriate action. Bob’s BM is 1.9 and he recovers after it is corrected.
Before measuring anything disconnect sliding scale – No – It would be important to rapidly establish if Bob is hypoglycaemic to guide appropriate action.
Having measured BM stix give sugary drink plus food, if needed, & inform doctor- Yes – In addition, if low you should inform the doctor and suggest giving a concentrated IV glucose bolus (eg 50 mls of 50% glucose). Bob may also may need to be moved to part of the ward where any seizure activity is likely to be noticed and recorded.
Page last reviewed: 04 Feb 2021
