ACS Sepsis Stroke Trauma GI bleed DKA Anaphylaxis Pregnancy trauma Child sepsis Status epilepticus APO HyperK Child DKA Hypo

Hypoglycaemia

Start this sheet when: Glucose below 70 mg/dL (3.9 mmol/L) with symptoms, or below 54 mg/dL (3.0 mmol/L) at any time. Check glucose in anyone confused, fitting, drowsy, 'drunk' or with stroke signs. Treat first, find the cause after.

Hospital (remembered on this device)Patient ID / UHID (not saved)Age / SexFilled by

Door dateDoor time (clock starts here)

Time since door

Targets met --Breaches 0

1.Capillary glucose checked
≤ 5 min from door · Local target: at triage
Enter door time
2.First treatment given (oral glucose, IV dextrose or glucagon)
≤ 5 min from glucose result · JBDS-IP: treat at once
Enter door time
3.Thiamine IV given with the dextrose(Alcohol use or malnourished)
≤ 5 min from glucose result · Never delays the glucose; prevents Wernicke's
N/AEnter door time
4.Glucose rechecked
≤ 15 min from first treatment · JBDS-IP: 10-15 min after treatment
Enter door time
5.Starchy food or 10% dextrose drip started
≤ 30 min from first treatment · JBDS-IP: once above 72 mg/dL, keep it there
Enter door time
6.Cause found and written down
≤ 1 h from door · Local target: dose error, missed meal, sepsis, renal, alcohol
Enter door time
7.Admitted for 24 h glucose monitoring(Sulfonylurea or long-acting insulin)
≤ 2 h from door · Local target: sulfonylurea or long-acting insulin
N/AEnter door time
8.Disposition decided
Record · Admit / transfer / OT; for the length-of-stay audit
Enter door time
9.Patient left the ED
≤ 2 h from disposition decision · ED KPI: decision to departure 2 h or less
Enter door time

Bedside checklist

☐Can swallow: 15-20 g fast sugar (4 tsp sugar in water); repeat if still low
☐Can't swallow: 10% dextrose 150-160 mL over 15 min; child 2 mL/kg
☐No IV: glucagon 1 mg IM (0.5 mg if under 25 kg or 8 years)
☐Glucagon fails in alcohol use, starvation and liver disease: go IV
☐Sulfonylurea: dextrose drip; octreotide 50-100 mcg SC 8-hourly if it recurs
☐Never 50% dextrose in a child; adults only if peri-arrest
☐Type 1 diabetes: never stop the basal insulin after treating the low
☐No diabetes: draw insulin, C-peptide and cortisol at the low if it won't delay treatment

References

Targets marked “local” are suggestions: agree your own with the quality committee before auditing against them.

Bedside checklist

☐Can swallow: 15-20 g fast sugar (4 tsp sugar in water); repeat if still low

☐Can't swallow: 10% dextrose 150-160 mL over 15 min; child 2 mL/kg

☐No IV: glucagon 1 mg IM (0.5 mg if under 25 kg or 8 years)

☐Glucagon fails in alcohol use, starvation and liver disease: go IV

☐Sulfonylurea: dextrose drip; octreotide 50-100 mcg SC 8-hourly if it recurs

☐Never 50% dextrose in a child; adults only if peri-arrest

☐Type 1 diabetes: never stop the basal insulin after treating the low

☐No diabetes: draw insulin, C-peptide and cortisol at the low if it won't delay treatment