FIELD REFERENCE
Full criteria & treatment guidance
Indications
- Hypoglycemia when IV access cannot be established under the matching OCEMS order.
Contraindications & local exclusions
- For the cited emergency glucagon injection kit: pheochromocytoma, insulinoma, or hypersensitivity to glucagon/excipients. Glucagonoma is a label contraindication specifically for diagnostic use, not a blanket hypoglycemia exclusion.
Precautions
- Glucagon may be ineffective when hepatic glycogen is depleted. Reassess glucose/mental status; nausea, vomiting and recurrent hypoglycemia require attention. Intranasal glucagon and injectable kits are different products.
- These are selected safety checks, not a complete prescribing monograph. Product labeling and OCEMS authorization answer different questions; confirm the actual product, patient population and applicable order.
Check before giving
- Do not give oral glucose to a patient without an intact swallow/airway reflex.
- If an unconscious hypoglycemic patient cannot receive IV dextrose and fails to respond to IM glucagon, check whether the patient meets the limited IO dextrose criteria.
Use in OCEMS
- A hypoglycemia option when IV dextrose cannot be given because IV access cannot be established.
- Use the glucose threshold from the patient’s applicable condition order and continue airway/ventilation support.
Adult / adolescent
| Indication / route | Dose & limits |
|---|---|
| Hypoglycemia without IV access | 1 mg IM once. I-15 covers glucose at or below 60 mg/dL or below 80 with symptoms suggesting hypoglycemia. |
Pediatric
- SO-P-065 lists 0.5 mg IM when IV access cannot be established for glucose below 60 mg/dL. The pediatric seizure, shock, and poisoning orders also list 0.5 mg.
- The pediatric dose in these OCEMS standing orders is not the adult 1 mg dose. Consult the appropriate pediatric condition order for its threshold.
Pediatric dose by age / weight
- SO-P-065: hypoglycemia below 60 mg/dL when IV access cannot be established. Other pediatric orders have their own glucose thresholds.
| Weight | Pediatric dose | Volume / route |
|---|---|---|
| Any eligible pediatric weight | 0.5 mg — fixed dose | 0.5 mL IM when reconstituted to 1 mg/mL |
Preparation & reassessment
- The inventory includes a 1 mg vial with diluent. Reconstitute the supplied product according to its labeling and verify the resulting concentration.
- Reassess glucose and consciousness, maintain airway support, and document the clinical response.
VISUAL FIELD REFERENCE
Hypoglycemia without IV access: adult vs pediatric
Adult & pediatric guidance · ALS
Use the glucose threshold and additional criteria from the applicable condition order.
- 1 mg IM
Adult
1 mg IM once. I-15 covers glucose at or below 60 mg/dL or below 80 with symptoms suggesting hypoglycemia.
- 0.5 mg IM
Pediatric
SO-P-065 lists 0.5 mg IM when IV access cannot be established for glucose below 60 mg/dL. The pediatric seizure, shock, and poisoning orders also list 0.5 mg.
The pediatric dose in these OCEMS standing orders is not the adult 1 mg dose. Consult the appropriate pediatric condition order for its threshold.
- Do not give oral glucose to a patient without an intact swallow/airway reflex.
Selected checkpoints; read the complete guide for criteria, exclusions, doses, and ongoing care. I-15 · I-20 · SO-M-020 · SO-P-065 · SO-P-075 · SO-P-080
UNDERSTAND THE CARE
Why lack of IV access does not finish the assessment
Glucagon is an option within the applicable hypoglycemia order when IV access cannot be established. Confirm the glucose criteria and patient findings in that condition order. The adult dose is not a default for a child, and preparation should follow the product carried.
Applying the guidance
After administration, continue observing the airway and response rather than waiting without reassessment. Record glucose, route, time, dose and the change in consciousness. If response is inadequate, follow the full condition pathway; the separate IO dextrose exception includes additional criteria and is not established solely by a failed IV attempt.
Dose, concentration and volume
Diagram text & teaching checkpoints
- Indication
- Condition-specific hypoglycemia criteria.
- Access
- Use the listed no-IV option.
- Preparation
- Adult/pediatric dose and exact product.
- Follow-up
- Consciousness, airway and subsequent criteria.
Sources for this explanation
Original OCMedic teaching synthesis of the references below. Educational expansion updated ; this is not a new independent clinical-review date. Source-specific dates and limitations remain in the full guidance.
- I-15 — Adult / Adolescent Standing Order Drug Guide
- I-20 — Pediatric Medication Volume Dose by Weight
- SO-M-020 — Altered Mental Status
- SO-P-065 — Altered Mental Status - Pediatric
- SO-P-075 — Seizure / Convulsion - Pediatric
- SO-P-080 — Shock (Symptomatic Hypotension) - Pediatric
- Product label — GLUCAGON kit
Keep the access problem and the glucose problem separate
When IV access is unsuccessful, document the access difficulty separately from the evidence for hypoglycemia. The indication is not simply “unable to start an IV.” Preserve the condition-specific glucose result and patient findings that led to treatment, the product prepared, and the time of administration.
If consciousness does not improve, give the next clinician a timed sequence: initial findings, unsuccessful access attempts, glucagon administration and the latest airway and mental-status assessment. This is more useful than “glucagon did not work,” which does not establish the elapsed time or what response was assessed.
Continue through the applicable altered-mental-status or other condition pathway. The IO dextrose exception includes additional criteria; it is not an automatic consequence of a failed IV. Adult and pediatric treatment instructions also remain distinct. Keep the supplied diluent and formulation instructions with the preparation step, and do not substitute an intranasal product’s directions for the injectable product described here.
Source: Altered Mental Status.