Endocrine and metabolic emergencies

Hypoglycaemia

Reviewed Nov 2026·1 references
New· views rounded down, updated weekly

Glucose < 70 mg/dL (level 1), < 54 mg/dL (level 2) or any value with cognitive impairment needing help (level 3). Give 15-25 g IV dextrose or IM glucagon, recheck at 15 min, then find and treat the cause; sulphonylurea overdose needs prolonged dextrose ± octreotide.

Definition
Level 1 < 70 mg/dL (3.9 mmol/L); level 2 < 54 mg/dL (3.0 mmol/L); level 3 severe event with altered mental or physical state requiring assistance.

At the bedside

Timed steps
  1. 1

    Treat

    0 min

    Conscious and able to swallow: 15-20 g oral glucose. Otherwise IV: 15-25 g dextrose (150-200 mL 10% or 50 mL 50% via a large vein). No IV: glucagon 1 mg IM/SC.

  2. 2

    Recheck

    15 min

    Repeat treatment until > 70 mg/dL, then give a long-acting carbohydrate or start a 10% dextrose infusion.

  3. 3

    Find it

    Cause

    Insulin (including stopped feeds), sulphonylureas, sepsis, liver failure, AKI/CKD, adrenal insufficiency, alcohol, malaria and quinine, insulinoma, salicylates.

  4. 4

    Prolonged risk

    Sulphonylurea

    Admit for ≥ 24 h; continuous 10% dextrose; octreotide 50-100 mcg SC every 6-8 h for recurrent hypoglycaemia.

  5. 5

    If malnourished

    Thiamine

    Thiamine 100 mg IV with or before dextrose in alcohol use or malnutrition (do not delay glucose).

Severe hypoglycaemia

Dextrose (glucose)

IV
Dose
15-25 g (150-200 mL 10%, or 50 mL 50%)
Worked example
Glucose 38 mg/dL, GCS 9: 50 mL 50% dextrose via antecubital vein, recheck 15 min → 112 mg/dL; start 10% dextrose 50 mL/h
Red flag · call your senior now
Recurrent hypoglycaemia after an oral hypoglycaemic overdose: needs 24-72 h of monitoring.
Red flag
Hypoglycaemia in septic shock or malaria: marker of severity.
Pitfall
Glucagon in liver failure, starvation or alcohol (no glycogen stores).
Pearl
Always check glucose in anyone with altered sensorium, seizures or focal deficits.

References

  1. 1

    American Diabetes Association Professional Practice Committee. 16. Diabetes care in the hospital: Standards of Care in Diabetes—2025. Diabetes Care. 2025;48(Suppl 1):S321-S334

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Glucose control in the ICU

Educational reference for trained clinicians. Check doses against your hospital protocol and the patient in front of you.