What is the immediate management of unilateral body paralysis during hypoglycemia (low blood sugar)?

Immediate Management of Unilateral Body Paralysis During Hypoglycemia

The immediate management of unilateral body paralysis during hypoglycemia requires rapid administration of glucose (15-20g) orally if the patient is conscious, or intravenous glucose or intramuscular glucagon if unconscious, followed by monitoring until symptoms resolve. 1

Initial Assessment and Recognition

When encountering a patient with unilateral body paralysis during hypoglycemia:

1. Check blood glucose immediately - Hypoglycemia must be considered in any patient with focal neurological deficits 2
2. Document blood glucose level before treatment if possible, but do not delay treatment 1
3. Recognize that hypoglycemia can mimic stroke with symptoms including:
   • Unilateral paralysis/hemiplegia
   • Altered mental status
   • Conjugate eye deviation
   • Involuntary movements 3, 4

Emergency Treatment Algorithm

For Conscious Patients:

1. Administer 15-20g of oral glucose (glucose tablets preferred) 1
2. Recheck blood glucose after 15 minutes 1
3. Repeat treatment if blood glucose remains <70 mg/dL 1
4. Once blood glucose is trending up, provide a meal or snack to prevent recurrence 1

For Unconscious Patients:

1. Administer glucagon via appropriate route: 5
   • Adults and children >25kg: 1mg subcutaneously or intramuscularly
   • Children <25kg: 0.5mg subcutaneously or intramuscularly
2. If no response after 15 minutes, administer a second dose while awaiting emergency assistance 5
3. OR administer intravenous glucose (under medical supervision) 2
4. Call for emergency assistance immediately after administering treatment 5

Monitoring and Follow-up

1. Continue monitoring blood glucose every 15 minutes until stable 1
2. Observe for resolution of neurological symptoms - paralysis typically resolves rapidly with glucose administration 6
3. Monitor for recurrent hypoglycemia as ongoing insulin activity may cause recurrence 1
4. Provide oral carbohydrates once the patient can safely swallow to restore liver glycogen 5

Important Clinical Considerations

• Rapid treatment is critical - Delayed treatment of hypoglycemia with neurological symptoms can lead to permanent neurological damage 2
• Complete resolution is expected - Neurological symptoms typically disappear within minutes after glucose administration 6
• Consider glucose reperfusion injury - In rare cases, neurological symptoms may worsen or appear after glucose administration due to reperfusion injury 4
• Reevaluate diabetes management plan after any episode of severe hypoglycemia 1
• Consider temporary relaxation of glycemic targets for patients with hypoglycemia unawareness or recurrent severe hypoglycemia 1

Common Pitfalls to Avoid

• Mistaking hypoglycemic hemiplegia for stroke - Always check blood glucose in patients with acute neurological deficits 2
• Delaying glucose administration - Treatment should not be delayed while waiting for confirmatory tests 1
• Inadequate follow-up monitoring - Continued monitoring is essential to prevent recurrence 1
• Failing to identify the cause - The underlying cause of severe hypoglycemia should be identified and addressed 1

Hypoglycemia-induced hemiplegia is a medical emergency that requires immediate recognition and treatment to prevent permanent neurological damage. The dramatic improvement following glucose administration is characteristic of this condition and distinguishes it from other causes of acute neurological deficits.