What is the recommended dose of glucose for a 1-year-old child with hypoglycemia?

Glucose Dosing for Hypoglycemia in a 1-Year-Old Child

For a 1-year-old child with hypoglycemia, administer 15g of oral glucose if the child is conscious and able to swallow, or 0.5-1.0 g/kg of intravenous dextrose if the child is unconscious or unable to swallow. 1

Assessment and Classification

Hypoglycemia in a 1-year-old is defined as blood glucose:

• Level 1: <70 mg/dL but ≥54 mg/dL
• Level 2: <54 mg/dL
• Level 3: Severe event requiring assistance 2

Signs and symptoms may include:

• Autonomic symptoms: sweating, pallor, tremors
• Neuroglycopenic symptoms: irritability, lethargy, confusion, seizures
• Young children often cannot articulate symptoms, making vigilant monitoring essential 1

Treatment Algorithm

For Conscious Child (able to swallow):

1. First-line treatment:

   • Administer 15g of oral glucose 1
   • Options include:
     • Glucose tablets (preferred if available)
     • 6-8 oz apple or orange juice
     • 6-8 oz regular (non-diet) soda
     • 1 tablespoon honey or table sugar 1

2. If unwilling/unable to swallow glucose but still conscious:

   • Apply a slurry of granulated sugar and water under the tongue 1

3. Follow-up:

   • Recheck blood glucose in 15 minutes
   • If not improved, repeat glucose administration
   • Once stabilized, provide a protein-containing snack 1

For Unconscious Child or Severe Hypoglycemia:

1. Emergency treatment:

   • IV dextrose: 0.5-1.0 g/kg (2-4 mL/kg of D25W or 5-10 mL/kg of D10W) 1
   • Avoid D50W in children as it is irritating to veins; dilution to D25W or D10W is preferred 1

2. If IV access unavailable:

   • Glucagon: 0.03 mg/kg up to maximum of 1 mg IM/SC 1
   • May repeat every 15 minutes up to 3 doses if needed 1

3. After initial stabilization:

   • Continuous glucose monitoring
   • Consider continuous infusion of D10W-containing IV fluids at 100 mL/kg per 24h if hypoglycemia recurs 1

Special Considerations

• Monitoring: Check blood glucose every 15-30 minutes until stable, then hourly until consistently normal 1

• Causes to investigate: Consider insulin excess, adrenal insufficiency, metabolic disorders, or inadequate intake 1, 3

• When to activate emergency services:

  • Seizure activity
  • Unconsciousness
  • Failure to respond to oral glucose within 10 minutes
  • Inability to swallow 1

• Prevention strategies:

  • Regular glucose monitoring
  • Ensuring adequate carbohydrate intake with meals
  • Adjusting medication if applicable
  • Educating caregivers about recognition and management 2

Cautions and Pitfalls

• Do not administer oral glucose to an unconscious child due to aspiration risk 1

• Do not delay treatment while waiting for laboratory confirmation of hypoglycemia; treat based on symptoms and point-of-care testing 1

• Do not underdose glucose - inadequate treatment can lead to prolonged hypoglycemia with risk of neurological damage 3

• Be aware that hypoglycemia may recur, especially if the underlying cause is not addressed 1

• Remember that young children have higher glucose requirements per kg of body weight compared to adults 4