When to administer Dextrose Normal Saline (DNS) in a 5-year-old male child with loss of consciousness due to Road Traffic Accident (RTA)?

From the Guidelines

DNS (Dextrose Normal Saline) should not be administered to a 5-year-old male child who has lost consciousness due to a road traffic accident (RTA). In pediatric trauma cases with loss of consciousness, isotonic fluids like normal saline (0.9% NaCl) or Ringer's lactate should be used instead at a dose of 20 ml/kg as an initial bolus, as recommended by the American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care 1. DNS contains dextrose (glucose), which can worsen neurological outcomes in traumatic brain injury by increasing cerebral edema and potentially exacerbating secondary brain injury. Additionally, trauma patients rarely need glucose supplementation initially, and hyperglycemia can worsen neurological outcomes.

• Key considerations in the management of a child with loss of consciousness due to RTA include:
  • Securing the airway first
  • Ensuring adequate oxygenation
  • Maintaining cervical spine precautions
  • Continuous monitoring of vital signs, neurological status, and blood glucose levels during resuscitation and treatment If the child shows signs of hypoglycemia (blood glucose <70 mg/dL) confirmed by bedside testing, then a separate dextrose bolus (2-4 ml/kg of D10W) can be administered. The use of isotonic crystalloid solutions, such as lactated Ringer’s solution or normal saline, is recommended for the treatment of shock, with no added benefit in using colloid (eg, albumin) during the early phase of resuscitation 1.

From the Research

Administration of Dextrose in a 5-year-old Male Child

Loss of Consciousness due to RTA

When considering the administration of dextrose to a 5-year-old male child who has lost consciousness due to a road traffic accident (RTA), several factors must be taken into account. The following points highlight the key considerations:

• The child's blood glucose level should be checked to determine if hypoglycemia is the cause of the loss of consciousness 2.
• If the child is hypoglycemic, administration of dextrose may be necessary to rapidly correct the blood glucose level 2.
• The choice of dextrose concentration (e.g., 10% or 50%) depends on the severity of the hypoglycemia and the child's overall clinical condition 2.
• A lower concentration of dextrose, such as 10%, may be preferred to minimize the risk of adverse events and hyperglycemic episodes 2.

Contraindications for Dextrose Administration

The following situations may contraindicate the administration of dextrose:

• If the child has a decreased level of consciousness due to a cause other than hypoglycemia, such as head trauma or other injuries, dextrose administration may not be appropriate 3.
• If the child has a history of diabetes or other conditions that may affect glucose metabolism, alternative treatments may be necessary 4.
• If the child is at risk of hyperglycemia or has a history of hyperglycemic episodes, caution should be exercised when administering dextrose 2.

Alternative Treatments

In some cases, alternative treatments may be preferred over dextrose administration:

• Maintenance fluid therapy with saline, dextrose-supplemented saline, or lactated Ringer solution may be used to correct dehydration and electrolyte imbalances 4.
• Subcutaneous infusion of fluids, such as hypodermoclysis, may be considered for mild to moderate dehydration 5, 6.