Patient selection: baby or child with severe hypoglycemia due to hyperinsulinemia or other cause
Requirements:
(1) Advice from an endocrinologist should be obtained when planning the transfer.
(2) The transfer has been coordinated with the receiving hospital.
(3) Intravenous access should be maintained before and during the transfer, even if intravenous fluids are not required.
(4) The child should be accompanied by suitable health care professionals.
(5) Glucose resuscitation fluids and medications should be available during the transfer.
(5a) 10% glucose for intravenous infusion.
(5b) Sugary drink.
(5c) Glucagon for intramuscular or intravenous administration.
(6) Glucose monitoring equipment and supplies should be available during the transfer.
(7) Monitor glucose before, during and after transfer. Stable patients can be monitored every hour. Unstable patients are monitored done every 15-30 minutes.
(8) The target blood glucose concentration is > 3 mmol/L (> 54 mg/dL).
If severe hypoglycemia occurs during the transfer:
(1) Give bolus of 10% dextrose at 2 mL per kg.
(2) Start maintenance infusion of 10% dextrose at 4-5 mL per kg per hour (6-8 mg per kg per minute).
If severe hypoglycemia occurs during the transfer and intravenous access is lost:
(1) Administer a sugary drink orally and check the blood glucose.
(2) Give 1 dose of glucagon intramuscularly at 0.1 mg/kg up to 1 mg maximum.
