For an AMS pediatric patient with BgL <60 mg/dl when IV access is not available, which treatment is indicated?

• A. D10 5 mL/kg IV/IO; max single dose 25 g
• B. GLUCAGON 0.5 mg IM (<20 kg); 1 mg IM (>20 kg)
• C. D10 5 mL/kg IM/PO
• D. Epinephrine 0.3 mg IM

Answer: (B)

When a pediatric patient is AMS with blood glucose below 60 mg/dL and IV access isn’t available, giving glucagon intramuscularly is the quickest and most reliable way to raise blood sugar. Glucagon acts by stimulating the liver to convert stored glycogen into glucose, so it can raise blood glucose without needing IV access. The dose is weight-based: 0.5 mg IM if the child weighs less than 20 kg, and 1 mg IM if they weigh more than 20 kg. This approach provides rapid correction and is specifically designed for scenarios where IV dextrose can’t be given right away. After giving glucagon, monitor the patient closely for a rise in glucose and improvement in mental status, and obtain IV access as soon as possible to continue treatment if needed. Epinephrine isn’t indicated for hypoglycemia, and dextrose solutions (D10) are given IV/IO; without access, they aren’t the preferred route here.