What is the fluid bolus for an AMS pediatric patient with BgL >60 mg/dl?

• A. Oxygen therapy
• B. Dextrose 5% IV
• C. NS or LR 20 mL/kg IV/IO; may repeat up to 60 mL/kg
• D. NS or LR 20 mL/kg IV/IO; may repeat up to 60 mL/kg; if BgL >250, then 10 mL/kg bolus

Answer: (D)

When a pediatric patient with altered mental status has a blood glucose not in the hypoglycemic range (greater than 60 mg/dL), the priority is to address potential poor perfusion with an isotonic fluid bolus rather than giving glucose or treating with oxygen alone. The standard approach is an isotonic crystalloid—normal saline or lactated Ringer’s—given at 20 mL/kg via IV or IO, and you may repeat to a total of 60 mL/kg based on the patient’s response.

If the blood glucose is very high (above 250 mg/dL), an additional 10 mL/kg bolus is indicated to support hydration and perfusion. Dextrose-containing fluids are not used when glucose is above 60 mg/dL, since they would worsen hyperglycemia. Oxygen can be provided as needed, but it does not substitute for fluid resuscitation in this scenario.

So the best choice reflects giving an isotonic fluid bolus of 20 mL/kg, with the possibility of repeating up to 60 mL/kg, and adding an extra 10 mL/kg if BG exceeds 250 mg/dL.